What should you know about lower stomach pain during sex?

Pain in the lower stomach may be felt at the vaginal entrance or deep in the pelvis. Deep pain can involve the uterus, ovaries, bowel, bladder or pelvic-floor muscles. Endometriosis and ovarian endometrioma may cause pain that is linked with the menstrual cycle. Pelvic inflammatory disease can cause pelvic pain with discharge, fever or bleeding. After menopause, genitourinary syndrome of menopause can cause dryness and sensitivity. Lichen sclerosus and vulvodynia may cause pain in the vulval tissues. Stress-related muscle tightening, constipation, urinary infection or a muscle strain can contribute too. The symptom does not point to one cause by itself.

Pause when pain appears and describe it precisely: burning or aching, surface or deep, one-sided or central, and related to a particular position. Note cycle timing, bleeding, discharge, urinary symptoms, bowel changes and pain at other times. More arousal, a suitable lubricant and reduced depth may ease discomfort related to friction or pressure. Book a medical appointment when pain recurs, persists after sex, changes suddenly or affects your relationship. Assessment may include a discussion of symptoms, examination, infection testing or imaging depending on the pattern.

Seek urgent help for severe sudden pain, fainting, heavy bleeding, fever, repeated vomiting, a rigid or very tender abdomen, or pain with possible pregnancy. Arrange prompt care for worsening pain, bleeding after sex, unusual discharge, pain when urinating or symptoms that do not settle. These warning signs need more than home measures.

Is the pain likely to be superficial or deep? Could dryness, pelvic-floor tension, infection or endometriosis explain it? Which tests are appropriate? What can I safely do for comfort while waiting? Which symptoms require emergency care?