Trace sexual pain

You can get closer to the cause of your problem, if you trace your sexual pain or discomfort. It might not be an easy puzzle to trace sexual pain and it is always your doctor’s job to find the right diagnosis.

For you to prepare for your meeting with the doctor, we have made this section.

It is not uncommon to have more than one nuisance in the pelvic region. For example, a pain condition can trigger tension in the pelvic floor muscles. Those tense muscles can cause constipation. It is a domino effect.

To help you get the right diagnosis from your doctor, we have listed typical correlations between locations of pain and their causes.

The following is not a complete list, and may not be used for self-diagnosing. It is your doctor who gives you a diagnosis as well as a treatment plan. 

First, try to answer these questions:

  • What triggers your pain?
  • Where is it located?
  • Does your pain only occur when there is contact?
  • Does your pain happen spontaneously or is it all the time?
  • What kind of pain do you have? Does it sting, itch or burn?


Problems, which occur in skin or tissue outside the vagina.

(the descriptions are guidelines only)

Causes in relation to itching and burning

  • Vaginal and vulvar dryness: Itching, stinging, or burning
  • Fungal infections: Itching, burning, accompanied by cottage cheese-like discharge, no change in smell
  • Bacterial vaginosis: Sensitive skin, itching. Discharge takes on a different scent, often described as fishy
  • Lichen sclerosis: Itching, burning, irritation. Sensitive skin, thinner or thicker in places. At times with white spots/plaques. Stenosis/narrowing of the vaginal opening
  • Lichen planus: Nuisances as with lichen sclerosis, can be found in the vagina. Might contain blood in discharge.
  • Contact allergy/eczema: Stinging, itching, warmth, inflammation/swelling, redness
  • Scar tissue: Shiny skin, sometimes puckered at the edges. Slightly different look than regular skin
  • Some sexually transmitted infections ie. Genital herpes, Genital worts, Clamydia
  • Female Circumcision: scar tissue, nerves cut or blocked by scar tissue


  • Muscle cramps: Painful tension, soreness, tightness
  • Nerve entrapments: Sharp, shooting pains. Often hurts worse when you are sitting, and is relieved when you stand up
  • Vulvodynia: Aching or sharp pains
  • Bartholinitis: Irritation and swelling of the Bartholin glands. Can inflict pain during intercourse, sometimes irritation develops due to friction


(the descriptions are guidelines only)

  • Vaginismus:  When penetration is attempt; involuntary muscle contractions. Feels like meeting a wall one or two centimeters up in the vagina. Insertion is possible for some
  • Muscle tension: Muscles that tighten up and stay tightened, like keeping a fist closed
  • Myosis: Specific pain point, much like what a bruise feels like
  • Scar tissue: Scars can form after inflammation, surgery or childbirth. They can cause tingling, numbness, or heightened sensitivity in the area. Feels like the tightness of an inability to stretch.
  • Scar strings: strings either at or over the vaginal wall, sometimes placed from the wall and into the tissue. It can feel like an excoriation when strings are stretched 
  • Vulva / vaginal dryness: Typically experienced as itching or burning, but the main symptom is the lack of lubrication/wetness 
  • Vulvar tears/weak skin: Breaks in the skin can feel like a cut or a friction burn. A lower layer of skin will be exposed at the surface. 
  • Bartholinitis: Irritation and swelling of the Bartholin glands. Can inflict pain during sexual intercourse,  women might have intercourse with no irritation at first, but later irritation develops due to friction.
  • A tissue ring structure in the vagina (Hymen): This pain is generally felt at the edges of the vaginal beginning during penetration.
  • Female Circumcision: Scar tissue and nerve pain.
  • Lichen sclerosis: the vaginal opening has narrowed or skin easily tears.


  • Lichen sclerosis: Scar tissue close to the clitoris can cause pain
  • Lichen planus: Scar tissue closes the clitoris can cause pain
  • Scar tissue: Scars can cause pain. Many nerves are located at the clitoris, leaving little room for scar tissue
  • Nerve entrapment: Nerves near or extending into the clitoris can become trapped and painful. Is typically worst when sitting
  • Herpes: Even without an outbreak, herpes can cause pain if near the clitoris. During an outbreak or the eruption of an outbreak, it can be painful in the clitoris
  • Female Circumcision: scar tissue, nerve pain


