Pain experienced during or after sex is medically termed dyspareunia, and it is a common concern affecting many people. This discomfort may be felt at the vaginal entrance or, more commonly, as a deep ache or sharp pain within the lower abdomen or pelvis, particularly with internal penetration. Deep pain often indicates contact or pressure on internal structures within the lower abdominal cavity. While many causes are simple mechanical issues, persistent pain should prompt a discussion with a healthcare provider to rule out underlying conditions.
Non-Medical and Positional Factors
The most straightforward reasons for lower abdominal pain relate to the physics of sexual activity and anatomy. Deep penetration is a frequent cause of discomfort, often described as “bumping into something.” This occurs when the penis or other object contacts the cervix or the ligaments supporting the uterus, creating pressure felt deep within the pelvis. Certain sexual positions that allow for maximum depth increase the likelihood of this collision pain.
Vigorous or prolonged activity can lead to temporary muscle soreness or strain. When activity continues without adequate arousal and lubrication, friction and tension increase, causing discomfort. A lack of relaxation or anticipation of pain can cause the pelvic floor muscles to involuntarily tighten, contributing to a deep, cramping sensation. Additionally, a retroverted, or “tilted,” uterus that tips backward toward the spine can be more susceptible to contact pain during deep penetration.
Gynecological Health Conditions
A range of specific gynecological conditions can cause recurring or chronic deep pain during penetration, often involving inflammation, growths, or scarring in the pelvic cavity.
Endometriosis
Endometriosis is a common cause where tissue similar to the uterine lining grows outside the uterus, often on the ovaries, fallopian tubes, or the outer surface of the uterus. Deep penetration causes physical movement and stretching of these affected organs, leading to significant pain. This discomfort is linked to the physical pulling on adhesions or contact with tender, inflamed areas.
Ovarian Cysts and Uterine Fibroids
Ovarian cysts, which are fluid-filled pockets on the ovary’s surface, are typically benign but sensitive to pressure. Deep thrusting can press against a cyst, causing a dull ache or sharp pain, especially if the cyst is large or has caused the ovary to twist (torsion). Similarly, uterine fibroids—noncancerous growths in the uterine wall—can cause pressure or contact pain during intercourse, depending on their size and location.
Pelvic Inflammatory Disease (PID)
PID, an infection of the upper reproductive organs, leads to chronic pain due to inflammation and scarring (adhesions) in the pelvis. These adhesions restrict the movement of the uterus, fallopian tubes, and ovaries. When these organs are jostled during deep penetration, the restricted movement of the scarred tissue causes painful stretching and pulling.
Non-Reproductive System Contributors
Pain felt in the lower abdomen during sex does not always originate from the reproductive tract, as the lower belly contains other sensitive organs.
Digestive and Urinary Issues
Digestive issues, such as Irritable Bowel Syndrome (IBS) or severe constipation, can make the bowels hypersensitive to pressure. The physical motion of intercourse can aggravate an already distended or inflamed colon, resulting in cramping or aching pain. This pain is often accompanied by other gastrointestinal symptoms like bloating or gas.
The urinary system is another source of potential discomfort, as the bladder sits close to the reproductive organs. Conditions like a Urinary Tract Infection (UTI) or Interstitial Cystitis (IC) cause the bladder wall to become irritated and inflamed. When pressure is exerted on the bladder during sex, the existing inflammation can cause deep pain. This pain is often distinguishable by accompanying symptoms such as frequent or painful urination.
Musculoskeletal Factors
Chronic tension or spasms in the pelvic floor muscles can also mimic deep abdominal pain. These muscles support the pelvic organs, and when they are involuntarily tightened or hypertonic, the movement and pressure of penetration can cause painful muscle cramping. Though rare, a hernia in the groin or lower abdominal wall can be aggravated by the abdominal straining and movement that occurs during sexual activity.
Warning Signs Requiring Prompt Care
While many instances of pain are benign, certain symptoms signal a potentially serious medical problem requiring immediate attention. Sudden, severe, or debilitating pain that appears acutely should be treated as an emergency. This acute onset, especially if accompanied by dizziness, faintness, or pallor, may indicate a ruptured ovarian cyst or an ectopic pregnancy.
A physician should be consulted promptly if the pain is accompanied by any of the following:
- Systemic symptoms such as a fever or chills.
- Unusual, foul-smelling vaginal discharge, which may indicate an active infection like Pelvic Inflammatory Disease.
- Any bleeding that occurs outside of a normal menstrual period or bleeding that happens after sex.
- Pain that persists for longer than 24 hours after intercourse.
- Pain severe enough to consistently prevent or limit sexual activity.