What Causes Painful Orgasms? Dysorgasmia, Explained
If you've ever found yourself close to climax—only to feel a sharp or nagging pain right when you reach the top, or soon after—you may have experienced dysorgasmia. Also known as painful orgasm, this condition can be distressing (cue the alarm and anxiety of wondering where that pain is coming from or what caused it or how long it will last), especially considering it occurred while you were in the throes of an otherwise satisfying sexual experience.
And while climaxing isn't necessarily the be-all and end-all of fulfilling sex, orgasms should ultimately be pleasurable, not painful. Unless ruined orgasms are your thing, painful sex is generally not considered normal. In fact, it could be a signal from your body that there's an underlying condition or pelvic floor issue—one that you should definitely get checked out.
What is dysorgasmia?
Dysorgasmia is the medical term for pain experienced during or after orgasm, usually in the abdomen. "It's typically the result of a muscle contraction or spasm that involves the muscles of the pelvic floor or the uterus," notes Felice Gersh, M.D., OB/GYN, founder of the Integrative Medical Group of Irvine in California, and author of PCOS SOS Fertility Fast Track.
To understand the mechanisms here, it's helpful to clarify what an orgasm is at its core: a neurophysiological culmination ending with an involuntary muscle spasm. Of course, there's more to that simplified story, but as to why the pain occurs? "Physiologically speaking, it's similar to how if you were to contract the muscles in your arm, there's a release and relaxation of those muscles afterward," notes Samantha DuFlo, DPT, PRPC, a pelvic floor physiotherapist and founder of Indigo Physiotherapy in Baltimore. With an orgasm, if those pelvic muscles that contract during orgasm don't fully release afterward, it can lead to pain and tightness.
Painful orgasms can be a common occurrence for adults, no matter their age or sexual anatomy. Unfortunately, Gersh says statistics on dysorgasmia are rarely kept, but in her practice, she typically sees a new patient with painful orgasms once every two months. Pain with sex in general (called dyspareunia) is much more common: At least 10 patients per month seek her help for this issue, and research has found the global prevalence of dyspareunia to be between 8 and 21%.
"Some people find that pain with orgasm is all they know, but it's not normal and certainly not something that you need to accept," DuFlo stresses.
What painful orgasms might feel like.
While the pain of dysorgasmia can be different for everyone, if you've ever experienced menstrual cramps, general abdominal cramps, ovulation pain, or pain related to endometriosis, then you're in the neighborhood.
Dysorgasmia may feel like a muscle spasm in your abdomen (similar to the type you'd get from menstrual cramps) or a strange pulling sensation deep within your pelvic floor. The pain itself can range from mild to severe, and onset and duration of pain can also vary greatly. It's all these variables that can make dysorgasmia difficult to identify.
"Some people will have pain immediately, feeling a sharp, shooting pain as they're orgasming," explains DuFlo. "Other times, people will have delayed pain. They may have achiness, tightness, gnawing pain, or dull pain afterward. It might start 15 minutes later, it might start four hours later, or they may just notice it throughout the following day."
Interestingly, you can experience pain elsewhere in your body following an orgasm, too, including facial or ear pain, foot pain, headaches, and emotional pain such as panic attacks. The mechanism for this other, less localized pain remains unknown, Gersh says.
Painful orgasms vs. painful sex.
In the wider medical community, painful orgasm often gets lumped into the broader category of "pain with sexual intercourse," but they're actually distinct experiences.
"There is overlap with these two conditions, but it is important to recognize that painful intercourse is not the same as painful orgasms," Gersh says. "Orgasms achieved without intercourse can help make this distinction."
To test this theory, try to notice if your pain with orgasm happens while masturbating and reaching climax on your own—or if your pain occurs more often during or following intercourse with a partner.
You could also have pain in both situations—both during intercourse and during orgasm—but DuFlo notes that painful intercourse can be related to many factors, such as hormonal changes that cause dryness (like perimenopause or breastfeeding) or pelvic floor dysfunction, where the pelvic floor muscles may spasm and cause pain. There could also be an underlying issue like an infection. Be sure to discuss any discomfort you're having with your doctor, who can help you get to the root of the problem.
What causes painful orgasms.
There is an expansive range of potential causes of dysorgasmia, both physical and emotional, and sometimes both factors may be at play:
1. Pelvic floor dysfunction
By far, the most common cause of dysorgasmia in those with vulvas is pelvic floor dysfunction. Think of the muscles of your pelvic floor like a basket that supports your pelvic organs. "If those muscles are too short and tight, and then your orgasm causes a contraction that pulls on those muscles repeatedly, that can cause residual pain," DuFlo explains.
