Painful Intercourse (Dyspareunia): Causes, Diagnosis, and Treatment

Painful intercourse can be difficult to name, especially when you are newly married, have recently given birth, are going through menopause, or worry that a clinician will dismiss the problem. The pain is real. You do not need to keep trying through it, and you do not have to accept an examination you are not ready for.

Dyspareunia means recurrent or persistent discomfort before, during, or after intercourse. The first useful distinction is where the pain occurs: at the vaginal entrance (superficial or entry dyspareunia), deeper inside the vagina or pelvis (deep dyspareunia), or both. That distinction does not make a diagnosis, but it helps a clinician choose the right questions, examination and tests. This article explains that pathway, the treatments matched to different causes, and the symptoms that need urgent care.

Key takeaways

• Entry pain and deep pain lead to different clinical pathways. Entry pain is more often linked to vulvar, vestibular, skin, lubrication, hormonal or pelvic-floor problems; deep pain raises pelvic causes such as endometriosis, pelvic inflammatory disease, bladder pain or fibroids (clinical review of female sexual pain).
• Painful intercourse is a symptom, not a personal failure. Dyspareunia is described as recurrent or persistent discomfort before, during or after intercourse and can be superficial, deep, primary or secondary (clinical review of female sexual pain).
• Vaginismus is not deliberate. Current diagnostic language groups pain, fear, penetration difficulty and pelvic-floor tensing under genito-pelvic pain/penetration disorder when symptoms persist for at least six months and cause significant distress (ACOG Practice Bulletin 213).
• Treatment should match the cause and may need more than one discipline. Guidance supports conservative, individualised care that can combine pelvic-floor physiotherapy, lubricants or moisturisers, cause-specific medical care and psychosexual support (ACOG Practice Bulletin 213; clinical review of female sexual pain).
• Your examination should remain under your control. Draft RCOG guidance advises offering choices, treating consent as active and ongoing, allowing a patient to pause or decline any part, and offering a chaperone for internal examinations (RCOG Green-top Guideline 41 peer-review draft).
• Sudden severe pain during sex with collapse, shoulder-tip pain, fever or rigors needs emergency assessment (NHS Scotland acute pelvic pain guideline).

What is dyspareunia?

Dyspareunia is recurrent or persistent pain associated with intercourse. It may occur before penetration, at the entrance, with deeper penetration, or afterwards. It can be present from the first attempted intercourse (primary) or begin after a previously pain-free period (secondary) (clinical review of female sexual pain).

Estimates vary substantially because studies use different definitions and populations. A clinical review cites an estimated US prevalence around 10–20% and a WHO-reported range of 8–21.1% across countries; another systematic review found far wider variation, so these figures should not be treated as a Saudi prevalence estimate (clinical review of female sexual pain). The practical message is simpler: clinicians see this problem often, but the experience is individual.

Pain can affect desire, arousal and closeness, but that does not mean relationship difficulty caused it. The body may start anticipating a painful touch. Muscles tighten protectively; arousal becomes harder; friction increases; the next attempt hurts more. This feedback loop can continue after the first trigger has improved. It is a biological and emotional learning process, not blame.

If speaking about sex feels uncomfortable, you can begin with one sentence: “I have pain at the entrance when penetration is attempted,” or “I feel deep pelvic pain with certain positions.” That is enough to open the clinical conversation.

Entry pain versus deep pain

The entry-versus-deep distinction belongs at the centre of dyspareunia assessment. Both types can coexist, and pain may move or change over time.

These are patterns, not rules. Review literature associates superficial pain with vaginitis, dermatoses, poor lubrication, vaginal atrophy and childbirth, while deep pain is associated with endometriosis, pelvic inflammatory disease, bladder pain syndrome, fibroids and other pelvic causes (clinical review of female sexual pain). A burning sensation does not prove infection, and a deep ache does not prove endometriosis.

Primary versus secondary pain

Primary dyspareunia has been present from the first attempted penetration. Secondary dyspareunia begins after a period without pain (clinical review of female sexual pain). This timing helps. Primary pain may direct attention toward lifelong penetration difficulty, vestibular sensitivity, anatomy or early fear-pain conditioning. Secondary pain makes a clinician ask what changed: childbirth, breastfeeding, menopause, an infection, surgery, medication, a new skin condition, pelvic pain or a difficult sexual experience.

