pelvic pain after intercourse: what you need to know
Have you ever struggled with discomfort or pelvic pain after intercourse? It is a common concern among folks who are sexually active. For some, discomfort after sex is present from their first sexual encounter, while for others, it is something that develops over time. Let’s talk about frequent causes of pelvic pain after intercourse and what you can do about it.
what is pelvic pain after intercourse called?
Pelvic pain after intercourse is commonly called “dyspareunia,” which falls under the subset of “Genito-Pelvic Pain and Penetration Disorder.” Dyspareunia is recurrent pelvic pain that can occur before, during, or after sexual activity and intimacy and can affect people of all gender identities.
how long does pelvic pain after sex last?
There are varying lengths of time when it comes to pelvic pain following intercourse. The two different types are:
Acute pelvic pain: pelvic pain that is sudden and severe and only lasts for a short period of time
Chronic pelvic pain: pelvic pain that has been occurring for at least six months and can be constant or come and go
how common is pelvic pain after intercourse?
Honestly, pelvic pain after intercourse or sex is widespread and affects around 75% of people who are assigned female at birth (AFAB) at some point in their lifetime and around 16% of people who are assigned male at birth (AMAB). Dyspareunia affects between 3-18% of the population worldwide and 10-28% of the population during their lifetime (regardless of gender identity or expression).
is it normal to have pelvic pain after sex?
Although pelvic pain after intercourse, sex, or intimacy is incredibly common, it is absolutely not normal or something that you have to deal with. I also want to emphasize the fact that if you are struggling with pain during or following sex or intimacy, you have done absolutely nothing wrong or something to cause the discomfort that you are experiencing. It is not your fault, and there is treatment available.
what can cause pelvic pain after intercourse?
Pelvic pain following intercourse can be due to a variety of causes and reasons. The most common causes include:
Dryness present during sex and intimacy
Pelvic dryness that is present during sex can frequently cause chafing and discomfort at the pelvic tissue and potentially even cause micro-tearing of the pelvic tissue, resulting in spotting or bleeding of bright red blood during or following sex. If you notice any spotting or bleeding during or following sex or intimacy, it is something you want to bring up with your medical care provider to ensure that nothing else is going on that could be causing your bleeding.
Sexually transmitted infections or STIs
STIs such as untreated chlamydia or gonorrhea can cause inflammation in the vaginal tissues, cervix, and pelvic organs because of bacteria. This can be further exacerbated during sexual activity, causing pelvic pain during and following sex.
Pelvic inflammatory disease (PID)
PID causes inflammation of the pelvic organs, including the fallopian tubes, uterus, and ovaries, and this inflammatory response can be exacerbated by sexual activity, causing discomfort following sex. Repeated episodes of PID can also lead to scar tissue that forms in the pelvic region around the pelvic organs, which can cause discomfort during and following sexual activity. In addition to pain during and following sex, it is also common to experience abnormal vaginal discharge, such as a change in color or smell, pain in the lower abdominal or pelvic region, pain during urination, fever or chills, and irregular bleeding from the pelvic region.
Different pelvic conditions like endometriosis, fibroids, or cysts
With different pelvic conditions, there can be nodules, lesions, or scar tissue that can be twisted, pressed against, or stretched, which can cause pressure, discomfort, and an increase in inflammation, causing pain during and following sex.
Urinary tract infections or UTIs
Undiagnosed UTIs can sometimes be a cause for pelvic pain that occurs following intercourse but typically is not chronic. Intercourse or sex can flare up pre-existing UTI-like symptoms, including pain or burning with urination, bloody or cloudy urine, and lower abdominal discomfort. If you think you may have a UTI, this would be an immediate need to seek out treatment from your physician or urgent care provider to get started on antibiotics.
Anatomy of partner(s) if having receptive penetrative intercourse
The anatomy and shape of the object that is penetrating you, whether it is a toy or a partner (or partners), makes a world of difference and can sometimes result in discomfort following sex. A common condition in people with penises is called Peyronie’s Disease. This is where a layer of the connective tissue in the penis (called the tunica albuginea) develops an accumulation of scar tissue, causing bending of the penis. This curvature of the penis can cause pain in partners during as well as following sex.
Pelvic floor muscle tension
The pelvic floor muscles wrap around the pelvic openings (including the urethra, where pee comes from, the vagina or front pelvic opening, and the anus or back pelvic opening) and also have a deeper layer inside the pelvis that helps to support your pelvic organs where they’re supposed to be. When these muscles get tight, tense, or tender to the touch, they can cause pelvic pain during and even following sex and intimacy. Ouch!