  • Fungal infection: Itching, burning with cottage cheese-like discharge. No change in discharge smell
  • Muscle tension: Tightened pelvic muscles slightly inside the vaginal opening. Pain in the mid of the vagina might be the psoas muscles. Typically muscle pain is not felt up near the cervix
  • Myosis: Specific point in the vagina where it hurts, like a bruise
  • Vaginismus: Involuntary muscle contractions
  • Intestinal problems: Intestinal irritation can cause penetration problems. The bowels and vagina are close to one another, so it can be difficult to mark exactly where the pain is. The pain can also be troublesome when defecating
  • Bladder/Urethra Problems: Same as bowel problems, although on the opposite side of the anus/rectum. Could be interstitial cystitis
  • Endometriosis: Pain is typically aggravated during menstruation, but the abdominal and pelvic pain is also generally present
  • Lichen planus: Itching, irritation generally inside the vagina. Might contain blood in discharge.
  • Vaginal dryness: Pain and discomfort generally caused by friction, like having sex, bicycling, and walking  
  • Scar tissue: Scar tissue and adhesions can stem from surgery, childbirth, radiation treatment, inflammation, and tearing. The vaginal wall can feel like it is stuck.
  • Scar strings: stings either at or over the vaginal wall, sometimes placed from the wall and into the tissue. When strings are stretched, it can feel like an excoriation

Deep vaginal or pelvic pain

  • Pelvic inflammatory disease: triggered by chlamydia [or other]
  • Trichomoniases or Gonorrhea: itching, foul-smelling vaginal discharge (yellow, green) painful urination, painful sex.
  • Interstitial cystitis: Also called painful bladder syndrome. Pain ranges from mild to intense in the bladder and surrounding pelvic region. Sex and menstruation can worsen the pain.
  • Endometriosis: Pain from endometriosis is often felt in the rectum, pelvis, vagina, lower abdomen, or lower back.  It can occur or worsen while defecating or during sexual intercourse.  The pain can range from mild to severe and is often sharp
  • Intestinal Problems: Intestinal problems are often characterized by discomfort and pain.  It can worsen when it comes to sex. Pain can be sharp or dull, and worsen during deep penetration.  There is also a possibility of experiencing muscle spasms, cramps, or muscle tightness
  • IUD implants: As convenient as IUD’s can be for contraception, sometimes they are accompanied by some pretty serious pain.  While generally not permanent, IUD’s can cause cramping and pelvic pain.  If your pain lasts more than a few days, go back to your doctor (preferably the one who did your insertion) and see if there is any complication with your IUD.
  • Cysts: Generally, cysts are not an issue if they are intact, but bursting can happen, especially for women with PCOS (polycystic ovarian syndrome). This would be super painful and located in the pelvis/lower abdomen and other parts of the body, like the shoulder region
  • Fibroids: Fibroids very close to the vagina can generate pain. You will typically come across a specific spot up inside that hurts
  • Scar tissue: Scar tissue and adhesions can come from surgery, childbirth, or radiation treatment. If the scar tissue is near the reproductive organs, this is especially so. Scar strings either at or over the vaginal wall, sometimes placed from the wall and into the tissue can generate pain when being moved. The cervix might even be fixated. When strings are stretched, it can feel like an excoriation
  • Ovulation: Some women can feel when they are ovulating and it can be painful. This type of pain can be aggravated by having sex


  • Intestinal problems: Intestinal problems can be aggravated by sex and can create lasting pain, even after the sex
  • Bladder problems/UTI’s: Sex can worsen urinary tract problems and even cause infections, leaving you with lasting pain
  • Muscle cramps: Just like when playing sports, your muscles can cramp up. When you use muscles, they need oxygen to work. When they don’t get enough oxygen, they cramp and this pain can endure for a period after onset
  • Skin tears: Inside and outside the vagina, the skin can tear. Just like when you get a cut or a burn somewhere else on your body, the pain lingers
  • Lubrication/Mucosal Problems: Too much friction is a bad thing when it comes to sex. Friction can create burn-like injuries inside the vagina and on/around its opening. (Props & Pearls recommends Lubrasilk) 
  • Infections: Bacterial imbalances in the reproductive, urinary, or gastrointestinal tract can be quite painful. Just like how you can get body aches with a flu infection, infections in these systems can leave you hurting, as well. If you have a sensitive body, sex can cause an infection. For example, seamen ph-level is higher that the level in the vagina which can lead to a infection
  • Endometriosis: This disorder is very painful on its own. Sexual activity can sometimes worsen the pain

Read See The Doctor about sexual pain

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