13 Causes of Painful Intercourse (Dyspareunia)

Experiencing pelvic discomfort after sexual activity isn’t just a mood killer, it can also be cause for concern, especially if the pain is persistent and severe. This could signal underlying health issues that require medical attention.

Such pain could stem from a range of conditions, including sexually transmitted infections (STIs), uterine fibroids, emotional trauma, endometriosis, urinary tract infections (UTIs), deep penetration, or dysmenorrhea. It's vital to consult a healthcare provider for proper diagnosis and treatment.

It’s important to seek medical attention if you’re experiencing pain after intercourse for several reasons. It aids in diagnosing and treating potential physical health conditions, addresses the emotional and psychological impact of the symptoms, helps maintain healthy sexual relationships, encourages an understanding of sexual health, and prevents the development of chronic pain.

Women should be encouraged to speak openly with their healthcare providers about any discomfort experienced during or after sex, as it is an important aspect of their overall health and well-being. Persistent or severe pelvic pain following sexual intercourse is a matter that shouldn't be ignored. If you're experiencing such discomfort, it's important to understand the potential causes and seek professional medical advice.

What Causes Pelvic Cramping After Sex?

Abdominal cramping after sex can be caused by several factors, ranging from benign to more serious conditions. Some common causes include:

Muscle Contractions: During orgasm, muscles throughout the body, including those in the abdomen, can contract intensely, which can sometimes lead to cramping.

Cervical Changes: Sexual intercourse can cause mild irritation or stimulation of the cervix, leading to cramps, especially if there's a condition like cervical ectropion (where the cells from the inside of the cervical canal are present on the outside of the cervix).

Endometriosis: This is a condition where the tissue similar to the lining of the uterus grows outside the uterus, causing pain and cramping, which can be exacerbated by sex.

Pelvic Inflammatory Disease (PID): PID is an infection of the female reproductive organs that can cause abdominal cramping and pain during or after intercourse.

Ovarian Cysts: These fluid-filled sacs can cause pain during intercourse, especially if they are large or ruptured.

Fibroids: These are benign tumors in the uterus that can cause pain and cramping during or after sex.

Irritable Bowel Syndrome (IBS): IBS can cause a heightened sensitivity to abdominal pain, which physical activities, including sex, can trigger.

Psychological Factors: Anxiety, stress, or fear related to sex can cause muscle tension, leading to cramps.

Inadequate Lubrication: Insufficient lubrication can cause friction and irritation during sex, leading to cramping.

It's important to note that while some of these causes are benign, others may require medical attention. If you experience recurrent or severe abdominal cramping after sex, it's advisable to consult a healthcare professional for a proper diagnosis and treatment.

Can PMS or Dysmenorrhea Cause Pelvic Cramping After Sex?

Sex can sometimes be less than enjoyable, leading to pelvic pain. If you're facing this issue, it might indicate a serious internal problem. It’s possible that the pelvic pain you’re experiencing during and after intercourse could be related to your menstrual cycle and caused by dysmenorrhea.

Dysmenorrhea refers to the medical term for pain associated with menstruation, commonly known as menstrual cramps. There are two types:

Primary Dysmenorrhea: This is the most common type, where the pain is not associated with any other pelvic condition. Pain usually begins a day or two before menstruation and may last from 2 to 4 days.

It's usually felt in the lower abdomen, back, or thighs and can be accompanied by nausea, vomiting, fatigue, and diarrhea. The pain is caused by uterine contractions and the release of prostaglandins, which are hormone-like substances that trigger muscle contractions.

Secondary Dysmenorrhea: This type of pain is usually due to a reproductive system disorder, such as endometriosis or fibroids. It tends to begin later in life and can be more severe and long-lasting than primary dysmenorrhea. The pain might start earlier in the menstrual cycle and last longer than the typical cramps.

Treatment for dysmenorrhea varies depending on its severity and cause. Common treatments include over-the-counter pain relievers, hormonal contraceptives to reduce prostaglandin production, and lifestyle changes such as exercise and stress management. For secondary dysmenorrhea, treating the underlying condition is often necessary.

If menstrual pain is severe or does not improve with over-the-counter treatments or causes pain during sex, it's advisable to see a healthcare provider for evaluation and management.

Identifying Dysmenorrhea Symptoms
A dysmenorrhea diagnosis requires the exclusion of other disorders. Symptoms include:

• Lower abdomen cramping
• Upper thigh and lower back pain
• Headaches
• Vomiting and diarrhea
• Fatigue and weakness
• Fainting

Approximately 16-29% of women experience significant disruptions in daily life due to dysmenorrhea, making it important to seek medical attention.

What Causes Dysmenorrhea?