How to know if this is you? "People with really tight pelvic floors may have other symptoms, too: They can't use a tampon, or initial penetration can be painful, or they may have chronic constipation. Those are all signs that the pelvic floor muscles may be too tight or dysfunctional."
That tightness could also be a result of fitness training. "I see a lot of athletes who are undergoing significant strength and endurance work, and their pelvic floor muscles end up being really tight," DuFlo says, "especially runners and those who do [high-intensity workouts like] CrossFit and have not learned how to properly engage their core and use their breath, so they inadvertently clench their pelvic floor muscles."
A pelvic physical therapist can help you understand how your pelvic floor relates to your core so you can stretch and release muscles rather than tightening or contracting them unnecessarily.
In endometriosis, uterine tissue (endometrium) may start to grow outside of the uterus (where it does not belong), causing scar tissue buildup in and around the pelvis that can be incredibly painful during sex or orgasm. If you're living with endo, as it's known in the community, you may also have long, heavy, painful periods, menstrual cramping, low-back pain, and pain with bowel movements or urination.
Like endometriosis, adenomyosis is a uterine lining problem. While the two conditions share similar symptoms (cramps, pelvic pain, low back pressure, heavy periods), there is one major difference. The uterine tissue in adenomyosis builds up inside the uterine walls, growing thicker with each menstrual cycle, and may eventually break through the uterine muscle wall. Because this condition can result in an enlarged uterus, your abdomen may be more tender and sensitive to pressure, resulting in pain with orgasm/sex.
4. Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is an infection of the reproductive organs usually caused by a sexually transmitted infection (STI) or other infection that has traveled from the vagina into the uterus or beyond into the fallopian tubes and/or ovaries. Symptoms can include pelvic pain during urination or sex, bleeding during sex, as well as fever and a change in discharge.
5. Uterine fibroids
Fibroids are noncancerous tumors that grow in the uterine wall. While they are almost always benign and may not cause symptoms, some larger fibroids may cause the uterus itself to enlarge, which can result in significant pain. Prolonged or heavy periods, back or pelvic pain, and abdominal pressure, especially during penetration, are common symptoms. An enlarged uterus may also put pressure on your pelvic floor muscles, causing pain during orgasm.
6. Ovarian cysts
Ovarian cysts are fluid-filled sacs that may appear in your ovaries after ovulation each month. They tend to form and then disappear, but in some circumstances, they can hang around for a while, increase in size, or even rupture. You may feel pain with penetration during sex, or pain with orgasm more on one side of your body than the other, as cysts tend to be localized more on one ovary (left or right).
7. Interstitial cystitis
Often mistaken for a urinary tract infection (UTI), interstitial cystitis (IC) is a chronic bladder condition also known as painful bladder syndrome. It can result in a frequent urge to urinate (just like UTI), pelvic pain or pressure, and major discomfort during sex/orgasm due to an irritated, inflamed bladder.
8. Crohn's disease
A type of inflammatory bowel disease (IBD), Crohn's disease is marked by inflammation of different areas of the digestive tract, leading to serious pelvic pain, as well as severe diarrhea, fatigue, weight loss, and blood in the stool. This inflammation can result in major tenderness in the abdomen, and so—at the very least—sex and orgasms may not feel as pleasurable as they can/should, or, plainly speaking, they could downright hurt.
9. Irritable bowel syndrome
If you have irritable bowel syndrome (IBS), you likely experience abdominal pain, cramping, bloating, gas, and regular diarrhea and/or constipation, and the resulting pelvic pain can make sex or orgasm uncomfortable. Arousal or orgasm may also make your IBS symptoms worse after climax, which experts believe may be caused by increased blood flow to your pelvis or contractions of the uterus, which is snuggled right up against the intestines and can irritate them.
10. Post-vaginal birth
If you've had a vaginal delivery that resulted in a perineal tear, you may have scar tissue that's causing problems now with orgasm. Scar tissue can cause tightness in your pelvic floor, even if your pelvic floor muscles are lax.
11. Post-cesarean birth, abdominal or pelvic surgery
It comes back to scar tissue again here: The healing processes from a cesarean-section or laparoscopic surgery can pull on your pelvic muscles in a way that's new and different because the myofascial structure has changed post-surgery, notes DuFlo. "You're basically changing the lattice of how your pelvic floor works," she explains, meaning that an incision anywhere in your pelvis, even a tiny one from laparoscopy, could have major effects on how your pelvic muscles function afterward.
12. Emotional and psychological causes
Don't overlook a history of emotional or sexual abuse as a reason for your pain: The mind-body (somatic) connection is powerful, and it's the previous experience of emotional pain or trauma that can sometimes cause the physical issue to endure.
