What should you know about low abdominal pain during sex?

Pain deep in the lower abdomen can relate to the position or depth of penetration, pelvic-floor muscle tightening, irritation, infection or a condition affecting the uterus, ovaries or nearby tissues. Endometriosis can present with pain during sex, and an ovarian endometrioma may cause pelvic pain. Pelvic inflammatory disease may cause lower abdominal pain with discharge, fever or pain when passing urine.

Dryness and fragile tissue may make sex painful around or inside the vagina. Genitourinary syndrome of menopause, lichen sclerosus and vulvodynia are different conditions that can cause genital discomfort, but they need different assessments. Pain can be sharp, aching, burning or present afterwards; describing its timing helps a clinician narrow the possibilities.

Pause penetration when pain begins and avoid pushing through it. Note when the pain occurs, its location, depth, duration, relation to the menstrual cycle, and any bleeding, discharge, urinary symptoms or fever. A water-based lubricant, more time for arousal and positions that limit depth may reduce friction or pressure, but ongoing or recurrent pain still warrants a gynaecological assessment.

Do not use leftover antibiotics or insert products that may irritate tissue. A clinician may examine the pelvis, test for infection and consider ultrasound or other tests according to the findings. Treatment depends on the cause; laparoscopic excision of endometriosis is one specialist option for selected endometriosis cases.

Seek urgent care for severe or worsening pain, fainting, heavy bleeding, fever with pelvic pain, repeated vomiting, or pain with a possible pregnancy. Arrange prompt assessment for new pain with abnormal discharge, bleeding after sex, urinary symptoms or pain that continues after intercourse. Recurrent pain deserves review even when it settles between episodes.

Tell the clinician where the pain starts, how deep it feels, whether it follows your cycle and whether you have bleeding, discharge, bowel or bladder symptoms. Ask which causes should be checked, whether infection testing or an ultrasound is suitable, and what temporary changes to sex or pain relief are safe while you wait.