So you've just finished a sex session with your partner, but instead of basking in the afterglow, you're realizing that something is hurting down below. Maybe it's a dull ache inside your vagina, or a burning sensation closer to your vulva, or more of a stabbing pain deeper into your pelvis. Whatever's going on, you know it isn't normal. Sex is supposed to feel amazing, not leave you wincing.
Post-sex pain is more common than you'd think. "One in three women have pain during or after intercourse,” Michael Ingber, MD, director of urogynecology for Saint Clare’s Health System in New Jersey and clinical assistant professor of urology at Weill Cornell Medical College in New York tells Health. Ob-gyns say it's one of the top issues they help patients deal with, and there are many possible causes—as well as treatments that can help.
The first thing to do is get an idea of what might be behind the pain you feel, then talk to your doctor about it. Here are the most likely (and a few rare but possible) explanations.
You have a UTI
One in five women experiences a urinary tract infection at some point in life, according to the National Kidney Foundation. Pain in and around your pubic area is one of the most common symptoms. What's going on? Inflammation from the infection "can cause spasms in the muscles surrounding the pelvic organs,” explains Dr. Ingber.
When you have penetrative sex, and your partner's penis makes repeated contact with the vaginal wall, these spasms can be exacerbated and really hurt. "Picture somebody punching you firmly, over and over, in the same spot in your shoulder,” says Dr. Ingber. “The muscles may become sore, and a natural response may be spasms of the muscles. The same thing happens in the pelvis, and the muscles surrounding the vagina and pelvic organs.”
If you have other UTI symptoms, such as foul-smelling pee or pain while urinating, let your doctor know. Relief can be just an antibiotic prescription away.
Your partner’s penis is too big
Here's a time when size does matter. “Anatomy plays an important role in pain after sex,” explains Dr. Ingber. If your partner is on the well-endowed side, the muscle group surrounding your vagina and other pelvic organs can cramp up and stay that way after the bumping and grinding is over.
“The average female vagina is no longer than five inches or so, therefore, the ‘average’ male, who may be six inches long, may still cause significant trauma to the pelvic floor that can cause post-sex cramping,” he says. If your significant other is particularly lengthy and after sex your vagina feels raw (even though you were super aroused and used plenty of lube), experiment with positions that make an XXL penis fit better, like spooning or woman on top.
You have an ovarian cyst
Most benign ovarian cysts are fluid-filled structures on your ovaries; they tend to resolve themselves in two to three months without you even knowing you had one.
But sometimes ovarian cysts trigger achy pain, typically in the lower right or lower left side of the pelvis where your ovaries are. "If they’re large enough, ovarian cysts can cause abdominal pain and cramping during and after sex,” Kecia Gaither, MD, ob-gyn, maternal-fetal medicine doctor, and the director of perinatal services at NYC Health + Hospitals/Lincoln, tells Health.
Most cysts stay under 4 inches, but some can grow much larger, and “these large cysts additionally can torse, or twist, which can be exceedingly painful,” she says. Your ob-gyn would have to do an ultrasound to see if you actually have a cyst, and then treatment would likely be watchful waiting. If she confirms that you do have one and the pain gets to be too much, you may have to have surgery to remove it.
You have endometriosis
An estimated one in ten women have endometriosis, a condition thought to be caused by uterine tissue that has migrated into the pelvic cavity, says Dr. Gaither. That tissue may adhere anywhere in the body, but typically it stays in the pelvic cavity and forms cysts on the ovaries, the peritoneum (the membrane that lines your abdominal cavity), the bladder, and around pelvic muscles. If the tissue adhesions are behind the vagina, penetrative sex can result in pain.
Not all women with endometriosis will experience pain during or after sex. But if you do, it'll likely be more of a deeper kind of sharp or stabbing pain. Other signs include killer menstrual cramps and pelvic pain all month long, even out of the bedroom. Endometriosis isn't curable, but medication and surgery can relieve symptoms, so let your doctor know if you suspect it.
You have pelvic inflammatory disease
Pelvic inflammatory disease (PID) is an infection of the organs of the upper reproductive tract. It's typically the result of an untreated sexually transmitted infection, such as gonorrhea or chlamydia. As the name states, it’s an inflammatory condition, says Dr. Ingber, and that can lead to pelvic pain, scarring, and even infertility. During sex, you'd likely feel the pain deeper into your pelvic area where your upper reproductive organs are.
If you suspect PID might be the cause of your pain, you should see your ob-gyn as soon as possible. “PID needs to be treated with antibiotics,” says Dr. Ingber.
You’re allergic to your partner's semen
It's super rare, but a semen allergy is an actual thing. As many as 40,000 women in the U.S. are allergic to their significant other's semen, according to a study review from the University of Cincinnati.
If you’re experiencing this kind of allergic reaction, your symptoms could be local (like swelling or itching) or systemic. “Women may feel severe burning, develop a significant discharge, and even have whole body reactions such as chills, fever, and low blood pressure,” says Dr. Ingber. If you have sex with a condom on and don’t experience any of these symptoms, an allergy may be the culprit. A doctor can also perform skin prick tests to give you a more definitive diagnosis. Treatment includes medication and desensitizing shots. Sure it's a buzzkill—but many women report that their symptoms lessen as time goes on.