Sex is supposed to feel good. But sometimes…it doesn’t. When that happens, experts call it dyspareunia—aka, doctor speak for recurring pelvic discomfort that happens before, during, or after intercourse. While this can feel different for everyone, dyspareunia typically feels sharp or throbbing and can happen only during sex or with other types of penetration, like putting in a tampon. This pain can either last for a few minutes or a few hours, depending on the person, but if you’re constantly asking, “Why does my uterus hurt after sex?” there could be an underlying culprit.

No matter what is causing your pain after sex, it shouldn’t necessarily be considered “normal,” Lauren Streicher, MD, an OB/GYN and medical director of community education and outreach at Midi Health, tells Well+Good.

That said, let’s take a look at the most common culprits behind uterus pain after sex—from infections to lack of lubrication and more—and what you can to do make sex feel more…satisfying.

10 reasons why your uterus hurts after sex

Pain after sex can be deep, likely stemming from your uterus (aka your womb), but it can also be shallow and stem from organs such as your cervix or vaginal opening. No matter the pain, there is likely an underlying cause. Here are some of the top reasons for your pain, and how to treat each.

1. You may have endometriosis

Endometriosis, a disorder where tissue similar to the lining of the uterus grows outside of the uterus, is one of the most common causes of painful sex, says Amir Marashi, MD, a New York City-based OB/GYN and founder and CEO of Cerē. This is especially true if you’re in sexual positions that involve deeper penetration—like doggy style or where your knees are near your chest. Apart from dyspareunia, the Mayo Clinic says endometriosis can make your periods painful and heavy, cause painful bowel movements, or cause infertility issues (i.e., trouble getting pregnant).

How to treat it

If your symptoms resemble that of endometriosis, reach out to your healthcare provider. They can prescribe medications—like birth control—to help manage pelvic pain and heavy periods. In some cases, surgery to remove endometrial lesions may be required.

2. You might have a tilted uterus

1 in 4 people with a uterus has something called a “tilted” or “retroverted” uterus—which means the organ is positioned backward toward the rectum rather than forward toward the abdomen. While there’s nothing dangerous or unhealthy about a tilted uterus, it can make deeper penetrative sex positions uncomfortable, says Rebecca Keith, MD, a board-certified OB/GYN with Pediatrix Medical Group in Elizabethtown, Kentucky.

How to treat it

You can’t change the tilt of your uterus, unfortunately. But switching it up in bed can make a difference. If positions like doggy style or missionary with your legs up are uncomfortable, try coming on top so you can control how deep things go, Dr. Keith recommends. Other good options: Lay side to side and have your partner enter you from behind, or try missionary with your legs lowered down.

3. It’s from an orgasm

Orgasms (i.e., the height of sexual arousal followed by small, pleasurable pelvic contractions) are supposed to feel good, but certain underlying conditions can make them painful instead. One of the most common conditions that cause painful orgasms is pelvic floor dysfunction, or when tight pelvic floor muscles can cramp and contract during orgasm to cause pelvic pain.

How to treat it

If you’re experiencing painful orgasms, it might be from pelvic floor issues which can be relieved through something called pelvic floor therapy. During this type of physical therapy, your practitioner will help you identify which pelvic floor muscles are too tense and show you exercises to stretch and strengthen those muscles.

4. You may have vaginismus

Vaginismus is a condition where your vaginal muscles tense or spasm involuntarily during penetrative sex or a gynecologic exam, which can cause pain. (In some cases, it can make it impossible to have penetrative sex.) The National Library of Medicine says this condition can happen to people with a history of sexual trauma or abuse, or to people who have an abnormal response to physical pain.

How to treat it

Treatment for vaginismus usually involves a multi-pronged approach to make you less sensitive to penetration. Common therapies include pelvic floor exercises to relax your muscles or sex therapy exercises like vaginal dilation (i.e., using a medical-grade tool to stretch and expand the opening of the vagina).

Because vaginismus can also stem from a history of abuse or other trauma, seeking help from a mental health professional in the form of talk therapy may help ease symptoms and reframe your narrative around sex.

5. It might be interstitial cystitis

Round-the-clock pelvic pain (including during sex) paired with nonstop peeing and urgency (think 60+ times a day) could be a sign of interstitial cystitis, a chronic condition where bladder inflammation messes with your normal “gotta-pee” signals. As a result, you feel like you need to pee pretty much nonstop. Interstitial cystitis can also cause symptoms like vaginal burning, difficulty peeing, or blood in the urine.

How to treat it

A combination of treatments can help relieve interstitial cystitis pain. Discovering what triggers a flare-up (i.e., certain foods or beverages, holding in your pee, exercise, etc.) and avoiding or limiting those things can help. Your healthcare provider may also recommend pelvic floor therapy or medications like antidepressants or antihistamines to reduce inflammation and the urge to pee.

6. It might be an infection

If you have an infection of any kind “down there” (namely, yeast infections, bacterial vaginosis, a sexually transmitted infection (STI), etc.), you’re probably going to have some pain, itching, and burning that gets worse after sex. Additionally, infections can cause a thick or smelly vaginal discharge (that’s different from your “normal” discharge). The American College of Obstetricians and Gynecologists (ACOG) notes that any difference in discharge color, consistency, or odor is worth looking into with your healthcare provider.

