It's Not Always A Health Issue That Causes Cramping After Sex

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Why Am I Cramping After Sex? 14 Potential ReasonsDavid Jakle - Getty Images

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Cramps are (unfortunately) a part of life, especially for women. Although cramps are usually associated with things like bloating and your monthly cycle, cramps can also arrive after a sexual bout in the bedroom. Cramping after sex is more common than you may think—but is it a cause for concern?

One of the main causes is orgasm, says Christine Greves, MD, an ob-gyn at the Winnie Palmer Hospital for Women and Babies. It's similar to the pain you get around your period, usually happens right away, and can linger for a few hours after sex. Similar to a period cramp, you can usually feel it anywhere in your vagina, lower abdomen, or back, she says.

Adeeti Gupta, MD, an ob-gyn, sexual health expert, and CEO and founder of Walk In Gyn Care explains that when you orgasm, your uterus and pelvic muscles contract, then relax. But if it hurts, it indicates that something is preventing your uterus from loosening up again after the tension is released.

Cramping after sex or experiencing an orgasm may be normal as the muscles contract, but it should be short-lived and go away. "If it persists, it may indicate that there is something wrong," explains Iris Kerin Orbuch, MD, an ob-gyn, endometriosis specialist, and director of Advanced Gynecologic Laparoscopy Center in Los Angeles and NYC, as well as the co-author of Beating Endo. If cramping after sex continues, schedule an appointment with your gynecologist to rule out any underlying medical conditions.

Meet the experts: Christine Greves, MD, is an ob-gyn at the Winnie Palmer Hospital for Women and Babies. Adeeti Gupta, MD, is an ob-gyn, sexual health expert, and CEO and founder of Walk In GYN Care. Iris Kerin Orbuch, MD, is an ob-gyn, endometriosis specialist, director of Advanced Gynecologic Laparoscopy Center in Los Angeles and NYC, and author of Beating Endo. Katharine O'Connell White, MD, is an associate professor of obstetrics and gynecology at the Boston University School of Medicine and the author of Your Sexual Health. Mindy Christianson, MD, is the medical director at Johns Hopkins Fertility Center and an associate professor of gynecology and obstetrics. Mary Jacobson, MD, a gynecologist and the chief medical officer of Alpha Medical. Kelly Culwell, MD, is an ob-gyn and nationally renowned women’s health expert who specializes in family planning.

Before you sound the alarm bells, know that cramping after sex does not always indicate a major medical issue or problem. Here are some of the common culprits, according to doctors.

14 Reasons Why You Feel Cramping After Sex

1. Orgasms

Before and during an orgasm, your heart rate, pulse, blood pressure, and breathing increase. "The muscle contractions that come with climax can sometimes cause pain," says Katharine O'Connell White, MD, an associate professor of obstetrics and gynecology at the Boston University School of Medicine and the author of Your Sexual Health. The muscles in your pelvic area contract, and these contractions can continue after sex has ended.

Post-orgasm cramps feel like tense spasms, but a few deep breaths and stillness will help the muscles in your body relax. Sex is physical, and your body needs rest after working.

2. Periods

Having sex while on your period can feel amazing, but given that your uterus is already working hard to expel menstrual blood, all that action and movement can add to and exacerbate your period cramps.

"For cramping that starts up (again) after intercourse, the treatments that work for cramping with your period will likely work for post-coital cramping too," says Dr. White. "Try a hot shower or bath (with or without your partner), or more targeted heat like from a heating pad or hot water bottle."

3. Anatomy

Some people are born with a uterus that’s tilted in a way where deep penetration hits the cervix and causes pelvic pain or cramping. Experimenting with different sex positions and vigor can help ease pressure and relieve cramps.

“Sometimes placing a pillow under your hips during a missionary position, or trying a sideways position which avoids thrusting pressure onto the cervix or the uterus can go a long way in avoiding sexual pain,” says Dr. Gupta.