Stress and anxiety
Stress and anxiety can cause an upregulation of the sympathetic nervous system, which is a big player in the functioning of the pelvic floor muscles. When this part of the nervous system is activated, it can cause increased tension and tightening of the pelvic floor muscles, which can cause pain during and following sex.
Sexual trauma
The body itself stores so much, including trauma and stress. For folks who have experienced sexual trauma, I am so sorry. You have done absolutely nothing wrong or anything to deserve what happened to you.
The muscles in the pelvic region naturally tense and guard to protect us from anything that could potentially harm us, and a history of trauma in the pelvic region causes upregulation of the body’s alarm system (the nervous system). This can cause the pelvic floor muscles to tighten or contract during attempted sexual activity, which can lead to discomfort during and following sex and intimacy.
Relationship dynamics
If you are struggling with pelvic pain after sex with a partner (or multiple partners), it could be due to emotional stress or communication issues between you and your partner(s). Whenever we experience a lack of emotional intimacy, feelings of disconnectedness, or communication problems, it can cause feelings of frustration and difficulty with being able to let go during sex. This can lead to resulting tension in the pelvic floor muscles, which can cause pain during and following sex.
how pelvic pain after sex impacts quality of life
Pelvic pain after sex can feel incredibly isolating or like you are the only person struggling with things. I am here to tell you that you are not alone and are in good company. I promise you that if you were the only person on the face of the planet struggling with pelvic pain during or following sex, I wouldn’t have a job as a pelvic floor physical therapist.
Experiencing pelvic pain after intimacy can result in many things when it comes to our physical and mental well-being, including:
Decreased libido or sexual desire
Stress, anxiety, or depression
Avoidance of sexual activity and sexual satisfaction which can cause strain among partners and can even cause increased instances of stress and decreased mood levels due to a reduction in the production of endorphins, which are released during sex and orgasm
Emotional distress or difficulty concentrating
Anxiety about future sexual encounters
Social isolation, avoiding intimate relationships, and decreases in feelings of overall well-being
Feelings of shame, guilt, and low self-esteem
when to seek help for pelvic pain after sex
If your pelvic pain during or following sex is not a one-off experience and is something you are starting to notice more frequently, has been going on for a while, or is starting to worsen or impact being able to live your life and participate in activities that you enjoy, you should see a specialist.
Gynecologists, urogynecologists, and urologists can help to rule out underlying causes of pelvic pain following intercourse like urinary tract infections (UTIs), pelvic inflammatory disease (PID), sexually transmitted infections (STIs), and other medical conditions that could be causing pelvic pain like endometriosis, fibroids, cysts, or Peyronie’s Disease.
Typically, working with a certified and skilled pelvic floor physical therapist can be incredibly helpful when it comes to addressing pelvic pain during and following intercourse that is caused by tension, tightness, and pain in the pelvic floor muscles. We have a specific skill set to assess your pelvic floor muscles and come up with a treatment plan to help resolve the pelvic pain that you are experiencing when it is due to issues from the musculoskeletal system.
treatment options for pelvic pain after intercourse
As a Board-Certified Pelvic Floor Physical Therapist, there are SO many things that we can do during pelvic floor physical therapy to help improve symptoms of pelvic pain during and following sex. Here are some general recommendations for some symptom relief for pelvic pain following sex:
Lubricant and moisture of your genitals is EVERYTHING
Typically, with dryness, using a high-quality lubricant can be incredibly helpful when it comes to managing dryness that is present during sex and intimacy, as well as following to help prevent chafing and the potential of micro tears forming in the pelvic tissue. Some of my go-to lubricants are:
Slippery Stuff, which is a water-based lubricant
Uberlube, which is a silicone-based lubricant and is great to use during water activities (just make sure you don’t use it with silicone toys or dilators!)
Aloe Glide by Desert Harvest is an aloe-based lubricant
Vulva balm by Medicine Mama is a total game changer when it comes to feeling dryness and irritation at the vulvar tissue throughout the day and with intimacy. This lovely stuff helps to lock in moisture at the vulvar tissues and can significantly help to reduce dryness and chafing at the external genitals and vulvar tissue if you’re feeling discomfort here during sex or intimacy.
Hormones are also everything
If you are perimenopausal, menopausal, postmenopausal, on hormonal birth control, pregnant, postpartum, or chestfeeding, you may be experiencing vulvar and vaginal or pelvic dryness because of hormonal changes, which can also cause issues with pelvic pain during and following intercourse. If this sounds like you, it is so important to have a conversation with your healthcare provider about potentially getting onto hormone replacement therapy (like topical estrogen, DHEA, or testosterone) to help improve some of your symptoms. Knowledge is power, and you should have the information that you need to help improve your pelvic pain!