Why the trigger matters

Pain only with initial insertion differs from pain after several minutes, pain the next day, or pain that also occurs with sitting, cycling, urination or tight clothing. Pain outside intercourse may need a location-first vulvar assessment; see Vulvar and Vaginal Pain: Causes by Location, Diagnosis, and Treatment. Deep pain linked with periods, bowel movements or urination raises a different set of questions.

What causes painful intercourse?

A cause-matched plan begins by resisting one-size-fits-all labels. Several contributors may operate at once.

Insufficient lubrication and arousal

Shorter arousal time, situational anxiety, relationship context and some medicines can reduce lubrication. Friction may be the whole problem, or it may magnify tender tissue. Lubricant can reduce friction, but it cannot treat an infection, dermatosis, endometriosis or an overactive pelvic floor. Persistent pain despite generous, compatible lubricant deserves assessment.

Hormonal tissue change and GSM

Genitourinary syndrome of menopause (GSM) includes vulvovaginal dryness, burning or irritation, dyspareunia and urinary symptoms associated with oestrogen deficiency (NAMS-published GSM consensus). Similar dryness and sensitivity can occur postpartum or during breastfeeding, although a clinician should not assume hormones are the only cause.

The 2025 AUA/SUFU/AUGS guideline reports very wide postmenopausal GSM prevalence estimates, from 13% to 87%, reflecting different populations and definitions (AUA/SUFU/AUGS GSM Guideline 2025). A physical examination should assess for other gynaecological pathology before GSM is diagnosed and hormone treatment begins (ACOG Practice Bulletin 213). A dedicated GSM page should own full menopause-treatment detail; here the point is routing.

Infection and inflammation

Vaginal or cervical infection can cause pain, discharge, odour, irritation or bleeding. Pelvic inflammatory disease can be missed because symptoms may be mild or nonspecific; dyspareunia is one possible presentation, and clinicians are advised to keep a low threshold for assessment when pelvic tenderness is present in a sexually active patient (CDC pelvic inflammatory disease guidance). Testing should guide treatment. Repeated empirical antifungal treatment without confirmation may delay the correct diagnosis.

Vulvar skin and vestibular pain

Dermatoses such as lichen sclerosus or lichen planus can cause soreness, splitting, itch or pain at entry. Provoked vestibular pain may make light touch or penetration painful even when routine swabs are normal. Vulvodynia has a specific definition—vulvar pain lasting at least three months without a clear identifiable cause—and should not be used as a label for every vulvar symptom (ACOG Committee Opinion 673). Full ISSVD classification and location mapping belong on the vulvar and vaginal pain page.

Pelvic-floor overactivity

Pelvic-floor muscles can become tender or remain contracted when the body expects pain. This can produce entry pain, a blocked feeling or a deeper ache. Internal single-digit palpation is described as the most reliable method in the sexual-pain review for evaluating pelvic muscle tenderness, but it should only be done with consent and tolerance (clinical review of female sexual pain). Tightness is not a moral or psychological failure, and unsupervised strengthening exercises may not address an overactive pattern.

Endometriosis and other deep pelvic causes

Deep pain during or after intercourse is one of the symptom patterns that should raise suspicion of endometriosis, particularly when combined with period pain that affects daily life, cyclical bowel or urinary symptoms, or infertility (NICE endometriosis recommendations). NICE recommends transvaginal ultrasound for suspected endometriosis even if abdominal or pelvic examination is normal, and explicitly says not to exclude endometriosis when examination and ultrasound are normal (NICE endometriosis recommendations). Normal imaging therefore does not rule it out.

Endometriosis is especially relevant to patients in the region because one study reported a mean 11.61-year delay from symptom onset to laparoscopic diagnosis among women of Arab ancestry, compared with 6.7 years in the referenced global study; this was an observational regional finding, not a prediction for any individual patient (Frontiers study of endometriosis in women of Arab ancestry). Deep dyspareunia should be assessed rather than normalised, but it is not proof of endometriosis.

Childbirth, scars and procedures

Perineal tears, scar sensitivity, breastfeeding-related dryness and pelvic-floor changes may contribute after birth. A review reported that 17–36% of women still described dyspareunia six months postpartum, while only 15% had discussed it with a health professional (clinical review of female sexual pain). Those figures come from older studies summarised in a 2018 review and may not represent Saudi practice, but they challenge the idea that everyone should be comfortable by a fixed six-week deadline.