4. IUDs

An intrauterine device (IUD) is a long-lasting birth control in the shape of a small, T-shaped, plastic device that is inserted into and left in your uterus. General discomfort is expected immediately after the insertion of an IUD. An increase in cramping, backaches, and even spotting are normal during your period and usually resolve within three to six months, according to the Winnie Palmer Hospital for Women and Babies.

However, the IUD should not interfere with sex or daily activities. If you experience extreme pain and cramping after sex with an IUD, you should check in with your doctor. They may need to check and make sure the contraceptive is in the right place, and if not, remove it safely to relieve the discomfort.

5. Ovarian Cysts

Ovarian cysts are fluid-filled sacs in the ovaries. They are normally harmless with little to no discomfort and disappear on their own. But a larger ovarian cyst can cause a dull ache in your pelvic area and can potentially rupture, especially with strenuous exercise or sexual activity. "[With] a burst (ruptured) ovarian cyst, the blood or fluid inside the cyst can be very irritating to the inner wall of your abdomen," says Dr. White. "The pain from a ruptured cyst is often sharp and stabbing."

If you feel a sudden, severe, and sharp pain after sex, contact your gyno immediately. They may ask you to keep track of your symptoms, prescribe some pain meds, or recommend surgery to remove the cysts.

6. Muscle Strain

Sex is meant to be enjoyed, but occasionally, too much sex can put a strain on your body. “Just like any other muscle in your body, you may have some discomfort after your uterus gets a workout,” Dr. Greves explains. It’s entirely possible to strain your uterus muscle, which can lead to soreness and cramps. If this sounds familiar, try easing up for a bit so your body can rest and recover.

7. Bowel Issues (IBS, Colitis)

A deep, dull, constant pain after sex could be related to an issue in your GI tract. Irritable bowel syndrome, which affects the large intestine, causes cramping, abdominal pain, bloating, and gas, and sex can make these symptoms worse. With colitis, inflammation of the colon causes urgent bowel movements and cramps that can be further intensified by sex. Talk to your doctor about the different treatments and medicine available to help ease the discomfort.

“Many women don't realize that the gut is a major culprit in sexual pain,” notes Dr. Gupta. Staying hydrated with water and taking probiotics to avoid constipation and bloating can go a long way.

8. Uterine Fibroids

Between 20 and 70 percent of women will develop fibroids, which are benign muscle tumors of the uterus, during their reproductive years, according to Johns Hopkins Medicine. And they’re almost always (99 percent of the time) harmless, says Mindy Christianson, MD, the medical director at Johns Hopkins Fertility Center and an associate professor of gynecology and obstetrics.

Some women have no symptoms at all and don't even know they have them. But other women can have very large ones or fibroids growing near the cervix, which can cause an enlarged uterus, increased and heavy bleeding, and abdominal pain, resulting in cramps after sex.

If you experience any of these symptoms, talk to your doctor, who can check for fibroids and suggest the correct treatment for you depending on the size and location. Treatments range from over-the-counter pain medication to surgery for more serious cases.

9. Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease occurs when sexually transmitted bacteria spread from your vagina to your uterus, fallopian tubes, or ovaries, according to the American College of Obstetricians and Gynecologists. If you experience a new pain in your lower abdomen and pelvis, an unpleasant vaginal odor, and pain or bleeding during or after sex, get tested for PID.

"When tissue is inflamed from an infection, the pressure of intercourse may irritate it more," says Dr. White. Sex can worsen PID and cause a dull pain in the lower belly. Antibiotics are usually needed for treatment.

10. Urinary Tract Infections (UTIs)

Ah, the infamous UTI strikes again. This common and usually harmless bladder infection combined with sex can cause a dull, cramping pain, per Dr. White. If you’re prone to UTIs and have cramps after sex, check in with your doctor. They can prescribe antibiotics to clear the infection.

11. Endometriosis

Pain after sex is one of the most common signs of endometriosis, a disease where tissue that grows on the uterus lining starts growing on areas outside of the uterus. A telltale sign of endometriosis is cramping pain after sex and extremely painful periods, says Dr. White.

