Pelvic Pain After Sex: Why and What To Do

Pain with sex, often referred to in the medical world as dyspareunia, can feel and present differently depending on the person. The pain may occur at entry, with deeper penetration, afterwards, during certain positions, or any combination of these. When the pain is specifically after sex, this may be called postcoital pain.

Strategies to decrease or eliminate this pain are dependent upon why it is occurring in the first place. By determining the root cause through pelvic floor therapy and medical team collaboration, your pelvic pain during or after sex can be more optimally treated to make sure sex is both pleasurable and comfortable--during and after!

What Causes Pelvic Pain After Sex?

Pelvic pain after sex can occur for a number of reasons, which may include one or several of the following:

• Vaginal dryness or lack of lubrication

• Body position

• Pelvic floor dysfunction

• Endometriosis

• Fibroids

• Ovarian cysts

• Infections (yeast, UTIs, bacterial vaginosis)

• Psychological factors

What Do I Do to Relieve Pain After Sex?

First line strategies to curbing pelvic pain after sex may include:

• Increase lubrication with a clean lubricant, applying to self and/or partner or toy as applicable

• Consider a vaginal moisturizer outside of intercourse

• Try out alternative positions and communicate with your partner about what feels the most comfortable (during and after)

• Consider adding vibration into the mix

• See if increased foreplay assists in arousal and lubrication

If this does not quite give you the relief and comfort you deserve, your pelvic floor as well as other medical concerns may be contributing to this pelvic pain. Pain after sex should not be written off as "normal" and there are options that can help you. For optimal pain relief, treatment from and collaboration between a pelvic floor therapist and your healthcare professional is essential for a path forward towards relief from pain after sex.

When to Go to the Doctor for Pain After Sex?

There are times when pelvic pain after sex warrants additional medical intervention by a gynecologist or related medical professional, such as when it is accompanied by any bleeding, fever, unusual discharge, or worsening of symptoms. This is important for ruling out infections, such as yeast infections, urinary tract infections (UTIs), or bacterial vaginosis.

Vaginal dryness or irritation that may be due to hormone fluctuations after childbirth, when breastfeeding, during peri-menopause or menopause, or as a result of contraceptive or birth control methods may require vaginal estrogen that is applied internally or around the vaginal opening. When this is the case, it should be discussed with your gynecologist for an appropriate prescription and use as it applies to you.

When pelvic pain after sex is due to suspected endometriosis, ovarian cysts, fibroids, or interstitial cystitis/bladder pain syndrome, diagnostics can be performed by a gynecologist or urogynecologist and treatment may or may not include medications or surgical measures in conjunction with pelvic floor therapy.

How Does Pelvic Floor Therapy Help Pelvic Pain After Sex?

When the cause of your pain after sex is more related to an infection, endometriosis, cyst, or fibroid, pelvic floor therapy helps instrumentally in conjunction with treatment by your healthcare provider. There may be additional contributors to pelvic pain after sex that are more muscular, nerve, scar tissue, or circulation-based, which pelvic floor therapists are well experts in supporting. 

It is common for what once was a recurrent infection issue or suspected infection to lead to increased pelvic floor tension, which becomes a driver, or additional contributor, to pelvic pain. Inversely, pelvic floor muscle tension is often a culprit for why the vulvovaginal tissues are not receiving the appropriate circulation, hormones, oxygen, and nutrients they need to maintain a healthy, pain-free homeostasis.

Pelvic floor therapy can help pain after sex by:

• Decreasing tension in pelvic floor muscles during hands-on manual therapy and supporting you with how to carry this over in your daily life

• Improving mobility in scar tissue related to vaginal tearing, endometriosis excision, ovarian cyst removal, or scar tissue removal

• Freeing up myofascial restriction related to tense pelvic floor, abdominal, or related muscles

• Providing recommendations for body position with intercourse based on your anatomy and concerns

• Helping you to understand which lubricant or vaginal moisturizer may be best for you

• Screening for if a consultation with a physician regarding vaginal estrogen may be warranted

• Creating a whole-body home exercise program while taking into account your body mechanics and concerns (i.e., exercises, stretching, pelvic wand or dilators as applicable depending on your presentation and concerns)

• Collaborating with your healthcare provider(s) on any related concerns that require medical management

If you have been to a medical professional and found that you did not receive clear answers or a way forward, consider discussing your concerns with a pelvic floor therapist at a practice that commonly works with individuals experiencing pelvic pain concerns. 

At Bloom Pelvic Therapy, we have a network of healthcare providers that we often work hand-in-hand with when healing pelvic pain through a collaborative approach. We know that it is often not just "one thing" contributing to pelvic pain after sex and are here to support you in identifying the root cause, addressing the issues, and getting you back to feeling confident and comfortable with all aspects of intimacy.

We work with clients experiencing pelvic pain and related concerns regularly and are here to support you in getting the relief you deserve.