Pain that began after childbirth or surgery also needs a recovery-focused assessment; see pain after childbirth and gynaecological procedures.

Bladder, bowel and musculoskeletal overlap

Pain with a full bladder, urinary urgency, bowel symptoms, hip or back pain, and position-dependent discomfort can change the differential. Chronic pelvic pain is often multifactorial, so tests are targeted to the presentation rather than ordered as a standard package (AAFP summary of ACOG Practice Bulletin 218).

Vaginismus and penetration difficulty

“Vaginismus” is still widely used in everyday clinical conversation, but current DSM-5 framing combines vaginismus and dyspareunia as genito-pelvic pain/penetration disorder (GPPPD). Criteria include persistent difficulty with vaginal penetration, marked vulvovaginal or pelvic pain, fear or anxiety about that pain, or marked pelvic-floor tensing; symptoms must last at least six months and cause clinically significant distress (ACOG Practice Bulletin 213).

The distinction is practical rather than judgmental:

• Dyspareunia describes pain associated with intercourse.
• Penetration difficulty describes what the body allows at that moment.
• Fear or anticipation may follow earlier pain and increase guarding.
• An underlying tissue or pelvic cause can coexist and must not be overlooked.

This is particularly sensitive for newly married patients. A rushed instruction to “relax” can make the next attempt harder. Assessment should first identify pain sources and then build safety and control. Treatment may include pelvic-floor physiotherapy, gradual self-directed exposure or dilator work, and psychosexual therapy when relevant. ACOG recommends pelvic-floor physical therapy for genito-pelvic pain and notes evidence from an RCT in which structured self-dilation with partner/therapist involvement plus psychotherapy increased the ability to have intercourse (ACOG Practice Bulletin 213). This does not mean dilators should be started without assessment or pushed through pain.

What happens during assessment?

A good consultation is not a test of endurance. It starts with conversation and proceeds only as far as is useful and acceptable to you.

1. The history

You may be asked:

• Is the pain at entry, deep, or both?
• Was it present from the first attempt, or did it begin later?
• Does it occur with touch, a tampon, an examination, specific positions or every form of penetration?
• Is there dryness, discharge, itching, odour, bleeding, a skin change or urinary symptoms?
• Does it track periods, bowel movements, bladder filling, childbirth, breastfeeding, menopause, an infection or surgery?
• What has helped, what made it worse, and how does it affect sleep, intimacy, mood or daily activity?

A pain score can help track change, but it is not the whole assessment. You can prepare with How to Describe Pelvic or Vaginal Pain to Your Doctor or a pelvic and menstrual pain diary.

2. Consent and privacy

Draft RCOG guidance under peer review in June–July 2026 says patients should be offered examination choices, may pause or decline any part, and should be offered a chaperone for internal examinations; it also recognises that an internal examination may not be appropriate at the first consultation (RCOG Green-top Guideline 41 peer-review draft). Because that document is a draft rather than final guidance, it should be read as a current direction of practice, not a finalised standard.

In Riyadh, you can ask when booking about a female clinician, a chaperone, interpretation, whether a support person may attend, and how clinical notes are handled. You do not need to explain intimate details to reception. “I need a confidential consultation for pain with intercourse” is sufficient.

3. A stepwise examination

A published clinical review describes a sequence that can include an external musculoskeletal assessment, visual and sensory vulvar examination, single-digit pelvic-floor palpation, bimanual examination and a small speculum if tolerated (clinical review of female sexual pain). Not every patient needs every step.

A patient-sensitive walkthrough may look like this:

1. You remain dressed while the plan is explained.
2. You agree which parts are acceptable today.
3. External inspection checks skin, scars, lesions, discharge and areas of tenderness.
4. Light touch may map the vestibule if entry pain is present.
5. One lubricated finger may assess pelvic-floor tenderness if you consent.
6. A speculum or bimanual examination is used only when its findings would change care and you can tolerate it.
7. The examination stops whenever you say stop.

Ask the clinician to narrate each step, show the instrument, use the smallest suitable speculum, change position, or defer an internal examination. Needing more than one visit does not mean the assessment failed.

Tests and imaging

Testing follows the history and examination.

• Swabs or cultures may be used when infection is suspected.
• Urine and pregnancy testing may be needed for urinary symptoms or new deep pelvic pain.
• Pelvic ultrasound may evaluate uterine, ovarian or other pelvic causes.
• Targeted blood tests depend on the presentation.
• Biopsy is for suspicious or unclear vulvar lesions, not for diagnosing pain itself.

