If you’re experiencing stomach pain after sex, you’re probably wondering what the eff is going on – and how to make it stop, like, yesterday. Obviously, any kind of stomach discomfort sucks, but it feels especially unfair when you’re doubled-over in pain after something that’s supposed to be, well, pleasurable.
Dr Mary Jane Minkin, an obstetric-gynaecologist at Yale New Haven Hospital, is quick to clarify that what you might think of as just “stomach pain” is actually “lower pelvic pain”. That’s because pain associated with sex tends to be “more towards the vagina rather than up at the abdomen”, but people can interpret it as pain in the abdominal cavity area. So, the next question is, WHY?
1. It’s a sexual position
When patients see Minkin about pain after sex, she first asks them what position they do most. If you always have pain after missionary or doggy style, it could be because of the deep penetration.
What to do: First try over-the-counter pain medications. “Taking one or two an hour before sex can be very helpful for some women,” says Minkin. She also recommends trying a position where you’re on top, such as cowgirl or face-off, and seeing what happens.
The key is choosing a position where you have more “control over the depth and frequency of penetration”, explains Dr Ja Hyun Shin, director of the pelvic pain clinic in the department of Women’s Health and Obstetrics & Gynecology at Montefiore Health System. She suggests trying a sideways position, like spooning, that allows for more shallow penetration.
Read more: 8 reasons why you’re having painful sex
2. You have endometriosis
Endometriosis happens “when the lining of the uterus (womb) grows outside of the uterus”, according to the Office on Women’s Health. Pelvic pain during and after sex is one of the most common symptoms of the condition, Shin says.
When you have a severe form of endometriosis of the pelvis, you can have dense adhesions (translation: pelvic tissues and organs sticking to each other) in the pelvic area. “Deep penetration [during sex] can cause severe pain because all your organs are kind of adhered together,” she explains. But you can also have pain without these adhesions since endometriosis causes pain from inflammation.
What to do: Go to your gynae. Even though you’re having stomach pain, your doc will probably ask you about your overall history with vaginal pain. Do you have pain with your periods? Are you bleeding heavily? She may then suggest an ultrasound or laparoscopy, a minor surgery to examine your pelvis. That’s the only way, Shin says, to diagnose endometriosis for sure. To treat it, your doc will likely prescribe you birth control pills or new endometriosis medications.
3. You have an ovarian or pelvic cyst
Many women have ovarian cysts – fluid-filled sacs or pockets in an ovary or on its surface – at one time or another. Most are harmless and disappear without treatment after a few months, but some can continue to grow and cause pain. And pelvic cysts are a bit different. Shin explains that a pelvic cyst can develop from pockets of adhesions from previous surgeries or possibly an infection where fluid collects in the pelvic area. “Think of the whole pelvis and vagina area as one unit,” she says. “Sex can cause pain in other areas of the pelvis.”
What to do: Your doctor will do an ultrasound to diagnose the problem, then you might need a laparoscopy to remove the cysts.
4. You have an infection or a past inflammatory disease
A vaginal infection from bacteria normally found in your vagina or from a sexually transmitted disease, such as chlamydia or gonorrhoea, can spread from your vagina to your uterus, fallopian tubes, or ovaries (a.k.a. pelvic inflammatory disease). As if an infection weren’t bad enough, it tends to give you vaginal pain and pelvis pain. This pain is pretty much constant, Shin says, but “sex can worsen it” because you’re irritating an already irritated area.
And get this – you don’t even need to have a current vaginal infection to have this kind of pain. According to Minkin, a previous pelvic inflammatory disease can cause post-sex pelvis pain if it left pelvic scarring.
What to do: If it’s an infection, you just need a round of prescription antibiotics. But if it’s a previous pelvic inflammatory disease, your obstetric-gynaecologist may need to prescribe pain medications or cut down the adhesions (during a laparoscopy, for example).
5. You’re experiencing vaginal dryness
Minkin says certain birth control pills can cause dryness, noting that a higher dose of oestrogen can be helpful. And if you’re heading toward menopause, you can probably blame that.
What to do: Grab some over-the-counter lube. If that doesn’t work, ask your doctor about prescription options. Minkin says vaginal oestrogen and/or vaginal DHEA (the hormone dehydroepiandrosterone) medication can do the trick.
6. You have a tilted uterus
Don’t freak out. “At least 30% of women have a uterus that tilts backwards, so it’s not abnormal,” says Minkin. “Now, if there is scarring there that holds the uterus in that position, well, then that would be painful.”
But if it’s not abnormal, then why the heck does a tilted uterus cause stomach pain? Minkin explains that doctors don’t really know, but they think it’s because the scarring attaches organs to other organs – ones that, uh, shouldn’t be attached – and they can get hit during sex. Basically, it’s gonna hurt if your intestines are attached to the top of your vagina. And if your intestines are attached to your uterus by scar tissue, they can get pushed or pulled during sex – and that’s pretty painful.
What to do: Your doctor will tell you if your uterus is just naturally tilted, or if it could be the result of scarring. If there’s no scarring, try a sex position with more shallow penetration. If it’s scarring, it’s likely due to endometriosis. Your doctor will know how to treat that.
Read more: 10 reasons why you’re crying during sex
7. You have fibroids
While fibroids are benign (non-cancerous) tumours of the uterus, they “may cause pain during intercourse depending on their size and location in the uterus,” says Shin. They can also cause muscle cramping, which may explain why you’re having pelvic pain after sex.
What to do: See your doc for an
ultrasound or an MRI of the pelvis, then discuss treatment options from there.
They range from an IUD to a hysterectomy.
When in doubt, talk to your doctor
Whenever you have pain in the pelvic area, both Minkin and Shin recommend talking to your gynaecologist. “It’s an important time to go in and [get an] exam because there are a variety of serious conditions that, if left undiagnosed, can lead to more pain in the future,” says Shin.
This article was originally published on www.womenshealthmag.