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Sex and Pelvic Pain

What is pelvic pain?

Pelvic pain is any pain that one experiences in the lower abdomen, pelvis, genitals or genital region, or rectum. Pelvic pain can be classified as:

Acute — pain that is sudden and severe
Chronic — pain that lasts over a period of months or longer (typically six months or more)

When the pain continues for a long period of time, it can become physically and mentally exhausting, causing individuals to make emotional and behavioral changes as a way of coping with the pain. Additionally, victims of chronic pelvic pain may have:


  • Deep, dull, and relentless pain
  • Difficulty sleeping or sleeping too much
  • Constipation
  • Decreased appetite
  • Depression
  • Slow-motion body movements and reactions
  • Less energy for physical activities
  • Social or behavioral changes
  • Limited or no pain relief from conventional treatment methods

Pelvic pain may worsen in certain situations, such as during sexual activity or when urinating, possibly causing additional distress for the individual. Although pelvic pain is a more common complaint among females, it does occur in males.

What Causes Pelvic Pain?

There are many causes of pelvic pain, including, but not limited to:

  • Smoking
  • Chronic infections (e.g. yeast, urinary)
  • Medications (e.g. hormonal birth control, acne, anti-fungal, infertility)
  • Pregnancy-related factors (e.g. vaginal delivery, episiotomy, ectopic pregnancy, postpartum dyspareunia, miscarriage or threatened miscarriage, breast feeding)
  • Surgery, especially surgery performed near the pelvis
  • Menopause
  • Menstrual cramps
  • Muscular contractions or cramps, especially within the muscles of the pelvic floor
  • Hysterectomy
  • Twisted or ruptured ovarian cyst or fallopian tube
  • Uterine fibroids: abnormal growths on or in the uterine wall
  • STIs
  • Autoimmune disorders (e.g. lupis, cancer)
  • Appendicitis
  • Allergic reactions
  • Psychological (mental) factors
  • Trauma (e.g. sexual abuse, rape, incest, lifetime sexual victimization)
  • Incoordination in the muscles concerning bowel and bladder function
  • Muscle weakness in the pelvis and pelvic floor
  • Bicycle riding
  • Effects from testosterone therapy (some FTM individuals report more post-orgasmic pain)
Types of Pelvic Pain

Vaginismus (a.k.a Pelvic Floor Muscle Dysfunction or Levator Ani Syndrome)
Vaginismus is an involuntary contraction of the muscles of the outer third of the vagina that interferes with intercourse and causes distress and interpersonal difficulties. The muscles around the vagina, bladder, and/or anus spasm, causing pain in the vulva and vagina during penetration.

Dyspareunia is pain experienced during intercourse with no obvious cause. Deep dyspareunia is discomfort or pain deep inside the vagina during penetration.

Vulvodynia is any vulvar discomfort that occurs in the absence of visible findings. Vulvodynia is usually given as a diagnosis when a doctor cannot find anything else wrong with a patient who is experiencing pain in the vulvar area.

Vaginitis is a condition of dryness that results from vaginal atrophy (inadequate estrogen levels in the vagina that most commonly occurs during menopause and aging).

Provoked Vestibulodynia (PVD) (once known as Vulvar Vestibulitis Syndrome)
Provoked vestibulodynia is the most common cause of sexual pain, affecting 16% of women. It consists of pain in the vulvar vestibule that occurs in response to some types of contact. Women who take hormonal contraceptives are much more likely to have PVD.

Endometriosis is a condition in which uterine tissue grows outside the uterus. It is one of the most complex, frustrating, and common conditions that occur in gynecology.

Persistent Genital Arousal Disorder
Persistent genital arousal disorder is a condition where women have a constant feeling of being sexually aroused and are unable to release this arousal.

Prostatitis is characterized by swelling and inflammation of the prostate gland, which can make urination painful and/or difficult. The swelling can also cause pain in the pelvic area or genitals, making other activities, such as sexual activities or sitting, uncomfortable and/or difficult to do.

Lichen Sclerosis
Lichen sclerosis is a chronic autoimmune inflammatory condition that affects the skin of the vulva or head of the penis—usually in uncircumcised men—and/or around the anus.

Interstitial Cystitis or Painful Bladder Syndrome (IC/PBS)
IC or PBS is an incredibly painful condition where one feels as though one constantly has to urinate, but nothing else, such as an infection, is occurring.

Irritable Bowel Syndrome (IBS)
IBS is a chronic or recurrent GI tract symptom that is not explained by structural abnormalities, infection, or metabolic changes during routine testing.

Urethral Syndrome
Also known as Urethritis, Urethral swelling  is irritation or inflammationof the urethra.

Pelvic Floor Myalgia
Pelvic floor myalgia (muscle soreness) is otherwise known as vaginismus.  It is a
common cause of sexual pain and is the condition associated with the involuntary
tightness of the pelvic floor muscles.

Pelvic Congestion Syndrome
Pelvic congestion syndrome occurs when varicose veins in the pelvic region become overly engorged, causing them to stretch and interfere with nearby nerves, often resulting in discomfort, pain, or pressure.

To Learn More:

On our resource page, we have listed various organizations and health care providers from around the world who specialize in treating pelvic pain.  The CSPH also has pamphlets, books and teaching kits dealing with pelvic pain.  The public is always welcome to browse through our materials during our office hours and members are eligible to check out our books and teaching kits.

The Pelvic Pain Kit includes:

  • various vaginal dilators
  • sphincter relaxation items
  • prostate health devices
  • kegel exercise kits
  • pain mapping materials
  • small metal speculum
  • mirror
  • bumper (used during sexual encounters to prevent deep penetration with a partner)

Members are eligible to rent out our Pelvic Pain Kit for demonstration purposes only.

Please contact: info@thecsph.org for more information

  • National Center for Pelvic Pain


  • The International Society for the Study of Vulvovaginal Disorders (ISSVD)


  • The National Vulvodynia Association (NVA)


  • The International Society for the Study of Women’s Sexual Health (ISSWSH)


  • The Section on Women’s Health of the American Physical Therapy Association (APTA)


  • Interstitial Cystitis Assocation (ICA)


  • Institute for Sexual Medicine