For suspected endometriosis, NICE recommends transvaginal ultrasound even when examination is normal, but also warns clinicians not to exclude endometriosis because ultrasound is normal (NICE endometriosis recommendations). Further imaging, referral or laparoscopy is selected case by case; surgery should not be presented as the automatic first step.

Treatment decision table

Treatment options in detail

Lubricants and moisturisers

Lubricant is used during sexual activity; a vaginal moisturiser is used regularly to reduce dryness. ACOG includes lubricants and moisturisers among options that may reduce dyspareunia, while vulvar-care advice favours products without perfumes, dyes, harsh soaps or irritating additives (ACOG Practice Bulletin 213; ACOG Committee Opinion 673). Stop a product that burns. Oil-based products may be incompatible with latex condoms; check the product label.

Purpose: reduce friction and support comfort. Best candidates: people with dryness or friction as a contributor. Limit: relief does not identify or cure deeper pathology. Alternative: assessment for hormonal, inflammatory, infectious or muscular causes.

Pelvic-floor physiotherapy

Pelvic-floor physiotherapy may use education, breathing, relaxation, manual techniques, movement retraining, biofeedback and a graded home plan. It is recommended for genito-pelvic pain/penetration disorders and may help high-tone pelvic-floor dysfunction and vaginismus (ACOG Practice Bulletin 213).

Purpose: reduce tenderness and protective guarding, then restore function. Candidates: people with examination-confirmed muscle overactivity, tenderness or coordination difficulty. Limits: access and therapist expertise vary; change is gradual. Risks: temporary soreness or flare if progressed too quickly. Alternatives: pain-source treatment, psychosexual therapy, or specialist pain care. Internal therapy should never occur without specific consent.

Graded exposure or dilator therapy

Dilators are not a test to pass. They can be used in a patient-controlled progression to make touch and insertion predictable and non-threatening. They should usually follow assessment and be taught by a clinician or physiotherapist familiar with sexual pain.

Purpose: reduce fear-pain conditioning and improve tolerance. Candidates: selected patients with penetration difficulty or GPPPD. Limits: not suitable as a stand-alone answer when infection, skin disease or untreated tissue pain remains. Risks: forcing progression may increase guarding. Alternatives: self-touch progression, physiotherapy, psychosexual treatment, or delaying penetration goals.

Hormonal and non-hormonal GSM treatment

The 2025 AUA/SUFU/AUGS guideline gives low-dose vaginal oestrogen a strong recommendation, vaginal DHEA a moderate recommendation, ospemifene a conditional recommendation, and moisturisers/lubricants a moderate recommendation for GSM-related symptoms; all of these dyspareunia-relevant recommendations rest on Grade C evidence (AUA/SUFU/AUGS GSM Guideline 2025). Seven RCTs including 2,072 participants showed mixed effects of vaginal oestrogen versus placebo on dyspareunia, while four trials including 1,472 participants found statistically significant improvement in dryness and dyspareunia with vaginal DHEA (AUA/SUFU/AUGS GSM Guideline 2025).

That means “recommended” is not the same as “guaranteed.” Choice depends on symptoms, examination, medical history, preference, cost and availability. Any postmenopausal bleeding needs evaluation regardless of whether low-dose vaginal oestrogen is being used (AUA/SUFU/AUGS GSM Guideline 2025).

For patients with breast cancer or high risk, non-hormonal therapy is generally first line, and any hormonal option needs individual shared decision-making. Vaginal DHEA has not been studied in breast-cancer survivors and its label warns against use; ospemifene is not FDA-approved for women with breast cancer (NAMS-published GSM consensus).

Infection or dermatologic treatment

Confirmed infection receives organism-appropriate treatment. Vulvar dermatoses need condition-specific therapy and follow-up. Purpose: remove an identifiable pain generator. Candidates: patients with examination or test evidence. Limits: symptoms may persist if pelvic-floor guarding developed alongside the original cause. Risks: medication-specific; ask what to expect. Alternative: reassess the diagnosis rather than repeating treatment indefinitely.

Endometriosis and deep-pain care

Endometriosis management may include analgesic, hormonal and surgical options after individual assessment. NICE advises investigation and initial treatment in parallel rather than requiring surgery before symptom care begins (NICE endometriosis recommendations). Surgery may help selected patients but cannot promise pain-free intercourse, particularly when pelvic-floor, bladder or persistent-pain mechanisms coexist.

