Back pain during sex: causes, relief and when to get help

The location and timing offer useful clues. Pain that changes with posture or movement may reflect strain in the lower back, hips or pelvic floor. Deep pelvic pain may also be felt in the back. Endometriosis, an ovarian endometrioma and pelvic inflammatory disease can present with pain during sex, while vulvodynia, lichen sclerosus or genitourinary syndrome of menopause may cause pain closer to the vaginal opening. These possibilities cannot be separated by symptoms alone.

Stop or change activity when pain begins rather than pushing through it. Try a position that keeps your spine supported and lets you control depth and movement. A water-based or silicone-based lubricant may help when dryness contributes. Note whether the pain is at the vaginal opening or deeper, which positions trigger it, whether it continues afterwards, and whether it follows a pattern around your period. Arrange a clinical assessment if it recurs, affects intimacy or is getting worse.

Seek urgent care for severe or rapidly worsening pelvic or back pain, fainting, marked dizziness, heavy vaginal bleeding, fever, vomiting, a rigid or swollen abdomen, or pain with possible pregnancy. Prompt assessment is also sensible for new unusual discharge, bleeding after sex, pain when passing urine, leg weakness or numbness around the groin. Without these warning signs, book a routine appointment for repeated pain or symptoms that do not settle.

Ask whether the pattern suggests a back, hip, pelvic floor or gynaecological cause; whether a pelvic examination, infection test or imaging would help; and which movements are reasonable while the cause is being assessed. Mention menstrual changes, pregnancy possibility, urinary or bowel symptoms, vaginal dryness, discharge and previous pelvic surgery because each can guide the evaluation.