You can (and should!) use assistive devices to help reduce your discomfort during and following sex and intimacy
I am all about sex and kink-positivity. So why not incorporate things that are fun and can potentially help with pelvic floor muscle tension and discomfort?!
One thing I love to recommend to my pelvic pain clients is a vibrator, which helps to increase blood supply and oxygen to the pelvic floor muscles and genitals and can also help to decrease pelvic pain. I love to recommend orgasm first to my clients before they engage in any form of pelvic penetration to help improve pelvic pain during and following sex. Some of my favorite vibrators are:
I also love to recommend the Ohnut to folks who are experiencing pain during and following deeper thrusting and pelvic penetration. This helps to reduce the depth of penetration and keep things in a more comfortable range so you can still get freaky while you’re working on improving your pelvic discomfort.
Work with a mental health provider if you are struggling with a history of stress, anxiety, depression, or sexual trauma
I am a HUGE advocate of mental health as a pelvic floor provider. I work with a mental health provider regularly myself and am personally medicated for anxiety and depression. So, from one human being to another, it’s okay to not be okay and to need help.
The pelvic floor muscles and stress, anxiety, and depression go hand in hand, and there is so much overlap when it comes to pelvic floor dysfunction and mental health diagnoses. I frequently recommend that clients who I am working with also work in conjunction with a mental health provider as we are helping to treat pelvic floor issues since the two complement each other so well.
If you are struggling with relationship issues with a partner or feelings surrounding sex and intimacy, working with a sex therapist can be a total game-changer
Similar to working with a mental health provider to help address ongoing stress, anxiety, depression, and PTSD, working with a sex therapist can help to address and focus on the mental or emotional aspects of sex-related issues. If you’re having issues when it comes to a lack of intimacy or difficulty communicating with a partner, working with a sex therapist can be a great resource.
Dilator therapy is a game-changer
Because pelvic floor muscle tension is so wrapped up with pelvic pain during and following sex, most clients who I work with who are struggling with or have struggled with pelvic pain with and following sex usually see so many improvements and benefits with using dilators to address their symptoms. The research proves that dilator therapy (in conjunction with working with a pelvic floor physical therapist) is one of the most effective ways to address pelvic pain during and following sex.
Think of dilators as a form of graded exposure where they gradually increase in size and length (starting as small as your pinky finger and gradually increasing up to the size of a large dildo). These tools help to desensitize, stretch, and lengthen your pelvic floor muscles to help improve the discomfort that you feel during and following sex and intimacy.
Some of my go-to dilators that I recommend to clients are from the following companies:
Intimate Rose Vaginal Dilators and Rectal Dilators
See a pelvic floor physical therapist!
If you are struggling with pelvic pain during or following intercourse, just know that it’s common but not normal and not something that you have to deal with. Working with a skilled pelvic floor physical therapist can help to identify the underlying cause of your issues and come up with a treatment plan tailor-made to you to help improve your symptoms.
So, if this sounds like you and you are located in Durham, NC, I would love to hear from you. Please don’t hesitate to reach out using the link below!
Have questions or feeling on the fence about whether or not pelvic floor physical therapy is for you? If you are looking for treatment for pelvic pain following intercourse and you’re located in Durham, North Carolina I would love to work with you! Reach out to me using the link below to tell me a little more about what is going on so we can chat more and get the process started.
Live outside of the state of North Carolina? I also offer virtual appointment options to provide more accessible care to those seeking out pelvic floor physical therapy treatment.
Struggling with pelvic pain following intercourse or other pelvic floor conditions and having a hard time finding a knowledgeable pelvic floor physical therapist?
Check out my website here to see what other conditions I treat as a pelvic floor physical therapist.
Dr. Brook Orvis (she/her) is a Board-Certified Women’s Health and Pelvic Floor Physical Therapist, Duke Residency-Trained in Women’s Health, and the owner of Flora Physical Therapy. As a momma to a spirited toddler, she understands the difficulty of being a parent while prioritizing self-care, including caring for your body and pelvic floor. She believes that pelvic floor therapy is for everyone and is passionate about providing accessible treatment options for birthing people, men, women, kids, and the LGBTQIA+ community so that they can take better care of themselves and receive equitable care. She loves educating and empowering clients to take charge of their body and health and to not accept leaking of urine, prolapse, pelvic pain, pain during sex, and core weakness as a normal part of being a human.
