What causes painful sex during pregnancy?

If you have been experiencing pain during sex while pregnant, please know that you are not alone and while it is common you don’t have to just live with it. It may feel too private to bring up with your doctor, and a lot of health care during pregnancy tends to focus on the baby. However, there are several valid reasons, medical or otherwise, why sexual intercourse is painful and there are steps you can take to mitigate that pain.

Some potential causes are:

Hormonal changes

Being pregnant causes rapid changes in hormone levels, and these hormonal shifts may create vaginal dryness and/or sore breasts and nipples that are painful to the touch. Using a lube can help with the dryness, and you may want to keep a bra on during sex to keep your breasts from too much movement or touch.  

Increased sensitivity in the pelvis 

During pregnancy, there is also increased blood flow to the pelvic region which causes increased sensitivity. This increased sensitivity can lead to more painful or uncomfortable vaginal intercourse. You can try different positions that put less pressure on the pelvis (side by side or ‘spooning’, for example), or place pillows under your hips to change the angle of your pelvis.

Round ligament stretching

There are two ligaments on either side of the uterus known as the round ligaments, which get stretched while you are pregnant. It can feel like a deep ache or cramping and may increase in intensity during sudden movement (ie. sneezing or standing up quickly). 

Extra pressure on the bladder

As anybody who has been pregnant can attest, the baby creates extra pressure on your bladder which can feel uncomfortable or painful during sex. Again, trying different positions or using pillows can help to alleviate that discomfort.  

Increased risk of infections

A side effect of pregnancy is that you are more susceptible to things like bladder infections and bacterial vaginosis (which usually presents as a discharge and/or a burning or itching sensation). If you are dealing with inflammation and pain from an infection in the pelvic area then sex is going to be uncomfortable. Fortunately, most infections can be cleared up with antibiotics. See your doctor or a health care provider right away if you think you may have an infection. 

Uterine contractions causing cramping

During orgasm the uterine walls contract and if the contractions are strong enough it can feel like cramping, similar to what is experienced during the menstrual cycle. These contractions can also be caused by a hormone-like substance in semen called prostaglandins. While there isn’t much that can be done to prevent this, the cramping should fade fairly quickly. Deep breathing and using a heat pack (no longer than 20 minutes) can also be helpful to alleviate pregnancy-related aches, soreness, and pain. If the pain is especially severe or lasts for more than an hour it’s best to seek medical care to make sure there isn’t a more serious issue at play. 

Increased stress & anxiety

Being pregnant is wonderful, but it can be stressful and anxiety-inducing as well. The body is undergoing a lot of changes and physical stress, and that can take a toll on mental health.

You may not be sleeping very well, and there is a lot to prepare before the baby arrives. Sex can feel like another item on an already overwhelming to-do list, with the added challenge that you may not be feeling very well or just not like yourself right now.

When we are stressed out or anxious, our nervous system shifts, sensations that once felt pleasurable can feel uncomfortable or even painful and we can tense up and tighten our muscles, especially the muscles of our pelvic floor. This is one of the most common reasons people experience pain during sex whether they are pregnant or not.

Talking with someone about what you’re experiencing is incredibly helpful, and this is what I do. If you’re feeling anxiety and stress or discomfort around sex and you’d like guidance from someone who understands the mental, physical, societal, and relationship dynamics that impact your enjoyment of sex and intimacy, please don’t hesitate to reach out, I’m here to support you.

Common causes of pain during sex by trimester

While issues can present themselves at any time during pregnancy, here are the most common reasons for pain during sexual intercourse by trimester.

First trimester:

During your first trimester, you are most likely to experience painful intercourse due to uterine contractions that lead to cramping, increased pressure on the bladder, and/or physiological changes related to stress and/or anxiety. 

Second trimester: 

The second trimester is when blood flow to the pelvis & sensitivity in the area increases. You may experience that deep aching feeling in the pelvic region due to round ligament stretching. You are also at increased risk for infections during this time. 

Third trimester: 

As the baby grows there is increased stretching of the uterus and the pelvis stretches out to prepare for childbirth, both of which can be uncomfortable. There can also be swelling of the labia or other tissue of the vagina. 

Don’t ignore painful sexual intercourse

Although pain during sex, while you are pregnant, is common, it should never be ignored. It’s important to remember that no matter what the cause of the pain is, you should always communicate with your partner about what currently doesn’t feel good and what you two can try instead. Sex doesn’t always have to be vaginal intercourse.

Not sure how to start the conversation about intimacy with your partner? Download my free guide: Let’s Talk About Sex below.

If you have any concerns that you may have an infection, you are bleeding more than normal spotting, or you have pain that lasts for more than an hour you should seek medical care.

If you’d like to talk to someone who understands the mental, physical, societal, and relationship dynamics that impact your enjoyment of sex and intimacy, let’s chat!

Schedule a free 20 min phone call with Dr. Rose and walk away with a roadmap of simple steps to get you feeling good in your body in and out of the bedroom!