What Causes Painful Orgasms? Dysorgasmia, Explained

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. 

"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.

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.

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.

There is an expansive range of potential causes of dysorgasmia, both physical and emotional, and sometimes both factors may be at play: 

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. 

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.

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.

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). 

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. 

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. 

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. 

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.

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. 

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.

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:  

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. 

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." 

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."

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.

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. 

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.