Wondering about the origins of severe pelvic pain during your period? Research points to prostaglandin F (PFG) as a key factor.

Primary dysmenorrhea involves PFG triggering strong uterine contractions during the shedding of the lining. Higher levels of this hormone can intensify the pain, causing cramps both before and after active menstruation has ended.

Secondary dysmenorrhea is linked to medical issues like endometriosis, pelvic inflammatory disease (PID), uterine fibroids, or infections, which also cause post-coital pain.

Could Cramping After Sex Be Related to Pelvic Congestion Syndrome?

It’s possible cramping after sex could be related to pelvic congestion syndrome. Individuals with varicose veins in the upper thighs, groin, vulvar region, and back of the thighs might suffer from Pelvic Congestion Syndrome (PCS).

Often, these varicose veins improve post-delivery, but they can persist in the pelvis, leading to pelvic pain and dysmenorrhea. Especially in cases of multiple childbirths, further diagnosis by a vascular specialist might be needed if gynecological issues are ruled out.

Pelvic Congestion Syndrome (PCS) is a chronic condition affecting the pelvis's veins. It's typically seen in women of reproductive age and can cause a range of symptoms, which may vary in severity. Some of the common symptoms include:

Chronic Pelvic Pain: This is the most common symptom of PCS. The pain is often described as a dull, aching sensation and can be aggravated by standing for long periods, during or after intercourse, and during menstrual periods.

Varicose Veins: Enlarged, twisted and inflamed veins may develop around the buttocks, vulva, and thighs. They are similar to varicose veins that commonly occur in the legs.

Postcoital Aching: Pain and discomfort in the pelvic region following sexual intercourse.

Painful Menstruation (Dysmenorrhea): Women with PCS may experience more painful menstrual periods.

Urinary Symptoms: Such as increased frequency or urgency to urinate.

Backache: Persistent lower back pain can also be a feature of PCS.

Emotional Distress: Due to the chronic nature of the pain, PCS can lead to emotional and psychological distress, including depression and anxiety.

Swelling or Feeling Fullness: Some women report a sensation of fullness in the legs or pelvis.

Irritable Bowel Syndrome-Like Symptoms: These may include bloating, constipation, or diarrhea.

Fatigue: General tiredness or a lack of energy may also be associated with PCS.

It's important to note that these symptoms can be similar to other conditions, so a thorough medical evaluation is necessary for an accurate diagnosis. Treatment options for PCS may include hormonal therapies, pain management, and, in some cases, surgical procedures.

How Is My Pelvic Cramping Evaluated and Diagnosed?

Chronic pelvic pain, especially post-sexual activity, necessitates a thorough medical evaluation, considering:

Menstrual History: Irregular, painful, and heavy cycles can indicate conditions like endometriosis or fibroids.

Timing of Pain: Pain occurrence times can hint at possible causes like endometriosis.

Pain Characteristics: Pain intensity, location, and progression are critical for diagnosis. Your medical team needs to know how bad the pain is, what kind it is (is it sharp, is it an ache, is it throbbing), where you’re experiencing pain, and if it’s worsening.

Sexual History: Pain during sex could be related to STIs or UTIs. Your medical team isn’t here to judge your past experiences, only to help you find solutions and answers. Be prepared to have an open conversation about relevant sexual history.

Past Medical History: Previous conditions like endometriosis or vaginismus could be indicative.

Prior Treatments: Past medical treatments can provide insights into possible causes.
Physical Examination: Includes ultrasounds, scans, or invasive procedures.

Pelvic Ultrasound in Diagnosis
While not always conclusive, pelvic ultrasounds assist in examining the pelvic vein and lower abdomen for vascular-related symptoms. These ultrasounds, either transvaginal or transabdominal, use high-frequency sound waves to create organ images.

Diagnosing pelvic pain includes working with your medical team to discuss things such as:

Medical History: Considering sexual, menstrual, and pregnancy histories.

Laparoscopy: Inserting a scope into the abdomen to view internal pelvic tissue.

Imaging Tests: Ultrasounds, CT, or MRI scans help identify the source of pain.

The Center for Vascular Medicine employs advanced imaging technology for quality patient care. We advise those experiencing these symptoms to consult a gynecologist before seeking a vascular specialist. Our diagnostic procedures, like IVUS and venogram, help in understanding blood flow in the veins, guiding us to the best treatment options.

We serve patients from Annapolis, MD, Columbia, MD, Easton, MD, Glen Burnie, MD, Greenbelt, MD, Prince Frederick, MD, Silver Spring, MD, Waldorf, MD, Fairfax, VA, Fredericksburg, VA, New Brunswick, NJ, and Union, NJ.