Deep pain during sex

What causes deep pain

Deep dyspareunia means pain felt inside the pelvis during deep penetration. Causes fall into a few groups.

Endometriosis. Tissue similar to the womb lining grows outside the uterus, often behind it, on the ligaments that support it or between the vagina and rectum. Deep thrusting presses on these areas. Painful periods, pain with bowel movements and pain between periods are common companions. Diagnosis often takes years, so it helps to describe your symptoms clearly.

Adenomyosis and fibroids. Adenomyosis is when the womb lining grows into the muscle wall of the uterus, making it tender and enlarged. Fibroids are non-cancerous growths in or on the uterus. Both can cause deep pain and heavy periods.

Pelvic infection. Pelvic inflammatory disease, often following an untreated sexually transmitted infection, makes the uterus and tubes tender. It can also cause fever, discharge and pain between periods. It needs prompt antibiotic treatment.

Ovarian cysts. Most are harmless and come and go, but larger cysts can cause one-sided deep pain with sex.

Pelvic floor tension. Overactive pelvic floor muscles can cause a deep ache as well as entry pain. This often develops on top of another cause, as the body braces against pain.

Position, angle and arousal. Without enough arousal the upper vagina does not lengthen fully, so the cervix is bumped more easily. This kind of pain is usually sharp, brief and limited to certain positions.

Bowel and bladder. Constipation, irritable bowel syndrome and bladder pain syndrome can all make deep penetration hurt.

What you can try right now

These steps make sex more comfortable while you look for a cause. They do not replace an assessment.

• Choose positions where you control depth and angle, such as being on top, or lying side by side facing each other or spooning.
• Try shallower penetration and slower movement. Let the person with pain set the pace.
• Spend longer on arousal before penetration. The upper vagina lengthens as arousal builds.
• Consider a depth-limiting ring. These soft, stackable rings sit at the base of a penis or toy and stop penetration at a set depth.
• Empty your bladder and avoid sex when constipated if those make the pain worse.
• Track pain against your cycle, position and bowel habits for a couple of months.

Talking about it with a partner

Deep pain tends to make people tense up before sex, which can create an ache of its own. A few plain agreements help:

• The person with pain controls depth and pace, and can stop at any point without explaining.
• Use a simple signal, a word or a tap, for "less deep" or "pause".
• Penetration does not have to be the main event. Touch, oral sex and external stimulation are full parts of sex.
• If one position works, it is fine to use it every time for a while.

Pain that is predictable is easier to manage than pain that comes as a surprise. Planning around it is not giving in; it keeps sex enjoyable while you get answers.

Pain after sex

Some people feel fine during sex and then ache for hours afterwards. A dull, cramping ache can come from uterine contractions after orgasm, which are normal but feel stronger when the uterus is tender, as with adenomyosis or endometriosis. A lingering deep ache can also come from pelvic floor muscles that stayed tense. Pain that lasts into the next day, or is getting worse over time, should be assessed rather than waited out. A warm bath or heat pad and lying on your side often ease the ache in the short term.

What a clinician will check

Expect questions about periods, bowel and bladder symptoms, fertility plans and sexual health. A clinician may:

• Do a pelvic exam, noting where tenderness is felt.
• Take swabs for sexually transmitted infections and check for pelvic infection.
• Arrange a pelvic ultrasound, ideally transvaginal, to look at the uterus and ovaries. A specialist scan can sometimes show deep endometriosis.
• Offer hormonal treatment to see whether symptoms improve, which can support a likely diagnosis of endometriosis.
• Refer you to a gynecologist, who may suggest laparoscopy (keyhole surgery) to confirm and treat endometriosis.

Treatment depends on the cause. Hormonal medicines can calm endometriosis and adenomyosis; surgery can remove endometriosis or cysts; pelvic floor physical therapy helps when muscles have become tense. The guide to finding a pelvic floor therapist explains how to find one.

How it differs from other pain

If the pain is right at the entrance rather than deep inside, see pain at the vaginal opening. If deep pain started after postpartum recovery or pelvic radiation, mention that history, since scar tissue and vaginal narrowing can play a role. If you also bleed with sex, read bleeding after sex.