Why Does Sex Hurt During Pregnancy?

While some pain during sex is totally normal and not a sign of a problem, it can still be uncomfortable. Let’s take a look at what could be causing that pain and what you can do about it.

Round ligament pain is a type of internal pelvic pain caused by the round ligaments–cordlike structures that connect the front of the uterus to your groin. This can feel like a sharp pain during or after sex, and may be exacerbated by certain positions.

Hormonal Changes

A growing baby and the surge of hormones that go with it can make you feel tender, increase your risk for infections such as bladder, yeast or bacterial vaginosis and lower your libido.

Hormonal changes can also increase the blood flow to the pelvic area, which can cause sensitivity and pain for some women during sex, especially in their first trimester. If this is the case for you, try using lubricant to ease the pain.

The uterus becomes heavier and bigger as pregnancy progresses, which can cause discomfort in your pelvic area, Levitt says. Your round ligaments—which connect the uterus to your pelvic bones—are stretched during pregnancy, too. The combination of all these things can feel like a deep ache or cramping during sex, especially when you have to change position suddenly or move your legs a lot.

Swelling in your labia (the outer and inner “lips” of your vulva) can also add to the discomfort, she says.

Some sex discomfort is normal, but if it’s too painful to have sex or you are having trouble staying asleep, it’s time to talk to your doctor. A few simple adjustments—such as switching positions, using pillows and lubricant and taking it slow—can help alleviate the pain. Also, be sure to tell your doctor if you have pain or bleeding during sex. This can indicate that something isn’t right and could harm the fetus.

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Vaginal Changes

A growing baby creates pressure in the abdomen and pelvis, and that can cause your vulva to swell. This can also lead to pain during sex, especially in certain positions. Using pillows, experimenting with different positions and using lubricant can help alleviate the discomfort.

Another thing that can happen is that your ligaments tighten, causing a burning sensation during intercourse. It’s best to talk to your doctor about this because it could be a sign of an infection, such as a bladder or yeast infections or even a pelvic inflammatory disease, explains Jimmy Belotte, MD, OB-GYN in the Department of Obstetrics and Gynecology at Montefiore Health System. If you’re also experiencing a strong urge to pee or have a burning sensation when you’re urinating, that’s a red flag as well.

Generally, painful sex during pregnancy isn’t anything to worry about, as long as it doesn’t last more than an hour and there’s no bleeding. In rare cases, though, the pain could be a sign of something more serious, like a genital infection or ectopic pregnancy (which is dangerous for both you and your unborn baby). But again, this isn’t very common. Usually, the cause is hormonal or physical changes. It’s a good idea to communicate with your partner and reassess the situation if it gets worse. You can always try a few different strategies, like sex with the help of pillows, using lubricant and experimenting with positions that are less painful.

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Uterine Changes

During the first trimester, a uterus that is growing larger may cause discomfort during sex because of increased pressure on the pelvic ligaments. This can also lead to a deep aching feeling in the pelvic area. Some women describe this as a feeling similar to the menstrual cramps they had before they were pregnant. This sensation can be relieved by using a water-based lubricant and trying different positions during sexual intercourse.

In the second trimester, a baby’s weight can add to pelvic discomfort because of increased pressure on the bladder and round ligaments. Women can relieve this pressure by drinking more fluids and by lying on their left side during sex or using a pillow to elevate their head and back.

Later in pregnancy, a hormone called relaxin can stretch the pelvic ligaments and widen the cervix. This can make sex feel uncomfortable or painful, especially during orgasm because of the contractions that occur during this time. The pain can also be caused by a hormone-like substance in semen known as prostaglandins.

Infections are another possibility for pain during sex, particularly urinary tract infections and yeast infections, since these conditions can be more common during pregnancy because of higher estrogen levels. A woman who experiences sex pain or burning should visit her OB/GYN for a diagnosis and treatment with a pregnancy-safe antibiotic.

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Pelvic Floor Changes

When you’re pregnant, it can feel like the entire pelvic floor is going through major changes. Your cervix may become drier due to pregnancy hormones and the pressure of the expanding uterus can make it easier for blood vessels to rupture, especially in the area around your vulva and labia (the erogenous zones). These changes may cause pain, soreness and even occasional light bleeding during or immediately after orgasm. This type of pain is usually not a cause for concern, but can be uncomfortable.

If you’re having pain or discomfort in these areas, try experimenting with different positions and using a water-based lubricant to see if this helps. It’s also important to talk it over with your partner and be honest if you’re having trouble—this can lead to solutions that work for both of you, such as a different position or massage.

Finally, if you’re experiencing pain during sex that is not related to any of these changes, it may be time to call your doctor. A urinary tract infection or yeast infection can also cause pain and burning during sex and are more likely to occur during pregnancy because of higher estrogen levels. These infections can be treated with a pregnancy-safe antibiotic. Your doctor will diagnose the problem and prescribe a course of antibiotics.

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