"We're learning more and more that the inherent link between our emotional and psychological well-being is deeply rooted in our bodies," says Kiana Reeves, somatic sex educator, pelvic care practitioner, certified doula, and chief brand officer at Foria. "Our emotional experiences are literally held in the body, and the body is essentially where the subconscious lives," she notes.
"Relationship issues, stress, and sexual trauma are all potential psychological causes for experiencing pain [and deriving less pleasure] from sex," confirms Nazanin Moali, a Los Angeles–based sex therapist and the host of Sexology Podcast.
Just as an exhausting workday can manifest as physical tension in your neck and shoulders, pelvic floor tension could also be related to an emotional experience that's been long-held in the body. Working with the nervous system to integrate those underlying emotional susceptibilities is essential to healing.
What to do about it.
While it may feel like you're relegated to having less satisfying or painful orgasms from here on out, know that dysorgasmia is not a phenomenon you need to keep experiencing. Treatment can very much help, and we know exactly where you should begin:
1. First, rule out underlying causes.
Start by scheduling a chat with your primary care provider or OB-GYN to rule out any conditions that may have cropped up, like undiagnosed PID, endometriosis, IBS, IBD, IC, uterine fibroids, or ovarian cysts, or to check in on the management of conditions that have already been diagnosed. Maybe your OB/GYN was keeping an eye on an ovarian cyst or uterine fibroid that's suddenly grown in size since your last visit, and it's now causing pelvic pain.
2. Then, seek out pelvic floor physical therapy.
Once you're equipped with that information, pelvic floor physical therapy is a cornerstone of treating dysorgasmia and any related pain you may be experiencing during sex. Aim to find a practitioner who has advanced training in pelvic floor health and understands how to make sex more comfortable for you. But the exact techniques and tools used may depend on two factors: what type of pain you're having and when it occurs.
Is your pain right at the moment of climax? Some preemptive manual therapy may be helpful, like using a dilator to help release muscle spasm or using yoga-based poses before having sex, such as a deep squat or happy baby pose, which can help stretch those hard-to-reach pelvic and hip muscles.
If you're having pain after orgasm, there are other techniques, like diaphragmatic breathing, that can be done after sex to mitigate tension. "But that's only part of the puzzle," DuFlo says. "Because if there's pain, there's usually something else going on there. That's why getting an evaluation or speaking to your health care provider first is important: to look into the underlying causes about why pain is occurring."
3. Talk to a sex therapist.
If you have a hunch that your pain may stem even partly from emotional or sexual abuse, don't hesitate to reach out to a sex therapist who can help you heal.
Even something as seemingly insignificant as being raised in a sex-negative household can mean you're holding on to internalized shame around sex, and that can make it hard for the mind to relax. That closed-off mental-emotional state can be translated into tension or tightness in your pelvic muscles when you're having sex. "A sex therapist can help people change the negative thoughts that might contribute to or amplify the pain," Moali says. Sex therapists can also offer tools such as relaxation exercises and guided meditations or visual imagery that can help with pain management.
The sooner you seek help for your pain, the better, Moali says. "In my experience, the longer a person waits, the more likely they will develop secondary issues, such as low desire."
4. Consider over-the-counter options for temporary relief.
While you're looking for answers to the root cause of your pain, there's no harm in taking an over-the-counter anti-inflammatory medication—orally or vaginally, Gersh says. "These include drugs like ibuprofen and naproxen, plus compounded suppositories. Cannabidiol (CBD) suppositories and oral gel caps or sublingual drops can help too," she says. "Warm compresses [applied to your abdomen], with or without essential oils such as lavender, castor oil, or others can also be beneficial."
Topical or suppository CBD formulas are two-pronged, as they can be both anti-inflammatory and also work to reduce muscle tension, which Reeves notes are major causes of intravaginal pain. She recommends seeking out intimate products that feature CBD along with botanicals used to assist in blood flow. "Essentially, the more aroused you are, the more blood flow you have in your erectile tissue beds, and the more likely you are to experience pleasure and deeply satisfying orgasms," says Reeves.
5. Don't wait.
Don't wait till dysorgasmia starts interfering with your sex life on a deeper level. "The brain learns," DuFlo notes. "If you start experiencing anxiety or fear related to pain while having sex, your brain can centralize that feeling and start clamping down those muscles even more." Putting it off could just perpetuate the vicious cycle.
The bottom line.
If you have a hunch that dysorgasmia is happening to you, too, speak to your doctor. Painful orgasms aren't something you should just shove under the covers—you deserve to have satisfying sexual experiences that aren't uncomfortable or painful.
"People should be able to achieve orgasm without pain," DuFlo says. Painful orgasms aren't normal, period. If your pain is recurring, tune in to your body's signals and get a checkup.
While it may take some time, effort, and energy to get to the bottom of what's causing your discomfort, know that treatment—and pain-free pleasure—are in reach.
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