Some lingering cramps after orgasm are normal, and they can be relieved by taking deep breaths or rest. But frequent or severe pain could be a sign of something more serious.
For example, if pelvic pain occurs around the time of ovulation, it could be caused by an infection or by endometriosis, which happens when tissue that lines the uterus grows on other areas, like the pelvis and fallopian tubes.
Cysts
Women with cysts — fluid-filled pockets on the ovaries or in the fallopian tubes — might have pain during sex. This pain can be caused by the lining of your stomach (endometriosis) or by other tissue that should only line the inside of your uterus growing outside your womb (fibroids). It might also be due to scar tissue from surgery, a pelvic infection or a condition that causes ovarian cysts to grow large enough to touch each other and create a painful mass (polycystic ovary syndrome).
Most ovarian cysts are small and don’t cause symptoms. They can affect the menstrual cycle by causing heavy or irregular periods or spotting between periods. Very large cysts can cause the ovary to twist, which is called ovarian torsion. This can cause severe abdominal pain and might make you vomit or have a fever.
Cysts can form anywhere on the body and might be filled with air, pus or blood. They might not need treatment and will go away on their own in a few months. However, large cysts might need to be drained or removed by your doctor. You can get a cyst diagnosis from your primary care provider, an obstetrics and gynecology (OB/GYN) doctor or certified nurse midwife. They’ll ask you about your symptoms and do a pelvic exam. They might use ultrasound or magnetic resonance imaging (MRI) to see the size and shape of your cyst.
Endometriosis
This is a condition in which tissue that normally lines the inside of the uterus grows outside of the uterus. It can cause pain in the pelvis, abdomen and lower back, which might be worse during or after sex. The condition affects about 11 percent of American women of reproductive age. It can also lead to heavy menstrual bleeding, infertility and bowel or bladder problems.
It is not known exactly what causes endometriosis, but experts believe it happens when cells that normally line the uterus change and start growing in areas outside the uterus. The tissues may grow in the ovaries, fallopian tubes or abdominal walls. They may also form cysts or scars. Some of these cells can migrate and cling to different organs throughout the body, causing inflammation, adhesions and painful periods. In some cases, the tissue may spread to the intestines and urinary tract, resulting in bowel or bladder dysfunction and a chronic painful period.
Doctors can diagnose this condition with a physical exam, blood tests and imaging scans such as ultrasound or an MRI. They may also perform a biopsy of the growths or other suspicious tissue to confirm the diagnosis. Treatments include birth control pills, surgery to remove the affected tissue and medications that help manage symptoms. If the symptoms are mild, the condition usually does not cause infertility.
Fibroids
Many women develop uterine fibroids, benign muscle growths in the womb, during their reproductive years. While they’re typically harmless, fibroids can cause pelvic pain and heavy menstrual bleeding, which may also hurt during sexual intercourse.
Fibroids can also be caused by emotional trauma, medication or hormonal changes. These growths can be asymptomatic and may not require treatment, though they can be treated to relieve symptoms such as abdominal and pelvic pain and heavy periods. Fibroids can grow during pregnancy due to higher estrogen levels in the blood, and they may shrink after pregnancy.
Some women are more prone to developing fibroids than others, and they can be hereditary. Black women, in particular, have a greater chance of developing fibroids than women of other races. Women who begin their periods at an early age are also more likely to develop fibroids.
A gynecologist can diagnose uterine fibroids through a pelvic exam. The doctor may use an ultrasound or a pelvic magnetic resonance imaging (MRI) to check the condition, size and texture of your uterus for signs of fibroid tissue. During an ultrasound, the doctor inserts a wand into your vagina or places a transducer over your abdomen to produce pictures of your internal organs using sound waves. They can also use a procedure called hysteroscopy to insert a lighted tube into the uterus through the cervix and look at your uterus up close, as well as take a sample of fibroid tissue for testing.
Painful intercourse
The good news is that painful intercourse usually has a cause, and it’s often treatable. If you’re suffering from pelvic pain during sex, talk to your gynecologist about it right away. They will likely do a pelvic exam and will be able to figure out what’s going on.
Pain during sex may be caused by a lack of sexual lubrication, or it might indicate an infection or other health issue like vulvodynia, pelvic inflammatory disease, uterine fibroids or endometriosis. Often, the first step is to try some sexual lubricants and more foreplay.
Cramps during sex are not uncommon and they are a normal part of orgasm, but if you are experiencing them long after climax, it could be a sign of a problem. A lingering cramp might also be an indicator of an infection or a condition like STIs or endometriosis, and if left untreated could lead to serious complications.
Pelvic pain during sex can be caused by infections, including chlamydia, gonorrhea and yeast infections. Yeast infections are especially common in women and they can spread to the ovaries, fallopian tubes or uterus. Pelvic inflammatory disease and scarring from past pelvic surgery can also cause pain during sex. Ovarian cysts are fluid-filled pockets that can enlarge and cause pain and pelvic pressure. Fibroids are non-cancerous growths on the ovaries that can cause heavy menstrual bleeding, pelvic pain and pain during sex.
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