Pain during sex, medically known as dyspareunia, occurs more often than many women realize, and it is not something to dismiss or push through. While it can stem from temporary causes like insufficient lubrication, recurring pain during intercourse can be a sign of an underlying condition that deserves medical attention. Possible causes of painful intercourse include vaginal dryness, infections, pelvic floor dysfunction, adenomyosis, endometriosis, ovarian cysts, and uterine fibroids.
Understanding what is causing your pain is the first step toward finding relief.
What Does Pain During Sex Feel Like?
Pain during sex can show up in different ways depending on the underlying cause, and recognizing what you are experiencing can help guide an accurate diagnosis.
Common types of pain during sex include:
- Sharp or stabbing pain: Often occurs during initial penetration or at the vaginal opening due to vaginal dryness, infections, pelvic floor muscle dysfunction, or irritation of sensitive tissues.
- Deep pelvic pain or pressure: Common with conditions affecting the pelvic organs, including uterine fibroids, endometriosis, adenomyosis, or ovarian cysts.
- Burning or irritation: May result from vaginal dryness, skin conditions, yeast infections, bacterial vaginosis, or sexually transmitted infections (STIs).
- Cramping during or after sex: Can develop while having sex or shortly afterward, and is usually linked to fibroids or adenomyosis.
- Lingering soreness: Persistent discomfort after sex is associated with deeper pelvic conditions and should be evaluated if it continues to occur.
The location, timing, and type of pain during sex often provide important clues about what’s causing it.
What Causes Pain During Sex in Women?
Where the pain occurs during sex in females, when it happens, and what other symptoms accompany it all point toward different underlying causes. Some of the most common include:
Some causes of pain during intercourse include:
- Uterine fibroids: These noncancerous growths, depending on their size and location, can place pressure on the uterus, cervix, and surrounding pelvic organs, leading to deep pelvic discomfort and painful sex.
- Endometriosis: An issue similar to the uterine lining forms outside the uterus, causing chronic pelvic pain and deep pain during intercourse, especially around menstruation.
- Adenomyosis: i Tissue from the uterine lining grows into the uterus’s muscular wall, causing painful sex due to pelvic pressure.
- Ovarian cysts: Fluid-filled sacs that form on the ovaries. Many cause no symptoms, but larger ones can produce sharp or aching pain during intercourse, particularly with deep penetration.
- Pelvic inflammatory disease (PID): An infection of the reproductive organs that can spread to the uterus, fallopian tubes, or ovaries, causing pelvic tenderness and pain during sex. Vaginal dryness: Insufficient lubrication increases friction during intercourse, often irritating the vaginal opening. It is more common during perimenopause and menopause, but may also occur after childbirth or as a side effect of certain medications.
- Pelvic floor dysfunction: When the pelvic floor muscles that support the bladder, uterus, and bowel are overly tight, weak, or uncoordinated, they may make penetration painful.
- Vaginal Infections: Yeast infections, bacterial vaginosis, urinary tract infections (UTIs), and STIs can all irritate vaginal tissues, causing burning, itching, inflammation, and pain while having intercourse.
If you are experiencing pain during sex, a medical evaluation can identify the cause of your symptoms and the most effective treatment.
Why Fibroids Cause Pain During Sex
Uterine fibroids are one of the most common and frequently missed causes of painful intercourse. Fibroid pain during sex develops because fibroids change the anatomy of the uterus and increase pressure within the pelvis.
Other reasons these growths can cause pain with intercourse include:
- Pelvic crowding: Large fibroids or multiple fibroids growing within the uterine wall cause the uterus to expand and occupy more space within the pelvic cavity. This “crowding” can lead to deep pressure and discomfort during penetration.
- Cervical proximity: Fibroids located near the cervix or lower uterus may be more sensitive to pressure during intercourse, particularly with deeper penetration.
- Pressure against surrounding pelvic structures: Depending on their size and location, fibroids can place pressure on the uterus and nearby pelvic organs, contributing to pelvic pain or discomfort during sex.
- Inflammation or degeneration: Some fibroids become inflamed or begin to break down, making the uterus more sensitive.
- Certain positions may increase pain: Some sex positions naturally allow for deeper penetration, increasing pressure on fibroids located near the cervix or deeper within the uterus.
Which Fibroid Types & Locations Cause Sexual Pain
Not all fibroids cause painful intercourse. Whether fibroids contribute to pain during sex can depend on their size and location. Larger fibroids may increase pressure within the pelvis, while uterine fibroids located near the cervix or lower uterus may be more likely to cause discomfort during intercourse.
The fibroid types most commonly associated with pain during sex include:
- Intramural fibroids: Grow within the uterus’s muscular wall. As they enlarge, intramural fibroids can increase the overall size of the uterus, leading to pelvic pressure and deep pain during intercourse.
- Subserosal fibroids: Develop on the uterus’s outer surface and may press against nearby pelvic organs or nerves when they grow larger.
- Submucosal fibroids: Form beneath the uterine lining, with the most common symptom being heavy menstrual bleeding. They are less frequently associated with painful sex, but can still cause pelvic discomfort and cramping.
Fibroid Symptoms That Often Accompany Painful Sex
Pain during sex rarely occurs on its own. Because fibroids are hormone-responsive growths, pain may range from mild discomfort to severe. Hormonal fluctuations can occur alongside other common fibroid symptoms, including:
- Deep pelvic pain during or after sex
- Lower abdominal pain during sex or pelvic cramping
- Pain that worsens in certain sexual positions
- Lingering soreness after intercourse
- Heavy or prolonged periods
- Pelvic pressure or bloating
- Frequent urination
- Lower back pain
Aside from abdominal pain during sexual intercourse, fibroids can trigger burning sensations or muscle tightness. Consulting a fibroid specialist and identifying the cause of your symptoms can help you access treatment before your fibroids worsen.