Psychosexual therapy and couple support

Sex therapy may improve genito-pelvic pain and help couples move toward pain-free intimacy (AAFP summary of ACOG Practice Bulletin 218). It can address fear, communication, pacing, desire discrepancies and the meaning attached to pain. It does not imply that pain is imaginary. It works best as one part of care when physical contributors are also assessed.

Procedures and surgery

Most sexual-pain care begins conservatively, and escalation to surgery is rarely necessary (clinical review of female sexual pain). Procedures may be appropriate for a defined lesion, selected endometriosis, scar problem or refractory localized vestibular pain. Ask what diagnosis the procedure targets, what non-surgical options remain, the chance of persistent or new pain, recovery implications, and how success will be measured.

Laser, radiofrequency and other vaginal energy devices should not be marketed as pain treatments. This article makes no recommendation for them because the supplied evidence map does not establish their effectiveness or safety for dyspareunia.

Self-care while you seek answers

Self-care should reduce irritation and preserve choice; it should not postpone needed assessment.

• Stop an activity when pain becomes sharp or escalates. “Pushing through” can reinforce guarding.
• Use generous, compatible lubricant and allow unhurried arousal. Adequate lubrication is part of vulvar-pain care guidance (ACOG Committee Opinion 673).
• Choose non-penetrative intimacy while symptoms are being assessed. Intimacy does not have to be organised around penetration.
• Avoid douching, perfumed washes, wipes and harsh soap on the vulva; ACOG recommends avoiding irritants and perfumed products (ACOG Committee Opinion 673).
• Do not start repeated antifungal courses, pelvic-floor strengthening or dilator escalation without knowing which problem you are treating.
• Keep a brief record of entry versus deep pain, cycle timing, position, bleeding, urinary or bowel symptoms, and what helped.
• If a clinician prescribed medication, use it as directed and report adverse effects rather than adjusting treatment from an online article.

For travel to Riyadh, bring prior imaging reports, laboratory results and a medication list. International patients may also want a concise English medical summary. Ask the clinic before travelling whether examination and imaging can be coordinated on the same day; this is a logistical question, not a promise that one visit will establish the diagnosis.

When painful intercourse is urgent

Seek emergency care now

Pain that begins suddenly during intercourse and is accompanied by collapse, shoulder-tip pain, fever or rigors requires emergency assessment (NHS Scotland acute pelvic pain guideline). New severe pelvic pain with a possible pregnancy also needs urgent assessment because pregnancy-related emergencies must be excluded.

Arrange prompt medical review

• Fever, lower abdominal pain, abnormal discharge or marked pelvic tenderness may indicate PID or another infection; CDC guidance notes that dyspareunia can be a mild, nonspecific symptom that contributes to PID being missed (CDC pelvic inflammatory disease guidance).
• Post-coital bleeding, irregular bleeding after age 40, or any postmenopausal bleeding warrants assessment (RCOG Green-top Guideline 41 peer-review draft; AUA/SUFU/AUGS GSM Guideline 2025).
• A new vulvar lump, ulcer, colour change, thickened area or persistent lesion needs examination rather than empirical treatment (BASHH national guideline on vulval conditions).
• Rapidly worsening pain, swelling, urinary retention or inability to function merits prompt review.

If you are unsure whether symptoms are urgent in Saudi Arabia, use local emergency services or the nearest emergency department rather than waiting for a routine clinic reply.

Myths and facts

Myth: Painful sex is something women should tolerate.
Fact: Recurrent or persistent pain is a medical symptom. It deserves assessment even if intercourse is technically possible.

Myth: Entry pain and deep pain mean the same thing.
Fact: They overlap, but they direct attention to different structures and investigations (clinical review of female sexual pain).

Myth: If an ultrasound is normal, endometriosis is excluded.
Fact: NICE explicitly advises against excluding endometriosis after a normal examination and ultrasound (NICE endometriosis recommendations).

Myth: Vaginismus is refusal or lack of effort.
Fact: GPPPD includes penetration difficulty, pain, fear and pelvic-floor tensing; care targets the pain-protection response rather than blaming the patient (ACOG Practice Bulletin 213).

Myth: Lubricant fixes every cause.
Fact: It reduces friction. It does not clear infection, treat a dermatosis, diagnose endometriosis or retrain an overactive pelvic floor.

