Managing Uterine Pain During Sex

Something simple but true: Sex is supposed to feel good for everyone involved. If you're experiencing painful sex, it could be caused by a number of factors, including fluctuating hormone levels, pelvic injury or certain uterine conditions.

"Dyspareunia is quite basically pain noted during sex; pain can be felt externally on the labia or internally in the vagina, uterus or pelvis," said Kecia Gaither. M.D., who is board-certified in OB-GYN and maternal-fetal medicine and the director of perinatal services/maternal-fetal medicine at NYC Health + Hospitals/Lincoln in the Bronx in New York City.

The condition affects as many as 20 percent of women. The pain may feel sharp or dull and persistent like menstrual cramps, and it can be hard to isolate the origin of the pain inside your body.

"It can be hard for a woman to know that her pain is due to her uterus. Typically, a woman would describe the pain as pelvic pain," said Leah Millheiser, M.D., an OB-GYN and expert in menopause and female sexual medicine, and the chief medical officer at Evernow in Palo Alto, California.

Uterine myomas

If pain during sex is specific to the uterus, it may be caused by uterine myomas, Gaither said. More commonly known as fibroids, myomas are noncancerous growths in the uterus. If the fibroids are lower down in the uterus, toward the opening of the cervix, you may feel pain during sex.

Trying a position with shallow penetration, like missionary, may help reduce the pain during sex caused by fibroids, as can timing your sex for the part of the month when your cervix is higher, which is typical during ovulation (this is also when you're fertile, so use protection if you're not trying to get pregnant).

"An enlarged uterus due to fibroids can sometimes cause discomfort during sex," Millheiser said. "It's estimated that between 75 and 80 percent of women with a uterus may develop a fibroid at some point. Most women do not even know that they have them."

If you're experiencing uterine or pelvic pain with sex, fibroids are one of the first conditions you should ask your doctor to investigate.

Uterine adhesions

Adhesions are bands of rope-like fibrous tissue in the uterus typically caused by infection or some trauma to the uterus. In some cases, Millheiser explained that these adhesions can tether the uterus to other organs in the pelvis, abdomen or abdominal wall.

"These adhesions may be related to prior infections, endometriosis or prior surgery. These adhesions will likely only cause pain if the tethering is tight; think of it like tight pulling," Millheiser said.

Endometriosis can also cause pain even without adhesions.

Pelvic floor injury

A pelvic floor injury can often feel like uterine pain. Common causes of pelvic floor injury include childbirth, injury to the pelvis, overusing pelvic muscles and certain surgeries. Pelvic tightness, often caused by holding in urine or overdoing Kegel exercises or certain other exercises, can also cause painful sex and may feel like the pain is in the uterus.

Infection or STDs

"An infection in the uterus or an STD may cause a generalized discomfort, but it will certainly get worse during sex," Millheiser said.

Sexually transmitted diseases (STDs) such as chlamydia and gonorrhea are most likely to cause pelvic pain.

Another potential cause of uterine pain during sex is pelvic inflammatory disease (PID), which is an infection of the reproductive organs caused by bacteria entering the body. Typically, it's caused by an STD, but in rarer cases, PID can be caused by douching or an intrauterine device (IUD). You may feel pain deep in the pelvis with PID.

Pain due to deep thrusting

Sometimes uterine pain during sex is simply due to sex itself.

Deep thrusting against the cervix can cause uterine pain during sex, Gaither said. If your cervix is low or sensitive, your partner has a large penis or you are in a position that allows deep penetration, your cervix may get bumped, causing painful sex.

What to do about uterine pain during sex

Both doctors agree that anyone experiencing dyspareunia or, specifically, uterine pain during sex should see a physician to evaluate potential underlying causes.

In most cases, the cause is easily treatable or the solution may be as simple as changing positions or using lubricant.

"A rapidly expanding size of the uterus could be the first sign of a type of uterine cancer called a leiomyosarcoma," Millheiser said. "In general, however, most pelvic pain during sex is related to benign conditions."