Private painful sex clinic in London, same-day women's health.

Where the pain is

• At the entrance (superficial) — suggests vaginal dryness, thrush or infection, a skin condition such as lichen sclerosus or eczema, an episiotomy or tear scar, or vaginismus.
• Deep inside — suggests endometriosis, ovarian cysts, fibroids, pelvic inflammatory disease, adhesions from previous surgery, or bowel and bladder conditions.
• Burning that persists afterwards, or provoked by any touch — suggests vulvodynia, a pain-sensitisation condition.
• Pain with tightness so that penetration is impossible — suggests vaginismus.

The common causes

• Vaginal dryness — the commonest cause overall. From the menopause, breastfeeding, the contraceptive pill, some medicines, or simply insufficient arousal time.
• Menopausal genitourinary changes — thinning and fragility of the tissues, which is progressive without treatment and responds extremely well to vaginal oestrogen.
• Thrush, bacterial vaginosis or an STI.
• Skin conditions — lichen sclerosus, eczema, psoriasis. Frequently misdiagnosed as recurrent thrush for years.
• Endometriosis — classically deep pain, worse around periods.
• After childbirth — scar tissue, pelvic floor changes, and hormonal dryness while breastfeeding. Very common and very treatable.
• Vaginismus — involuntary tightening of the pelvic floor muscles, often with a cycle of anticipation and fear.

What helps

What assessment involves

A conversation first, then examination only with your agreement and at your pace — a smaller speculum, your own control of the examination, or examining nothing at all on the first visit are all reasonable and can be arranged. Swabs, a cervical check if due, and pelvic ultrasound where deep pain suggests endometriosis or ovarian causes.

The relationship part

Painful sex affects partners and relationships, and avoidance often becomes the bigger problem. Partners frequently interpret it as rejection or loss of attraction. Involving them, where you want to, tends to help considerably — and psychosexual therapy is effective for the anxiety cycle that builds up around it, whatever the original physical cause.