Myth: Pain after childbirth must disappear by six weeks.
Fact: A review found 17–36% still reported dyspareunia at six months postpartum, although the evidence is older and estimates vary (clinical review of female sexual pain).

Myth: Vaginal oestrogen always cures menopausal painful sex.
Fact: It is guideline-recommended for selected GSM patients, but the evidence grade is C and trial effects on dyspareunia were mixed (AUA/SUFU/AUGS GSM Guideline 2025).

Myth: Psychological support means the clinician thinks pain is imaginary.
Fact: Psychosexual care can address anticipation, communication and avoidance while medical and muscular contributors are treated.

Myth: A pelvic examination must be completed in one visit.
Fact: Consent is ongoing, and draft RCOG guidance says patients may pause or decline any part of assessment (RCOG Green-top Guideline 41 peer-review draft).

Myth: Painful sex is something women should tolerate.
Fact: Recurrent or persistent pain is a medical symptom. It deserves assessment even if intercourse is technically possible.

Myth: Entry pain and deep pain mean the same thing.
Fact: They overlap, but they direct attention to different structures and investigations (clinical review of female sexual pain).

Myth: If an ultrasound is normal, endometriosis is excluded.
Fact: NICE explicitly advises against excluding endometriosis after a normal examination and ultrasound (NICE endometriosis recommendations).

Myth: Vaginismus is refusal or lack of effort.
Fact: GPPPD includes penetration difficulty, pain, fear and pelvic-floor tensing; care targets the pain-protection response rather than blaming the patient (ACOG Practice Bulletin 213).

Myth: Lubricant fixes every cause.
Fact: It reduces friction. It does not clear infection, treat a dermatosis, diagnose endometriosis or retrain an overactive pelvic floor.

Myth: Pain after childbirth must disappear by six weeks.
Fact: A review found 17–36% still reported dyspareunia at six months postpartum, although the evidence is older and estimates vary (clinical review of female sexual pain).

Myth: Vaginal oestrogen always cures menopausal painful sex.
Fact: It is guideline-recommended for selected GSM patients, but the evidence grade is C and trial effects on dyspareunia were mixed (AUA/SUFU/AUGS GSM Guideline 2025).

Myth: Psychological support means the clinician thinks pain is imaginary.
Fact: Psychosexual care can address anticipation, communication and avoidance while medical and muscular contributors are treated.

Myth: A pelvic examination must be completed in one visit.
Fact: Consent is ongoing, and draft RCOG guidance says patients may pause or decline any part of assessment (RCOG Green-top Guideline 41 peer-review draft).

Frequently asked questions

The bottom line

Painful intercourse becomes easier to investigate when you can say whether pain is at entry, deep, or both; whether it began with the first attempt or later; and what else happens with it. That map guides care, but you do not have to arrive with a diagnosis. If the symptom is broader than intercourse, return to the vaginal and pelvic pain hub to choose the right route.

Seek emergency help for sudden severe pain with collapse, shoulder-tip pain, fever or rigors. Otherwise, a confidential, patient-paced consultation can begin with conversation, followed by only the examination and tests that you consent to. Treatment may be simple or layered. The goal is not to make you endure penetration; it is to identify the cause, reduce pain and support the form of intimacy and function that matters to you.

To arrange a private consultation in Riyadh, contact Dr. Dina Rezk Clinic through its official booking channel. You may ask in advance for a female clinician, chaperone, language support, or a conversation-only first visit. Please do not send intimate photographs or detailed medical histories through an unsecured messaging account; ask which secure channel the clinic uses for clinical information.

References

1. Evaluation and Treatment of Female Sexual Pain: A Clinical Review
2. ACOG Practice Bulletin 213: Female Sexual Dysfunction (university-hosted mirror)
3. AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause, 2025
4. NAMS-published consensus recommendations for GSM management
5. NICE NG73: Endometriosis—diagnosis and management
6. CDC STI Treatment Guidelines: Pelvic Inflammatory Disease
7. ACOG Committee Opinion 673: Persistent Vulvar Pain
8. AAFP summary of ACOG Practice Bulletin 218
9. RCOG Green-top Guideline 41, third-edition peer-review draft
10. NHS Scotland: Acute Pelvic Pain Initial Management
11. Frontiers: Endometriosis in Women of Arab Ancestry
12. BASHH national guideline on vulval conditions