8 Reasons You Might Be Feeling Pain After Sex
If you've ever wondered why you're having pain after sex and what you can do about it, these common reasons might sound familiar.
In ~fantasy land~, sex is all orgasmic pleasure (and none of the consequences!) while post-sex is all cuddles and afterglow. But for many people with vaginas, pain after sex and general discomfort are surprisingly (and unfortunately) common.
"More than one-third of people will vulvas will experience pain after penetrative sex at some point in their lifetime," says Kiana Reeves, a Somatic sex expert and sex and community educator with Foria Awaken, a company that creates products intended to reduce pain and increase pleasure during sex. (Pssst: They make a pretty awesome lube/arousal oil that has weed in it.)
"So, so many many many people come to see me for that reason," agrees Erin Carey, M.D., a gynecologist who specializes in pelvic pain and sexual health at the UNC School of Medicine.
There's a surprising variety of possible reasons for having pain after sex. "But while there are many potential causes for painful intercourse, most of them can be remedied with treatment," says Reeves. Phew.
In order to resolve the pain, first, you have to understand the underlying cause. Here, experts break down the most common reasons you might experience pain after sex. (If any of these symptoms sound familiar, call your doc.)
1. You need a better warm-up routine.
During sex, it should never feel like you're trying to fit a square peg into a round hole. "Women can fit a 10 cm baby head through the vaginal canal without it tearing; it's pretty elastic," says Steven A. Rabin, M.D., FACOG with Advanced Gynecology Solutions, Inc in Burbank, California. For the vagina to become elastic, though, you need to be turned on. "It's part of the female sexual response," he explains.
If your body isn't adequately primed for sex, penetration might not be possible at all, or the over-tightness can lead to too much friction during sex, causing micro-tears in the vaginal wall. In this case, you might feel "a stingy, raw sensation internally" during sex, says Reeves.
Then, if the inside surface of your vagina feels raw or sore and in pain after sex, you may just need more foreplay and/or lube before attempting penetration. Instead of doing trial and error, Reeves suggests touching the labia pre-insertion. The firmer it feels to the touch, the more turned on you are. (Related: What Happens When You're Really Turned On)
It's worth noting that some women can only tolerate penetration after an orgasm because then the muscles are more relaxed and your body is more primed for entry, explains Dr. Carey. "Other women could have a high-tone [tight] pelvic floor and may need to learn how to relax the vagina before penetration," she says. Consider seeing a pelvic floor therapist who can give you exercises that will train those muscles to relax enough in order for penetration to 1) happen at all 2) happen without the excessive friction or pain mentioned above, she says.
Another possibility is chronic vaginal dryness, says Dr. Carey. If extra foreplay isn't helping, check with your doc. (See more: 6 Common Culprits of Vaginal Dryness).
2. You have BV, a yeast infection, or a UTI.
"These three issues can cause sexually active individuals a great deal of pain around sex and often unwarranted worry," says Rob Huizenga, M.D. an LA-based celebrity physician, sexual health expert, and author of Sex, Lies & STDs. While they're all super common, the pain that each causes during and after sex is a little bit different.
Bacterial Vaginosis (BV): When BV (an overgrowth of bacteria in the vagina) is symptomatic, it usually comes with a strong, fishy odor and thin, discolored discharge. Again, you may not ever want to have sex when your vagina smells off, but if you do… ouch! "It's going to cause inflammation to the vaginal mucosa, which is going to get further irritated from sex," explains Dr. Carey. "Any irritation in the pelvis can also cause the pelvic floor muscles to spasm in response." These spams can create a throbbing or pulsating sensation that's uncomfortable and leaves you with pelvic pain after sex. Fortunately, BV can be cleared up with a prescription from your doctor.
Yeast Infection: Caused by the candida fungus, yeast infections often present with "cottage cheese" discharge, itching around the pubic area, and generalized soreness in and around your nether-bits. Basically, sex and yeast infections are about as compatible as Ariana Grande and Pete Davidson. So, if you find yourself doing the dirty when you have one, it's probably going to be uncomfortable. "Because yeast infections cause the localized tissue in the vagina to become inflamed," explains Dr. Carey. Combine the friction of penetration with the preexisting inflammation, and it'll certainly exacerbate any pain or irritation. In fact, Dr. Barnes says the inflammation can be on the inside or the outside, so if your labia look redder after the fact, that's why. Thank u, next. (Pro tip: follow this Step-By-Step Guide to Curing a Vaginal Yeast Infection before heading South.)
