Are you worried why you have mild or severe pain after sexual intercourse? Do you feel severe pain during sexual intercourse? Are you concerned cramps after sex may be due to vaginal infections or a serious health issue?
Vaginal intercourse should be enjoyed and be a way to express your feelings. However, it’s possible you may sometimes experience some discomfort after intercourse.
Pain after sexual intercourse can sometimes occur in women; though persistent vaginal or lower abdominal pain may indicate something more serious. Ongoing pain during or after sex (called dyspareunia) is common but not something you should ignore, and it’s important to tell your doctor or nurse if it keeps happening. Patient+1
Some possible causes of severe cramps after sexual contact are endometriosis, vaginal infections, pelvic inflammatory disease (PID), ovarian cysts, uterine fibroid, and, rarely, more serious conditions such as ovarian cancer.
Nevertheless, pain after sexual intercourse may also be due to pressure symptoms, lack of sexual appetite, psychological perception of pain, pelvic floor muscle tension, or inadequate vaginal lubrication. If your vagina is not well lubricated, it could result in tear, bleeding, and pain after intercourse.
During pregnancy, cramps may also occur either during or after intercourse. Mild cramps that settle quickly are usually not harmful, but severe pain, heavy bleeding, or pain that does not go away should be checked urgently.
The truth is most common causes of cramps after sexual intercourse may not mean a serious medical issue. SO DON’T PANIC. But if the pain is severe, keeps coming back, or you notice other worrying symptoms (fever, abnormal discharge, heavy bleeding, dizziness), you should see a doctor.
This article explains the possible causes of cramps after intercourse and when to worry.
What causes cramps after sex?
If you are currently having cramps during or after intercourse, here are the possible causes.
1. A rough sexual intercourse
Sometimes, sexual intercourse can get very rough; this may result in a vaginal tear or slight trauma to your cervix.
The uterus is made up of different parts. The body of the uterus houses a baby if you get pregnant. The neck of the uterus (which is medically referred to as the cervix) connects the vagina to the uterus.
Depending on when you have sexual intercourse during your menstrual cycle, your cervix may be hard, soft, high, or low down in your vagina.
A low-lying cervix means you can comfortably feel the cervix down in your vagina, while a high cervix may be difficult to feel or high up in your vagina.
Your menstrual cycle is made up of 2 parts. The first part occurs before ovulation, while the second part of the menstrual cycle occurs after ovulation has occurred.
During the first part of the menstrual cycle and after your period ends, it’s normal for your cervix to be lower in your vagina and firmer. Having sexual intercourse at this time may cause pain when your partner’s penis hits the cervix.
During ovulation, which occurs when your ovaries release an egg, your cervix gets softer and higher up in your vagina. Some women may notice less cervix-related pain at this time, but others can still have cramps or one-sided ovulation pain.
Also, just before your period begins, your cervix will be low and firm again and may result in pain.
Other reasons cramps may occur are reduced sexual arousal, poor vaginal lubrication, tension or anxiety about sex, and fear of pain.
2. You had an orgasm
It is possible you are having cramps due to an orgasm. If you had an orgasm, it’s not abnormal to feel mild discomfort and cramps in your lower abdomen. This is caused by rhythmic contractions of the uterus and pelvic muscles.
Some women may have mild pain that will last for few hours. Nevertheless, it’s not normal that you have severe cramps for days. If cramps are very painful or last longer than a day or two, see your doctor.
3. Endometriosis
Women who have endometriosis may complain of different problems; pain after sexual intercourse is one of them.
Endometriosis means tissue similar to the uterine endometrium, which is the blood-thickened layer that covers the inner surface of the uterus, is found in other parts of the body (for example, on the ovaries, ligaments, or inside the pelvis). ACOG+1
Commonly, endometrial tissues can be found on the ovaries; though they can be seen in the abdomen, broad ligaments and, rarely, in the vaginal wall.
Symptoms of endometriosis are
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Severe lower abdominal or pelvic pain that often worsens around your period and may become more constant over time.
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Severely painful menstrual cramps that occur days before your period will start.
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Severe painful intercourse.
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Pain while urinating or opening your bowels, especially around your period.
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Increased frequency of urination.
If you are currently having these symptoms, it’s possible you have endometriosis. Chances are higher if your mother or sister was diagnosed with the disease. Up to 1 in 10 women of reproductive age are thought to be affected worldwide. ACOG+1
What to do?
It’s important you talk to your doctor about possible reasons you have pain down there and in your lower abdomen.
