Possible causes of painful orgasms

When you think of orgasms, you typically think of pleasure. However, for some people orgasms range from just okay to downright painful.

Officially known as dysorgasmia, painful orgasms are something someone of any anatomy can experience.

Dysorgasmia is defined as a painful orgasm, but without any prior pain during sexual intercourse. The pain often manifests as a cramping sensation in the pelvis, buttock(s) or abdomen. The duration of pain can last from seconds to minutes to several hours.

“Interestingly, most peer-reviewed articles relating to dysorgasmia appear to be studying the phenomenon in males after radical prostatectomy – surgical removal of the prostate gland, usually for prostate cancer,” acknowledges consultant venous surgeon Professor Mark Whiteley.

“In females, dysorgasmia has only been reported in scientific journals following removal of the rectum and colon as a child with reconstruction of the bowel (proctocolectomy), in women with long-term type I diabetes (insulin-dependent diabetes) and in one woman following removal of an embryological cyst intimately lying between her bladder and belly button (urachal cyst),” adds Prof. Whiteley.

Lack of scientific study does not make the issue any less real or frustrating though. If you are experiencing what you think is dysorgasmia, it’s important to seek help as it could be a signal from your body that there’s an underlying condition or pelvic floor issue that you should get checked out.

What does it feel like?
Dysorgasmia symptoms can vary, but it often feels like cramping.

It may also feel like a muscle spasm in your abdomen or a strange pulling sensation deep within your pelvic floor. The pain itself can range from mild to severe, and the onset and duration of pain can 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. Other times, people will have delayed pain. They may have achiness, tightness, gnawing pain, or dull pain afterwards. It might start 15 minutes later, it might start four hours later, or they may just notice it throughout the following day,” says pelvic floor physiotherapist Samantha DuFlo.

It’s different to pain during sex
Painful orgasms often get lumped into the medical category of ‘pain with sexual intercourse’ but they’re different experiences.

“There is overlap with these two conditions, but it is important to recognise that painful intercourse is not the same as painful orgasms,” says gynaecologist Dr Felice Gersh.

To help identify which type of pain you may be experiencing, try to notice when you feel the pain. Are orgasms painful when you reach climax on your own, or more often following intercourse with a partner?

Read more: How to cope with painful sex

Causes of painful orgasms

Pelvic floor dysfunction
By far, the most common cause of dysorgasmia in those with vulvas is pelvic floor dysfunction.

If the muscles in your pelvic floor are very short and tight, an orgasm can repeatedly pull on those muscles causing residual pain.

Tight pelvic floor muscles can come as a result of frequent exercising.

“I see a lot of athletes who are undergoing significant strength and endurance work, and their pelvic floor muscles end up being really tight,” Ms 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.”

Read more: The importance of core strength

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.

Endometriosis is an often painful disorder in which tissue similar to the tissue that normally lines the inside of your uterus – the endometrium – grows outside your uterus. This causes scar tissue build-up in and around the pelvis that can be incredibly painful during sex or orgasm.

The primary symptom of endometriosis is pelvic pain.

Like endometriosis, adenomyosis is a uterine lining problem; but in this case endometrial tissue exists within and grows into the uterine wall.

Adenomyosis most often occurs late in childbearing years and typically disappears after menopause.

Sometimes, adenomyosis may cause heavy or prolonged menstrual bleeding, severe cramping, pain during intercourse or blood clots that pass during a period.

Pelvic inflammatory disease (PID)
PID occurs when an infection spreads from the vagina to the cervix, the endometrium and the fallopian tubes. The infection is usually sexually transmitted but it can also occur after a ruptured appendix or a bowel infection.

PID is often called the ‘silent epidemic’ because it is common among sexually active women but does not always cause symptoms. About 10,000 women in Australia are treated for PID in hospital each year and many more are treated as outpatients.

Symptoms can include pelvic pain during urination or sex, bleeding during sex, as well as fever and a change in discharge.

Uterine fibroids
Fibroids are noncancerous tumours 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.

Ovarian cysts
If you are suffering from ovarian cysts, 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 localised more on one ovary (left or right).

Read more: How to find and exercise your pelvic floor muscles

Interstitial cystitis
This chronic condition can cause bladder pressure, bladder pain and sometimes pelvic pain. The pain ranges from mild discomfort to severe pain.

It’s often mistaken for a urinary tract infection but is actually a chronic bladder condition.

It can result in a frequent urge to urinate, pelvic pain or pressure, and major discomfort during sex or orgasm due to an irritated, inflamed bladder.

What to do about it
Dysorgasmia is not something that you just have to live with, once the underlying cause is identified, treatment can help.

First, book an appointment with your GP to discuss your symptoms, they’ll often want to run some tests to try to find the root of the problem.

Once you’re equipped with the right information, pelvic floor physical therapy can be great at 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.

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.

Have you ever experienced dysorgasmia? Tell us in the comments section what you would say to a friend experiencing the same thing.

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Disclaimer: This article contains general information about health issues and is not advice. For health advice, consult your medical practitioner.

Ellie Baxter
Ellie Baxter
Writer and editor with interests in travel, health, wellbeing and food. Has knowledge of marketing psychology, social media management and is a keen observer and commentator on issues facing older Australians.
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