Urinary Tract Infection (UTI): A UTI happens when bacteria gets lodged in your urinary tract (the urethra, bladder, and kidneys). Granted, you're probably not going to be in the mood if you have a UTI, but if the opportunity comes knocking and you chose to partake, it's going to feel less than amazing. "The bladder lining gets irritated when you have a UTI, and because the bladder lies on the front wall of the vagina, penetrative intercourse can agitate an already irritated area," explains Dr. Carey. "As a result, the pelvic floor muscles, (which surround the vagina and bladder), can spasm, resulting in secondary pelvic pain after sex." Luckily, an antibiotic can clear the infection right up. (Related: Can You Have Sex with a UTI?)
3. You have an STI or PID.
Before you freak out, know that "STI's are not known for causing pain during or after sex," according to Heather Bartos, M.D., an ob-gyn in Cross Roads, Texas. Still, some STI's may lead to pain after sex, especially if they go undetected and untreated for a long time.
Herpes is the STI most classically associated with pain, says Dr. Bartos. "It can present with painful genital or rectal ulcers, sores, or skin breaks that can be extremely painful and uncomfortable not only during and after sex, but also in regular life." All experts offer the same advice: If you're in the middle of a herpes outbreak, don't have sex. Not only do you risk transmitting the infection to your partner, but sex can cause those external sores to open or enlarge and become even more tender until they heal. (Related: Here's How to Get Rid of a Cold Sore In 24 Hours). Plus, since the herpes virus lives in the nerves, it also results in chronic nerve pain, says Courtney Barnes, M.D., an ob-gyn with University of Missouri Health Care in Columbia, Missouri.
Other STI's like gonorrhea, chlamydia, mycoplasma, and trichomoniasis can also lead to pain during and after sex if they've developed into pelvic inflammatory disease (PID), says Dr. Huizenga. "It's an infection of the reproductive tract and gut—specifically the uterine, tubal, ovarian, and intra-abdominal lining—that causes them to be inflamed." A hallmark sign of PID is what doctors call the "chandelier" sign, which is when barely touching the skin above the cervix causes pain.
Sex or not, "people can actually become quite ill from this disease as it progresses; it can cause significant abdominal pain, fever, discharge, nausea/vomiting, etc. until it's treated," says Dr. Barnes. The solution? (Bless, there is one!) Antibiotics. (Note: Any vaginal bacteria can ascend and cause PID, not just sexually transmitted infections, so don't jump to conclusions—unless, of course, you're experiencing other symptoms of STIs.)
And friendly PSA: Most STI's are asymptomatic (like these Sleeper STDs You're at Risk For), so even if you're not experiencing the symptoms mentioned above, don't forget to get tested every six months, or between partners, whichever comes first.
4. You're having an allergic reaction.
If your vagina feels irritated or raw, swollen, or itchy after intercourse (and that goes internally or externally), "it could be an allergy or sensitivity to your partner's semen, the lubricants, or the condom or dental dam," says Dr. Carey. Semen allergies are rare (research shows only 40,000 women in the US are allergic to their SO's semen), but the solution here is to use a barrier to avoid exposure, she says. Makes sense. (Related: Should You Be Using Organic Condoms?).
On the other hand, according to Reeves, latex allergies and sensitivities to your lube or sex toy are pretty common. If you have a latex allergy, there are animal skin condoms or other vegan options, she says.
As for lubes and toys, if there are any ingredients you can't pronounce, just say no! "Generally, water-based lubricants are less irritating," says Dr. Carey. "Some women who are particularly sensitive will use natural oils such as olive oil or coconut oil as a lubricant during intercourse." Just note that the oil in these natural options can break down the latex in condoms and make them ineffective. (Related: How to Tell If Your Sex Toys Are Toxic).
If none of these solutions appeal to you, you can visit an allergist for allergy skin testing to see what the exact allergen is, says Dr. Bartos. (Yes, they can even do this with semen, she says.)
5. You have vaginismus.
For most women and folks with vaginas, when something—be it a tampon, a speculum, finger, penis, dildo, etc.—is about to be inserted into the vagina, the muscles relax to accept the foreign object. ("Alexa, relax vaginal muscles.") But for people with this little-known condition, the muscles aren't able to relax. Instead, "the muscles have involuntary contractions which tighten the entry to the point where penetration is either impossible or downright painful," explains Dr. Rabin.
Even after attempted penetration, the vagina can tighten and clench in anticipation of more pain, explains Dr. Barnes, which in itself can be painful and lead to prevailing muscular soreness, not to mention cause lasting pain after sex. (Related: The Truth About What Happens to Your Vagina if You Haven't Had Sex in a While).
There isn't one cause of vaginismus: "It could be caused by a soft tissue injury from sports, sexual trauma, childbirth, inflammation in the pelvic floor, infection, etc.," explains Reeves.
It's often thought to part psychological and physical (as most things are!). "It's like the vagina is trying to 'protect' the person from further trauma," says Dr. Bartos. That's why she and Reeves recommend seeing a trauma-trained pelvic floor physical therapist who can work with you release these muscles and address the underlying cause, if there is one. "I suggest a hands-on sex and pelvic floor therapist, if you can find one," says Reeves.