If you’ve also been experiencing severe painful periods and sexual intercourse, your doctor may request an ultrasound and sometimes a laparoscopy (a small camera to look inside your abdomen).
Sometimes, it’s possible to identify an endometriosis mass during your clinical examination.
If your doctor thinks you have endometriosis, you may be placed on pain relief medications, hormonal treatments (like combined oral contraceptives or progestogen-only methods), or sometimes surgery to ease symptoms. There is currently no simple cure for endometriosis, but symptoms can often be managed very well. ACOG+1
You can read more in this patient-friendly guide from ACOG on endometriosis.
4. You are ovulating
Ovulation occurs during your menstrual cycle. It is the release of an egg from your ovaries. In fact, if you do not have ovulation, it’s impossible to conceive.
During ovulation, women may experience vaginal or lower abdominal pain; however, this only lasts for a few hours or days and occurs about two weeks before your next period.
Low abdomen pain for days to weeks may mean something more serious.
Other signs of ovulation are
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Occasional brownish colored discharge a week after your period ends.
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Mild abdominal pain which is more on one side of your abdomen.
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Breast pain.
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Tightening, distended and painful abdomen (bloating).
5. You have pelvic inflammatory disease (PID)
Vaginal and cervical infections are usually caused by germs such as chlamydia and gonorrhea that are passed on during unprotected sexual intercourse, rather than “poor hygiene”. If these infections are not treated, they can spread upwards and cause pelvic inflammatory disease (PID), which is an infection of the womb, fallopian tubes and ovaries. nhs.uk+1
Gonorrhea, chlamydia and trichomonas infections are commonly transmitted through unprotected sexual intercourse. This implies that if you do not practice safe intercourse, you may have an infection.
One easy way to tell if you have an infection is the way your vaginal discharge smells or looks. Most women will have whitish discharge from their vagina that is without odor.
A smelly discharge that is yellowish or greenish in color is abnormal and often due to an infection.
If vaginal infections such as chlamydia or gonorrhea are left untreated for weeks or months, they may cause inflammation of the uterus, fallopian tubes, and surrounding tissues. This is called pelvic inflammatory disease and may cause lower abdominal cramps after sexual intercourse.
Other symptoms of PID are
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Pain after sexual intercourse.
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Difficulty in getting pregnant.
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Ectopic pregnancy if fallopian tubes are affected.
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Pain while urinating.
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Abnormal smelly odor down there.
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Long-term low abdomen or pelvic pain.
What to do?
If you experience these symptoms with severe cramps after intercourse, you should inform your doctor. Vaginal and cervical infections can usually be treated with antibiotics, and your partner may also need treatment. nhs.uk+1
However, treatment delays may result in damage to your fallopian tubes. This can lead to infertility or an ectopic pregnancy in the future.
You can read more about pelvic inflammatory disease (PID) on the NHS.
6. You have a large fibroid
Uterine fibroids are well-known to be common among women of reproductive age. They are non-cancerous tumors that grow on the uterus. Uterine fibroid may be located within the wall of the uterus (interstitial fibroid) or beneath the endometrium (submucous fibroid). ACOG+
It’s also possible you may have a cervical fibroid, where the fibroid mass grows in the cervix. This may result in pain during intercourse.
In some women, fibroid will be very huge, extending into the cervix. This may lead to a painful sexual experience and low abdomen cramps.
If you have a fibroid, you may experience any of these symptoms
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Mass or swelling of your belly (if fibroid is huge).
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Heavy persistent vaginal bleeding or bleeding between periods.
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Cramps after intercourse.
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Frequent urination with occasional constipation.
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Prolonged menstrual periods that last for more than seven days.
What to do?
Depending on the location and size of a fibroid you may not have any symptoms at all. However, if you have these symptoms, you should talk to your doctor.
In some people, certain fibroids can be associated with difficulty getting pregnant or miscarriage, especially if they distort the cavity of the womb, but many women with fibroids still conceive and have healthy pregnancies. Treatment depends on your symptoms, size and location of the fibroid, and whether you want future pregnancies. Mayo Clinic+1
You can read more in this FAQ on uterine fibroids from ACOG.
7. You have an ovarian cyst
If you are having cramps after sexual activity, it could be due to an ovarian cyst.
The female reproductive system is made up of the uterus and two ovaries on both sides – the right and left ovaries.