Keep in mind that some infections can also progress and cause symptoms like fever, chills, or fatigue.

How to treat it

Visit your healthcare provider if you think you have any kind of vaginal infection. If you think you have an STI, in particular, you can also get tested at your healthcare provider’s office or local health clinic. The ACOG notes most infections need to be treated with antibiotics, and the sooner you start them, the sooner you’ll get relief.

7. It’s from pelvic inflammatory disease

Pelvic inflammatory disease (PID) is a condition that often stems from an untreated STI—like gonorrhea or chlamydia—and causes inflammation around your cervix, which can make sex and urination painful. Other common symptoms to look out for include ongoing lower abdominal pain, a fever, foul-smelling discharge, or irregular periods, according to the Office on Women’s Health.

How to treat it

PID is also an infection that requires antibiotics to heal. If you think you have PID, visit your healthcare provider for STI testing and treatment. Untreated PID can get worse and lead to possible long-term complications such as infertility, ectopic pregnancy (when fetal tissue grows outside the uterus), or chronic pelvic pain.

8. You may have ovarian cysts

Sometimes, your ovaries (small reproductive organs that store eggs) can develop fluid-filled sacs called cysts. While they’re usually harmless, ovarian cysts can cause symptoms like one-sided abdominal pain which comes and goes (including during sex), bloating, and a feeling of abdominal pressure or fullness. It’s rare, but in some cases, ovarian cysts can burst and cause severe pelvic pain and bleeding which may require medical treatment.

How to treat it

If you have all the symptoms of an ovarian cyst, check in with your healthcare provider. While some cysts go away on their own, others may grow larger and require surgery to remove them. Additionally, if you have sudden or severe pelvic pain, fever, vomiting, weakness, or lightheadedness, seek emergency medical attention. This could mean that a cyst has ruptured or burst.

9. It’s from uterine fibroids

Fibroids are benign (harmless) growths that form on the lining of the wall of the uterus. While they’re typically known for causing symptoms like heavy and painful periods or making your abdomen feel oddly full, they can sometimes cause lower back, pelvic, or abdominal pain during sex. In some cases, people may not even know they have fibroids at all because they don’t have symptoms.

How to treat it

Treating uterine fibroids will depend on how much they are affecting your life. If the fibroids are small and range from “not noticeable” to “mildly uncomfortable,” your healthcare provider might suggest taking over-the-counter pain relief medication (like Ibuprofen) or getting hormonal birth control to relieve symptoms. Larger fibroids that cause intense pain, however, may need to be surgically removed.

10. You could be ovulating

In some instances, uterus pain after sex could be from ovulation. For most people with a uterus, ovulation (i.e., when an ovary releases an egg) happens each menstrual cycle—about halfway between their periods. This process can sometimes cause one-sided abdominal pain or cramping, which can be felt if you’re having sex around the same time. For example, you might notice a brief twinge or sudden, sharp pain in your pelvic region while having sex, which goes away after a day or two.

How to treat it

Because ovulation pain is typically harmless and short-term, certain at-home remedies—like a heating pad or OTC pain medication—can ease discomfort. If your ovulation pain is interfering with your quality of life every menstrual cycle, reach out to your healthcare provider. They may prescribe certain birth control pills that stop ovulation, Dr. Streicher says.

How to prevent and treat uterine pain after sex

Of course, if anything feels uncomfortable or painful during sex, it’s best to stop, says Dr. Keith. Depending on how you feel, you and your partner (or on your own if you’re having a solo sesh) can decide when to try again (i.e. when you’re no longer in pain). Or, you may refrain from sex for a few days until you can get the problem checked out by a healthcare provider.

From there, treating and preventing uterus pain after sex will depend on the underlying cause. Here are some go-to options recommended by the experts:

• Changing sex positions: Again, sometimes switching sex positions makes a big difference. Skip the deeper penetrative ones (like doggy style or ones where your knees are up by your chest) and go for something where you can control how deep your partner goes, like you on top, Dr. Marashi recommends. Standard missionary or side-lying positions are good, too.
• Heat: A heating pad or hot water bottle draped over your lower abdomen may help relieve cramping, Dr. Keith says.
• Pain relief meds: OTC options like Motrin, Aleve, or even Midol can also help with minor cramping or irritation, says Dr. Keith.
• Pelvic floor therapy: Conditions like pelvic floor dysfunction, interstitial cystitis, and vaginismus often respond to pelvic stretching and strengthening exercises.
• Medications: If you have an underlying condition like endometriosis or fibroids, your healthcare provider might prescribe hormonal meds. They’ll also recommend antibiotics for an infection.
• Surgery: In some cases, issues like endometriosis and fibroids may need surgical treatment if they don’t respond to medications.

When to see a healthcare provider

A slight twinge of pain from a certain sex position isn’t likely cause for concern, especially if the pain goes away when you switch to something different. But if you’re experiencing frequent discomfort or pain from sex, you should let your healthcare provider know.

“Sex should not be painful,” says Dr. Streicher, and you shouldn’t ever feel like you have to “muscle” through it. Together, you and your healthcare provider can talk through your symptoms to figure out the underlying issue, and decide on how to treat it, so sex (whether solo or with a partner) can feel good again.