Rectal pain during sex: what to know

Deep penetration can place pressure on the rectum, vagina, pelvic floor, or ovaries. Pain may be more likely when muscles tighten in anticipation of discomfort, when lubrication is low, or when the tissues are irritated. Pelvic floor spasm can cause aching or sharp pain during and after sex.

Endometriosis can present with deep pain during sex and pelvic or bowel symptoms. Pelvic inflammatory disease can present with pelvic pain, abnormal discharge, fever, or pain with sex. After menopause, genitourinary syndrome of menopause may cause dryness and tissue sensitivity. Vulvodynia and lichen sclerosus can cause vulval pain that is felt during sexual contact. An ovarian endometrioma may cause deeper pelvic pain.

Stop or change activity when pain begins; pain is not something you need to push through. Consider slower activity, more lubrication, positions with less depth, and time for arousal. Note whether pain is at the entrance or deep inside, whether it lasts afterward, and whether discharge, bleeding, urinary, bowel, or cycle-related symptoms accompany it.

Book a gynaecology assessment when pain is persistent, worsening, or affecting intimacy. Treatment depends on the cause and may include treating infection, addressing tissue changes, pelvic floor rehabilitation, or discussing specialist options such as laparoscopic excision of endometriosis.

Seek urgent care for severe or sudden pelvic or rectal pain, fever, fainting, heavy bleeding, vomiting, or pain with a possible pregnancy. Prompt assessment is also needed for new severe pain with foul-smelling discharge or marked abdominal tenderness.

Is the pain superficial or deep, and what examination could clarify its source? Could endometriosis, infection, pelvic floor tension, or tissue dryness explain it? What changes in sexual activity are reasonable while I am being assessed?