We often talk about the pleasure that sex gives us—how good it feels; how relaxing it can be—however, we don’t often talk about sex-related pain. Women’s sexual pain is underreported, so it can be difficult to estimate how many suffer from post-sex abdominal pain and cramping. But medical experts reassure us about two things: 1) You’re definitely not alone, and 2) There’s usually always a way to get to the bottom of it and fix it.
The causes of post-sex cramping and pain can often differ from the things that cause pain during sex, says Lauren Streicher, MD, medical director of Northwestern Medicine’s Center for Sexual Medicine, clinical professor of obstetrics and gynecology at Northwestern University’s medical school, The Feinberg School of Medicine, and author of Sex Rx: Hormones, Health, and Your Best Sex Ever. Though sometimes, they can be related.
We asked medical experts to explain some of the reasons people may experience abdominal pain and cramping after sex and what to do about it.
If it happens rarely, it’s likely just a muscle cramp
During an orgasm, the muscles in the pelvic floor—the muscles that support the pelvic organs, including the uterus, bladder, and rectum—tense up and then release. “That release is part of the pleasurable feeling of an orgasm,” says Dr. Streicher. But just like any other muscle, these areas can cramp up and not fully release, which can cause a dull cramping sensation after sex.
The uterus can also cramp up if it’s being hit repeatedly, says Susan S. Khalil, MD, director of sexual health at Mount Sinai Health System and assistant professor of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine. Often times it’s positional: Certain positions, like doggie style or woman on top, can lead to deeper penetration than normal, hitting the uterus in a way that’s a bit uncomfortable and causes it to tense up and cramp, says Dr. Khalil.
It may also be that time of the month
As if you need another reason to be annoyed by your monthly period, it could cause you to be more prone to abdominal cramping after sex. “Some women are more sensitive during different points in their menstrual cycle, specifically leading up to it,” says Dr. Khalil. Extra poking and prodding and pressure in sensitive areas can leave you feeling crampy for a bit afterward. In this case, you’d be able to notice a monthly trend for when you experience post-sex cramping and pain.
Cramping can also be a sign of a bowel issue
Bowel issues like irritable bowel syndrome (IBS) or Crohn’s disease can also cause post-sex cramping, says Dr. Streicher. This is more so because chronic bowel issues can impact the function of the pelvic floor muscles over time, leading to tensing and cramping that doesn’t fully release when it’s supposed to. For some people, though, something as simple as severe constipation can make them tense up during sex and experience abdominal cramping afterward, she says. If that’s the case, treating and clearing out the constipation could resolve the issue and get rid of any sex-related discomfort.
Delmaine Donson/Getty ImagesYour pelvic floor may not be working optimally
“For 90 percent of women who have pain during and after sex, pelvic floor dysfunction is [a part] of it,” Dr. Streicher says. “What happens is that initially, you may have pain for some other reason, and it very quickly will turn into a pelvic floor dysfunction.” When sex is uncomfortable or painful, the muscles in and around your vagina react and tense up, basically to stop you from having sex. Over time, the muscles learn to stay tense and don’t release [as] they should. “They are in protective mode and we have to re-educate those muscles and teach them that you are going to have something in your vagina and it’s not going to hurt,” she says.
There are a lot of things that can cause discomfort and ultimately lead to pelvic floor dysfunction—from dryness to stress to a more serious medical problem. A lot of things may not start out as a pelvic floor problem, but eventually turn into one, Dr. Streicher notes. The good news is that since it’s a learned problem, it can also be unlearned with pelvic floor physical therapy, she says. (And, of course, figuring out what caused the pain in the first place.) Check out the 10 silent signs you have a pelvic floor disorder.
Uterine fibroids and ovarian cysts can also cause abdominal pain
Sometimes, post-sex cramping can be caused by a uterine fibroid or ovarian cysts, says Dr. Khalil. Fibroids are benign growths in the uterus that are common and often asymptomatic. Many women with fibroids never know they have them. But when they are symptomatic, they can cause pelvic pressure or pain and constipation, both of which can lead to uncomfortable post-sex cramping. Cysts are fluid-filled sacs that grow in or on the surface of the ovaries. Like fibroids, cysts are common and often don’t cause any symptoms or problems, but an especially large cyst can cause pelvic pain and fullness or heaviness in the abdomen.
Frequent post-sex pain may also be a sign of a more invasive issue
If you feel pain every time or most times you have sex, it may be a sign of a medical issue that needs attention.
Endometriosis is a condition where tissue that is similar to the the type lining the uterus starts to grow in other places in the pelvic area, says Dr. Khalil, who runs a pelvic pain clinic. “Sometimes it infiltrates the nerve supply in the pelvis or the ovaries and with movement, it triggers a painful cycle,” she says. “For some women, it’s sharp pain; for some, a dull, aching sensation.” Endometriosis could be anywhere in the pelvic area, but it’s primarily in the lower abdomen, and some patients have it in one side or the other, says Dr. Khalil. Some people may even have this tissue growing on their colon or bladder.
Other conditions that can cause post-sex pain are adenomyosis, which is when the uterine tissue grows in the wall of the uterus, and certain pelvic infections, says Dr. Streicher.
Past trauma may also play a role
Sometimes, pelvic pain after sex can be completely unrelated to the physical act and more due to the result of past sexual trauma. Trauma presents in many delayed forms, Dr. Khalil notes, and many people may not connect that current sexual discomfort is related to something that happened in the past. It may happen only in certain situations that are triggering, or it may happen every day and be debilitating, she says. If there’s a psychological basis for sex-related pain, your gynecologist can be a great starting point and help you find psychological support and care when it’s warranted. (Here are 12 steps than can help you heal from a traumatic experience.)
If you experience post-sex abdominal cramping and pain often, or if it lingers for a few hours, talk with your doctor
Both Dr. Streicher and Dr. Khalil say that generally, if you experience abdominal cramps and pain after sex every once in a blue moon, it’s not something to worry about. Using a heating pad and taking NSAIDs like ibuprofen or naproxen may help ease the discomfort. But if it happens more times than not, you feel a sharp pain during or after sex, and/or your symptoms last longer than a couple of hours, you should see a doctor to figure out what’s going on. (See a doctor immediately if you experience sudden sharp abdominal pain, as it can be a sign of ovarian torsion, says Dr. Khalil. It’s rare, but requires immediate medical attention.) Regular or persistent post-sex abdominal cramping and pain is usually a sign that something’s off, and your doctor can help you sort it out and figure out the cause so that you can properly treat it and be able to enjoy sex without worrying about that nagging discomfort.