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Hi Aunt Vadge,
I’m having deep pain during sex – I’ve never had this before and it’s quite severe. It doesn’t feel like surface pain; I feel it near my lower abdomen. I also get pain for hours afterwards that feels like menstrual cramps, even though I’m at least 2.5 weeks from my period.
I’m on birth control, I’ve tested negative for STIs, and my partner and I are each other’s only partner. Why could this be? Is it an infection, and should I be worried?
Sincerely,
Deeply Pained
Age 18, Canada
Dear Deeply Pained,
What you’re describing has a proper name – deep dyspareunia, deep pain with sex – and that’s actually helpful, because it points to a recognisable shortlist rather than ‘who knows’. With your STI test clear and the pain feeling deep and crampy, an infection is unlikely, so here are the most likely culprits, including two you can start experimenting with today.
Start with the common, fixable ones.
The first is simply hitting the cervix or an ovary: if penetration is deep and fast, or you’re not fully aroused, the vagina hasn’t ‘tented’ – lengthened and lifted the cervix up out of the way – so the penis bumps the cervix, which gives exactly that deep ache during sex and a menstrual-like cramp for hours afterwards.
The fix is in your hands: plenty of arousal before penetration, and positions where you control the depth and angle (you on top). Try shallower, slower and more warmed-up, and see if it changes. The second is a tight pelvic floor – guarded, over-tight muscles cause deep ache during and after sex, and they respond beautifully to pelvic-floor relaxation work with a physiotherapist.
The one I really want taken seriously, though, is endometriosis. Deep pain with sex plus a menstrual-type cramping ache is a textbook flag for it, and it’s massively under-diagnosed, with women often waiting years to be heard.
So if the position-and-arousal tweaks don’t fix it, push for endometriosis to be properly considered rather than brushed off – you’re young, but it starts young, and being believed early changes everything.
Worth ruling out alongside it: an ovarian cyst creating pressure-pain when it’s pushed against, PID (less likely given your clear STI test and no discharge, but the after-pain makes it worth excluding), and your bowel, since constipation can refer pain by sheer proximity.
New pain where there was none means something has changed, so it does warrant a proper examination – your doctor can use scans and tests, and may refer you to a pelvic physiotherapist or gynaecologist. But while you wait for that appointment, trial the arousal-and-depth-control changes, because for a lot of people that alone solves it.
And don’t have painful sex in the meantime; pain is a signal, not something to push through. There’s more on why sex can hurt if you’d like to read around it.
Warmest regards,
Aunt Vadge
This is general information based on current research and our clinical experience, not a substitute for personalised medical advice.
