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There are many possible reasons for painful sex and expert help is mostly needed to ensure that serious underlying physical causes have been ruled out or are properly treated. Different conditions can cause sex to be painful at different stages in a woman’s life. Some women have always found sex painful, for others it may come on suddenly. Sometimes there seems to be an obvious reason, such as recent childbirth, but generally, any persistent problems or sudden onset should definitely be investigated. Certainly some STIs such as Chlamydia can present with deep pain with sex, so no-one should just ignore these signs. Doctors and nurses should be sympathetic and able to carry out intimate tests with care or refer for specialist help.

Sometimes sexual intercourse may be painful for a women in the long-term and this in itself can be very psychologically upsetting. There are very highly trained therapists who are skilled at helping with these issues and no-one should be worried about asking for help

Problems with sexual intimacy may have their basis in a physical cause but equally their may be a psychological component. Vaginal dryness and discomfort or pain with sex may easily cause problems; however, loss of desire may occur without these physical issues. Other problems include inability to fantasise or reach orgasm. There may be a hormonal basis for some of these issues at certain times.

Many women experience some problems with some aspect of sexual intimacy at some stage in their life. The reasons for this may be quite simple or very intricate and the best advice is to seek expert help if a problem becomes distressing or long-term.

Sometimes help comes by approaching your own GP, but some individuals or couples like to go directly to a specialist sex therapist (for instance at Relate) for diagnosis and possible help.

It is normal for the vagina to be lubricated and most women will be aware of their natural vaginal secretions and that their type and amount may vary at different times especially during the monthly cycle in women before the menopause. There will be big changes in the normal vaginal secretions at puberty, during pregnancy, whilst breast-feeding, during the menopausal transition and postmenopausally.

The vagina is not a sterile environment and women have naturally occurring organisms in the secretions, mainly lactobacillus, which keeps the acid balance in the normal range, acting as a natural defence. Sometimes the secretions can be altered, especially by hormonal changes, which can prevent the normal flora from thriving, or by over-washing.

So alterations in the secretions do not necessarily imply a sexually transmitted infection. On occasion there may be an overgrowth of Candida, a yeast, causing itching, soreness, swelling and altered discharge ("thrush"). This is not an STI (Sexually Transmitted Infection), but may well need investigation and treatment, especially if it persists. Sometimes the lactobacillus is suppressed by the overgrowth of other non-STI organisms causing a condition called Bacterial Vaginosis (BV); again this needs diagnosis and treatment, and can be recurrent.

However true alterations in the vaginal flora can occur through infection with an STI (such as chlamydia, gonorrhoea, trichomonas) causing genuine vaginal discharge. This may be the only symptom, or may be accompanied, for instance, by pelvic pain, abnormal bleeding, pain on urinating, ulcers etc.

These symptoms should always be investigated and never ignored. No-one should feel embarrassed about going to see their doctor for help.

Importantly, however, it is common to have an STI (such as Chlamydia) with no symptoms, certainly without an altered vaginal discharge, so having a check up is a good idea!

GPs and practice nurses can organise this but it is also possible to pick up a test kit in many pharmacies, visit NHS Direct Walk-in centres or go directly to Sexual Health Clinics around the country.