What should you know about upper abdominal pain during sex?

Pain high in the abdomen may be triggered by deep penetration, a position that increases pressure, abdominal muscles tightening, or an unrelated digestive or urinary problem. Pelvic conditions can also be felt higher in the abdomen, including endometriosis, an ovarian endometrioma, or pelvic inflammatory disease. Genitourinary syndrome of menopause, lichen sclerosus, and vulvodynia more often cause vulval or vaginal pain, but symptoms can overlap. The location and timing of pain help guide assessment.

Stop or change activity when pain begins; do not push through it. Note whether the pain is deep or superficial, one-sided or central, linked to a position, and accompanied by bleeding, discharge, fever, nausea, bowel changes, or urinary symptoms. Try slower activity, more lubrication, and positions that limit depth only if they feel comfortable. A clinician may perform an abdominal and pelvic examination and arrange tests or imaging. Treatment depends on the cause; [Laparoscopic Excision of Endometriosis] is one procedure used in selected endometriosis cases.

Arrange an appointment if pain returns, affects intimacy, or occurs with bleeding after sex, unusual discharge, painful periods, or pain outside sexual activity. Seek urgent help for sudden severe pain, faintness, shoulder-tip pain, fever with vomiting, heavy bleeding, or possible pregnancy, because these symptoms can signal an urgent abdominal or pelvic problem. [Pain During Sex] offers broader symptom guidance.

Ask whether the pain pattern suggests a pelvic, abdominal, muscular, or vulval cause, and whether you need a pregnancy test, infection testing, ultrasound, or referral. Share your cycle pattern, prior surgery, contraception, bowel or bladder symptoms, and whether penetration depth changes the pain.