During a normal cycle, a fluid-filled follicle grows on the ovary, then releases an egg. Sometimes these follicles or the corpus luteum can fill with fluid and form a functional cyst. Many of these cysts cause no symptoms and disappear on their own. Mayo Clinic+1
A lot of women will have had a cyst in their lifetime without even knowing. This is because an ovarian cyst is usually harmless with no symptoms at all.
Most common symptoms you may experience are a dull ache or pain in the lower part of your abdomen, which may worsen after sexual activity or exercise.
Other symptoms of ovarian cyst are
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Bloated abdomen or feeling of fullness.
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Nausea or vomiting.
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Pelvic pressure.
You should know that, though ovarian cysts are mostly harmless, a large cyst may twist your ovary (ovarian torsion) or rupture. This can cause sudden, severe abdominal pain, dizziness, or fainting and is an emergency. Mayo Clinic
What to do?
Talk to your doctor. It’s sometimes possible to feel an ovarian cyst during a clinical examination, but diagnosis is usually confirmed with an ultrasound.
You can read more about ovarian cysts from Mayo Clinic.
8. You are having sexual intercourse for the first time
In young girls and women who have never had intercourse, the vaginal opening is covered partly by a hymen.
During your first intercourse, the hymen may break open with severe discomfort and sometimes vaginal bleeding.
Within the first few months and years after losing your virginity, pain during intercourse will usually subside as you and your partner learn what feels comfortable and as your body adapts.
However, if pain is severe, you cannot tolerate penetration, or bleeding is heavy or keeps returning, you should see a doctor to rule out other causes such as vaginismus, infections, or skin conditions. Patient+1
9. Your vagina is unfriendly to intercourse
Normally, you should get wet when stimulated or aroused. This is due to secretions from the Bartholin’s glands and vaginal tissues located on the sides of the vaginal wall.
When aroused, the Bartholin gland will secrete a whitish fluid that helps lubricate your vagina and prevent vaginal tear during intercourse.
However, this may not occur for some reasons. Women with low body estrogen, hormone imbalance, breastfeeding, some medications and perimenopause or menopause will experience vaginal dryness. Royal Berkshire NHS
What to do?
It’s important you discuss with your partner on the need to get wet before intercourse. This can be achieved through adequate foreplay, water-based or silicone-based lubricants, and other techniques listed here. If dryness is persistent or happens after menopause, your doctor may also discuss vaginal moisturisers or hormone treatments.
You can read more about causes of pain having sex (dyspareunia) on Patient.info.
10. During pregnancy
If you are pregnant, you may get very concerned when you get cramps after intercourse.
When pregnant, women may experience low abdominal cramps that occur due to uterine contractions during an orgasm. Mild cramps and a little spotting that settle within a day are usually harmless and do not mean you will miscarry. Mayo Clinic
However, you should talk to your doctor or midwife urgently if:
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The pain is severe or keeps getting worse.
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You have heavy bleeding like a period or passing clots.
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You feel dizzy, faint, or unwell.
Treatment of cramps after sexual intercourse
Depending on the cause, you are better off talking to a specialist close to you. Do not ignore severe or persistent pain, and do not keep taking painkillers without finding out the underlying problem.
Uterine fibroid, endometriosis, ovarian cysts, cancer, and vaginal infections will require further investigations.
Sometimes, a large fibroid or endometriosis mass may need surgery. Likewise, vaginal swabs (and sometimes cultures) are necessary for a suspected vaginal infection or sexually transmitted infection.
Most commonly, you have an important role to play. Talk to your partner, use a condom to reduce the risk of sexually transmitted infections and unwanted pregnancy, and get a suitable lubricant if dryness is a problem.
Proper vaginal lubrication and gentle, well-communicated intercourse will prevent pain during penetration and after sexual intercourse in many women.
You should seek urgent medical help (emergency department or urgent care) if you:
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Suddenly develop very severe lower abdominal pain, especially on one side.
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Feel dizzy, faint, or have a racing heartbeat.
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Have fever or feel very unwell.
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Have heavy vaginal bleeding after sex, especially if you might be pregnant. MSD Manuals
Dr Akatakpo Dunn is a Nigerian medical doctor, sonologist and Medical Director of Verah Clinic & Maternity in Warri, Nigeria. He holds an MBBS from the University of Nigeria, Nsukka, a Postgraduate Diploma in Diagnostic Ultrasound (India) and a Professional Diploma in Obstetrics & Gynaecology (RCPI). Through Medplux, he explains women’s health, pregnancy, fertility and ultrasound in clear, practical language so readers can make informed decisions with their own doctors.
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