"However, for others with endometriosis, they may also experience painful periods, painful ovulation, gastrointestinal symptoms, such as constipation, or diarrhea or bloating," adds Dr. Orbuch.

Treatments include hormone therapy and pain medicine, or surgical operations such a laparoscopy or a laparotomy. Immediately after sex, Dr. Orbuch recommends applying a heating pad to your abdomen or back, and assuming a child’s pose position while taking long, calming, relaxing breaths to temporize symptoms.

12. Adenomyosis

Adenomyosis is endometriosis found inside the outer, muscular walls of the uterus, explains Dr. Greves. This can lead to the uterus expanding in size, abdominal pain, and heavy periods. On top of that, having sex can lead to discomfort, cramping, or aching. If you have or think you have adenomyosis, consult your doctor for the right treatment for you, from pain medication to hormonal birth control to a hysterectomy.

13. Vaginismus

Vaginismus is involuntary contraction and tightening of the pelvic floor muscles which interferes with sexual intercourse. "In other words, vaginal cramping occurs before, during, and after sex. Vaginismus may preclude sexual intercourse," says Mary Jacobson, MD, a gynecologist and the chief medical officer of Alpha Medical.

Vaginismus has also been associated with a high risk of disruption of marital relationships, anxiety, depression, and low self-esteem.

"The ideal treatment for vaginismus must access the complex interplay amongst the biological, emotional, psychological and relational components of the person's and couples' lives," says Dr. Jacobson. It typically includes a combination of therapy and medications.

14. Inadequate Lubrication

There may be a number of reasons why your body is not creating enough natural lubrication, from a drop in estrogen levels postpartum to taking certain medications such as antidepressants, blood pressure meds, sedatives, antihistamines, and certain birth control pills.

To help, try using lubrication. There are many types of lube you can explore based on your preference, like water-based lubricant and lubes for sensitive skin—and even flavored options if you want to spice things up. Another major way to enhance your arousal before sex is to spend more time on foreplay.

How To Relieve Cramping After Sex

“Some home options for relief of cramps include heating pads or warm bath or shower," says Kelly Culwell, MD, a board-certified ob-gyn, and nationally renowned women’s health expert. "Some people might also find relief from over-the-counter pain medications like acetaminophen or Aleve. Certain positions, such as lying down on one side with your knees bent, may also relieve cramps.”

How To Prevent Cramping After Sex

Dr. Culwell suggests first taking note of how you're having sex and avoiding any specific activities that bring you discomfort. “Some people may notice more cramping after sex in certain positions, so paying attention to this and avoiding positions that are uncomfortable or cause pain after sex is important,” says Dr. Culwell.

Dr. Culwell says you will also want to make sure you have adequate vaginal lubrication from either sufficient foreplay and/or the use of water-based or silicone-based lubricants. “Lubrication can help prevent pain or difficulty with penetration, which can cause pelvic floor spasms or cramps in response,” she explains.

It may sound simple, but Dr. Culwell also recommends making sure you have emptied your bladder and that you're having regular bowel movements since pelvic cramping can originate in the bowels or bladder.

Another tip? Pay attention to your pelvic floor. “Pelvic floor physical therapy can also be a good option for women who have cramping after sex related to spasms of the pelvic floor muscles,” shares Dr. Culwell. “Pelvic floor physical therapists can help with muscle relaxation during physical therapy sessions and teach techniques to employ at home as well.”

When To See A Doctor For Cramping After Sex

Although cramping after sex can happen occasionally, it shouldn't become a regular thing. “If the cramping is severe and limits your activity after sex, is impacting your sex life, or if it occurs regularly—even if it is mild—you should see an ob-gyn for evaluation,” notes Dr. Culwell.

In some cases, cramps may be a sign of something more serious. “There may be a medical condition such as endometriosis or uterine fibroids that requires medical or surgical treatment," Dr. Culwell adds. "Or, if the cramping is related to the muscles of the pelvic floor, an ob-gyn can refer you to pelvic floor physical therapy.”

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