6. Your ovarian cysts are bugging you.
Ready to have your mind blown? Every vulva-owner of reproductive age who's not on birth control makes an ovarian cyst during ovulation every single month, explains Dr. Carey. Woah. Then, these cysts rupture to release the egg without you ever knowing one was hanging out in there.
However, sometimes these fluid-filled sacs cause pain—specifically in the right or left side of the abdomen, where the ovaries are. (Hellooo, cramps!) According to experts, there are three main reasons why.
First, the actual rupture might cause an uncomfortable ache or abdominal pain. Second, while the fluid from the popped cyst will get reabsorbed by the body within a few days, "it can cause irritation of the pelvic peritoneum (the thin membrane that lines the abdomen and pelvis) making your vaginal canal sensitive, and intercourse painful before it's fully absorbed," says Dr. Carey. In both cases, you may have pain before, during, and after sex. But don't think "well, if it's going to hurt anyway, I might as well" because, having sex "can cause an inflammatory response in the pelvis which often leads to worse pain after sex," she explains.
Knowledge is power here: "Every month, you'll know that there's a day or two where sex in a certain position might hurt," says Dr. Rabin. "Make an adjustment and change the angle of attack." Or, just leave sex for the other 29 days a month. (Related: This Actress Was Hospitalized for a Ruptured Ovarian Cyst).
Sometimes though, these cysts don't rupture. Instead, "they grow and grow and become painful, especially during penetration," explains Dr. Rabin. And, yep, they can cause pain after sex, too. "The penetration causes a blunt trauma inside you that hurts even after the fact."
Your ob-gyn can perform an ultrasound to diagnose whether or not that's actually what's causing your pain. From there, "they can be monitored, or you can go on a birth control pill, ring, or patch," he says. Occasionally, he says, they may require surgical intervention. While this news sucks and nobody likes thinking about going under the knife, think about all the pain-free sex you can have after!
7. You have endometriosis.
Chances are, thanks to Julianne Hough and Lena Dunham sharing their struggles, you've probably at least heard of endometriosis—if not know someone who suffers from it. ICYDK, it's a condition where "menstrual tissue cells implant and thrive elsewhere in the body—typically in your pelvis (such as the ovaries, Fallopian tubes, intestines, bowels, or bladder)," explains Dr. Rabin. "This misplaced menstrual tissue swells and bleeds, causing an inflammatory response and sometimes scar tissue." (See more: The Endometriosis Symptoms You Need to Know About).
Not everyone with endometriosis will experience pain during sex or pain after sex, but if you do, inflammation and/or scarring are usually the culprits. By now, you know inflammation=pain, so it shouldn't be surprising that's why there's pain during and/or after sex.
But, "in some severe cases, the scarring response is extensive, and penetrative intercourse can create a sensation that the vagina, uterus, and surrounding pelvic organ are being pulled," says Dr. Barnes. And if that's the case, she says the pain—which could include anything from slight soreness to an internal stabby sensation or burning—can linger after sex too. Ugh.
For some patients, sex and its aftermath will only be painful around their menstrual cycle, says Dr. Carey, but for some folks, sex is painful every day of the month. "Endometriosis doesn't currently have a cure, but the next step is to see a physician who understands the pathophysiology of the disease because medication and surgery can help manage symptoms." (Related: How Much Period Pain Is Normal).
8. You're going through some ~hormonal changes~.
"During menopause and right after you've given birth, there's a decline in estrogen," explains Reeves. A decrease in estrogen leads to a decrease in lubrication. ICYDK, when it comes to sex, the wetter the better. So, this lack of lube can result in less pleasant sex and pain after sex, since your vaginal canal may actually feel raw and chafed. Dr. Carey says the best fix here is a combination of lube and vaginal estrogen therapy.
The bottom line: Sex is *not* supposed to be painful, so if you're experiencing pain after sex, talk to your doctor about it. "Figuring out the exact cause of pain after sex may take a little bit of patience because there are actually so many other possible causes of painful intercourse," on top of those already discussed says Dr. Barnes. Some less-common reasons include lichens sclerosis (a common genital skin condition in post-menopausal women), vaginal atrophy (the thinning, drying, and inflammation of the vaginal walls that occurs when your body has less estrogen), thinning of the vaginal walls, internal scarring or adhesions, Interstitial Cystitis (a chronic bladder pain condition) or even a disruption of vaginal flora—but your doc should be able to help you figure out what's up.
Remember though, "in most, cases treatment is available and can help make sex enjoyable again!" says Dr. Barnes.
"So many women experience pain during and after sex, but don't know that isn't a normal thing," adds Reeves. "I wish I could tell everyone that sex should only be pleasurable." So, now that you know, spread the word. (Oh, and FYI, you also shouldn't be experiencing pain during sex, either).