What should you know about lower left abdomen pain during sex?

Deep pain may be triggered when penetration moves the cervix, uterus, ovaries or nearby tissues. Endometriosis and an ovarian endometrioma can cause deep pelvic pain, sometimes more noticeable on one side. Pelvic inflammatory disease may cause pelvic pain with discharge, fever or bleeding. Genitourinary syndrome of menopause can make vaginal tissues drier and more sensitive, while lichen sclerosus or vulvodynia may cause vulval pain that is felt during sex. Constipation, irritable bowel symptoms, a urinary infection, pelvic-floor tension or a muscle strain can also refer pain to the lower left abdomen. Location alone cannot establish the cause.

Stop or change the activity when pain begins rather than trying to tolerate it. Record whether the pain is at the entrance or deep inside, its left-sided location, timing, position, cycle relationship and associated symptoms. More time for arousal, a suitable lubricant and positions that control depth may reduce friction or pressure. Arrange a gynaecology review if the problem repeats, affects intimacy, follows childbirth or menopause, or occurs with bleeding, discharge, urinary or bowel changes. A clinician may discuss an examination, infection tests or imaging.

Seek urgent care for sudden severe pain, fainting, heavy bleeding, fever, repeated vomiting, a rigid abdomen, or pain with a possible pregnancy. Get prompt assessment for new pain with foul-smelling discharge, pain on urination, bleeding after sex, or worsening tenderness. Do not wait for another sexual encounter to test whether these warning signs settle.

Is this deep pelvic pain or pain from the vulval tissues? Could endometriosis, an endometrioma, infection or pelvic-floor tension fit? Which tests are useful? What changes to sexual activity are sensible while I am being assessed?