Most women who raise painful sex with a doctor have rehearsed it in the car park and then said almost none of it. What comes out is a shortened, softened version, and the shortened version gets a shortened answer.

This is not because the appointment is short, although it is. It is because painful sex is hard to describe without a vocabulary for it, and without description there is nothing for a clinician to work with.

So here is the preparation. It takes about ten minutes and it changes the appointment.

THREE SENTENCES TO HAVE READY

Write them down. Take the paper in. Read from it if you need to.

One: where it hurts. At the entrance, or deeper inside, or both. If you can, say whether it is on the way in, during, or afterwards.

Two: when it started, and whether anything changed around then. A birth, a surgery, a new medication, a change in periods, a course of treatment, a hard year. You are not required to know the connection. You are only reporting the timeline.

Three: what it stops you doing. This is the sentence most often left out, and it is the one that establishes this as a clinical problem rather than a preference. "I have been avoiding sex for eight months and it is affecting my relationship" is information. "It is a bit sore sometimes" is not.

WORDS THAT DESCRIBE EACH KIND OF PAIN

Clinicians are listening for a pattern, and the pattern lives in the adjectives. Use whichever of these fit, and do not worry about choosing the right one.

Burning or stinging, especially at the entrance, and especially if it lingers afterwards.

Tearing or splitting, at entry, sometimes with small amounts of bleeding.

A deep ache, felt further in, often with certain positions or at certain points in the month.

A sharp catch, sudden, in one particular spot, and reproducible.

Tightness that prevents entry altogether, sometimes with a sense of the body closing without permission.

Rawness or soreness the next day, disproportionate to what happened.

Then add the timing: only since a specific event, only with one partner, only at certain times of the month, every single time, or gradually more often than it used to be.

That is a clinical history. It is very different from "sex hurts", and it is the difference between being examined and being reassured.

ASK THE QUESTION DIRECTLY

You are allowed to say what you want from the appointment. Try one of these.

"I would like this examined, please."

"What are the possible causes of this kind of pain?"

"Is this something vaginal oestrogen would help, and can we discuss whether it is appropriate for me?"

"Who would you refer me to if this does not improve?"

IF YOU ARE DISMISSED

It happens, and it happens often enough to be worth planning for rather than being wounded by in the moment.

If you are told it is normal, that it is stress, that it is your age, or that you should have a glass of wine and relax, you have three moves.

Ask for it to be recorded. "Could you note in my file that I have reported pain during sex, and the date." This is a reasonable request, it costs nothing, and it changes the tone of a conversation more than almost anything else you can say.

Ask the closing question. "What would need to be true for this to be worth investigating?" It is polite, it is specific, and it is difficult to wave away.

Book with someone else. Not as a complaint, simply as a next step. Ask the reception staff whether any of the doctors at the practice have an interest in women's health or menopause. They usually know, and they will usually tell you.

Being dismissed is evidence about that appointment. It is not evidence about your body.

If you would like to work out what to say before you say it, the Free Reconnection Assessment is a short and private place to start putting words to it. You will find it at sosw.mykajabi.com/reconnection-assessment

This is education and wellness information, not medical advice or treatment. Persistent pain during sex, and any bleeding after sex, should be assessed by a clinician who can examine you.