Painful sex

Painful sex.

This has specific causes and specific treatments, and almost all of them are treatable. Where it hurts — at the entrance or deep inside — is the single most useful thing you can tell us.

How this is approached here

What the first visit covers

  1. 01

    Where, when and how long

    Entrance pain and deep pain have almost entirely different causes, so the history separates them before the examination does.

  2. 02

    A cotton-swab examination of the vestibule

    Where entrance pain is described, which identifies provoked vestibulodynia and takes less than a minute.

  3. 03

    Pelvic floor muscle assessment

    Because high-tone pelvic floor dysfunction is one of the commonest causes and is not visible on any scan.

  4. 04

    Examination for lichen sclerosus and other

    Vulvar skin disease, which is frequently treated as thrush for years before anyone looks.

  5. 05

    Ultrasound where deep pain points at endometriosis

    Adenomyosis, fibroids or an ovarian cause.

  6. 06

    An assessment for genitourinary syndrome of menopause where the timing fits — the most common cause after 45 and among the most treatable.

What treatment looks like

Matched to the cause, not to the symptom

Pelvic floor physical therapy where muscle

Tone is the driver. It is the primary treatment, not an adjunct, and it works.

Vaginal estrogen or DHEA for genitourinary

Syndrome of menopause, which usually improves things within eight to twelve weeks.

Topical treatment for vulvar dermatoses

With a diagnosis first — lichen sclerosus needs a potent steroid and long-term follow-up, not an antifungal.

Treating the underlying gynecologic cause where

Deep pain has one: endometriosis, adenomyosis or a fibroid in the wrong place.

Referral for sexual health counselling where it would help

Offered as part of the plan rather than instead of one.

Painful sex: common questions

Is this in my head?
No. Pain has physical drivers that can be identified on examination, and it also has a nervous-system component that becomes more significant the longer it goes untreated. Both are real and both are treated. Neither means you imagined it.
I have been treated for thrush repeatedly and nothing changes.
That is a common history and usually means it was never thrush. Provoked vestibulodynia, lichen sclerosus and high-tone pelvic floor dysfunction all present this way and all need a different treatment entirely.
Will the examination hurt?
We start with the history, with you dressed, and the examination is led by what you tell us. A cotton swab is gentler than a speculum and often all that is needed at the first visit. You can stop it at any point.
How long does treatment take?
For genitourinary syndrome of menopause, eight to twelve weeks of vaginal estrogen. For pelvic floor dysfunction, usually a course of physical therapy over a few months. Vulvar dermatoses need ongoing treatment rather than a course. None of it is quick, and all of it is worth starting.

Know before you book.

Vireo opens in 2027. Until then the plan list, panel status and first-available wait for every office are published on this site and kept current. Questions can go to the practice office on (305) 555-0180.

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