When Pain During Intercourse Needs Medical Attention
Occasional discomfort during sex can happen for many reasons and is not always a sign of an underlying condition. However, pain that is severe, recurring, or getting worse over time is worth discussing with a healthcare provider. Getting an evaluation is the most reliable way to understand what is causing your symptoms.
Consider scheduling an evaluation if you notice:
- Repeated pain during or after sex
- Pain that grows in severity over time
- Pain interfering with intimacy or your quality of life
- Bleeding after intercourse
- Fever, chills, or abnormal vaginal discharge along with pain
- Pain after menopause
- Painful intercourse alongside pelvic pressure, heavy menstrual bleeding, or urinary symptoms
Several conditions can cause pain during intercourse, including uterine fibroids, endometriosis, adenomyosis, hormonal changes, and pelvic floor dysfunction. A pelvic exam, ultrasound, or MRI can help identify the underlying cause and guide next steps.
If fibroids are identified as a contributing factor, minimally invasive options such as uterine fibroid embolization (UFE) may help reduce symptoms without the recovery time associated with open surgery.
How Doctors Diagnose the Cause of Pain During Sex
Since many conditions can cause pain during sex, diagnosis begins with identifying where the pain occurs, when it happens, and whether other symptoms are present.
An evaluation for conditions like fibroids typically includes:
- A detailed medical history
- Pelvic examination
- Ultrasound imaging
- Blood tests if heavy menstrual bleeding suggests anemia may be present.
- Additional imaging, if necessary, to plan treatment
If fibroids are causing your pain during intercourse, your fibroid specialist can discuss treatments that shrink fibroids and relieve symptoms.
How Do You Treat Pain During Sex?
Since pain during intercourse is a symptom rather than a condition itself, lasting relief generally comes from addressing the underlying cause. When fibroids are identified as the source, treatment focuses on reducing or eliminating the fibroids driving the symptoms.
UFE for Fibroid-Related Pain During Sex
When fibroids are responsible for painful intercourse, a fibroid specialist can help determine whether treatments such as UFE are appropriate for symptom management.
UFE can significantly reduce symptoms without surgery by blocking the fibroid’s blood supply, causing it to shrink.
Key benefits of uterine fibroid embolization (UFE) include:
- No large incisions
- No general anesthesia
- Outpatient treatment
- Able to go home the same day as treatment
As an outpatient treatment, UFE offers a shorter recovery time than surgery, with most women resuming normal activities within one to two weeks. Our fibroid specialists at USA Fibroid Centers are experts in UFE and have helped many women experience relief from fibroid pain during sex, pelvic pressure, and other fibroid-related symptoms.
Find Relief From Fibroid-Caused Painful Intercourse
Pain during sex should not be something you simply accept. If fibroids are the cause, effective, minimally invasive treatment is available. The fibroid specialists at USA Fibroid Centers provide comprehensive evaluations and personalized treatment plans at convenient nationwide locations, with online scheduling available seven days a week.
Frequently Asked Questions
Is pain during sex something to worry about?
Occasional discomfort during sex can happen due to minor, temporary reasons, like insufficient lubrication. However, recurring or severe pain during sex should be evaluated by a healthcare provider.
Can fibroids cause stomach pain after sex?
Yes. Stomach or pelvic pain after sex is one of the more common symptoms associated with uterine fibroids. It occurs because fibroids can press on the uterus, cervix, or surrounding tissue during intercourse. The pain may feel like cramping or a dull ache in the lower abdomen and can last from a few minutes to several hours afterward.
Pain after sex can also be caused by other conditions, including endometriosis, ovarian cysts, pelvic inflammatory disease, or muscle tension. If you experience regular or severe pain after sex, a physician can help identify the cause and recommend appropriate treatment
Why do I have lower abdominal pain during sex?
Lower abdominal pain during sex can result from conditions like gas or bloating, urinary tract infections (UTIs), ovarian cysts, or underlying conditions like endometriosis or fibroids.
Can fibroids cause bleeding after sex?
Fibroids can cause bleeding after sex. This happens because fibroids increase blood vessel fragility in the uterus, press on the cervix or vaginal canal, or disrupt the blood supply to the fibroid itself during intercourse. Submucosal fibroids, which grow along the uterine lining, are particularly associated with this symptom. Other common fibroid symptoms include heavy or prolonged periods, pelvic pain or pressure, pain during sex, frequent urination, and fatigue (often due to anemia from blood loss). Postcoital bleeding has several possible causes, so anyone experiencing it regularly should consult a physician.”
Will painful intercourse go away after fibroid treatment?
For most women, fibroid treatment significantly reduces or eliminates pain during sex. Common treatment options include myomectomy (surgical removal of fibroids while preserving the uterus), hysterectomy (removal of the uterus), and minimally invasive procedures such as uterine fibroid embolization (UFE). The right option depends on the size and location of your fibroids, your symptoms, and your plans for future pregnancy. Results vary: most women report major improvement after treatment, but in some cases pain may persist due to factors like scar tissue, fibroid recurrence, or a separate pelvic condition. If you still experience pain during sex after treatment, talk to your physician to identify the cause.”
Do certain sex positions hurt more with fibroids?
Certain sex positions can hurt more with fibroids near the cervix or lower uterus. Trying different positions can temporarily reduce fibroid pain during intercourse, but it does not always address the underlying cause when the fibroid is located in certain places. A fibroid specialist can help evaluate persistent fibroid pain during sex.
Can you feel fibroids during sex?
You may not directly feel fibroids during sex, but you may notice pressure, deep pelvic pain, or discomfort during intercourse when fibroids are near the cervix or lower uterus.