Yes, Painful Orgasms Are A Thing & We Need To Talk About It

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February 20, 2021 — 12:10 PM

If you've ever found yourself close to climax—only to feel a sharp or nagging pain right when you reach the top, or soon after—you may have experienced dysorgasmia. Also known as painful orgasm, this condition can be distressing (cue the alarm and anxiety of wondering where that pain is coming from or what caused it or how long it will last), especially considering it occurred while you were in the throes of an otherwise satisfying sexual experience.

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. 

Dysorgasmia is the medical term for pain experienced during or after orgasm, usually in the abdomen. "It's typically the result of a muscle contraction or spasm that involves the muscles of the pelvic floor or the uterus," notes Felice Gersh, M.D., OB/GYN, founder of the Integrative Medical Group of Irvine in California, and author of PCOS SOS Fertility Fast Track.

To understand the mechanisms here, it's helpful to clarify what an orgasm is at its core: a neurophysiological culmination ending with an involuntary muscle spasm. Of course, there's more to that simplified story, but as to why the pain occurs? "Physiologically speaking, it's similar to how if you were to contract the muscles in your arm, there's a release and relaxation of those muscles afterward," notes Samantha DuFlo, DPT, PRPC, a pelvic floor physiotherapist and founder of Indigo Physiotherapy in Baltimore. With an orgasm, if those pelvic muscles that contract during orgasm don't fully release afterward, it can lead to pain and tightness. 

Painful orgasms can be a common occurrence for adults, no matter their age or sexual anatomy. Unfortunately, Gersh says statistics on dysorgasmia are rarely kept, but in her practice, she typically sees a new patient with painful orgasms once every two months. Pain with sex in general (called dyspareunia) is much more common: At least 10 patients per month seek her help for this issue, and research has found the global prevalence of dyspareunia to be between 8 and 21%. 

"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.

While the pain of dysorgasmia can be different for everyone, if you've ever experienced menstrual cramps, general abdominal cramps, ovulation pain, or pain related to endometriosis, then you're in the neighborhood. 

Dysorgasmia may feel like a muscle spasm in your abdomen (similar to the type you'd get from menstrual cramps) or a strange pulling sensation deep within your pelvic floor. The pain itself can range from mild to severe, and onset and duration of pain can also 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," explains DuFlo. "Other times, people will have delayed pain. They may have achiness, tightness, gnawing pain, or dull pain afterward. It might start 15 minutes later, it might start four hours later, or they may just notice it throughout the following day."

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.

In the wider medical community, painful orgasm often gets lumped into the broader category of "pain with sexual intercourse," but they're actually distinct experiences. 

"There is overlap with these two conditions, but it is important to recognize that painful intercourse is not the same as painful orgasms," Gersh says. "Orgasms achieved without intercourse can help make this distinction."

To test this theory, try to notice if your pain with orgasm happens while masturbating and reaching climax on your own—or if your pain occurs more often during or following intercourse with a partner. 

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.

By far, the most common cause of dysorgasmia in those with vulvas is pelvic floor dysfunction. Think of the muscles of your pelvic floor like a basket that supports your pelvic organs. "If those muscles are too short and tight, and then your orgasm causes a contraction that pulls on those muscles repeatedly, that can cause residual pain," DuFlo explains.

How to know if this is you? "People with really tight pelvic floors may have other symptoms, too: They can't use a tampon, or initial penetration can be painful, or they may have chronic constipation. Those are all signs that the pelvic floor muscles may be too tight or dysfunctional." 

That tightness could also be a result of fitness training. "I see a lot of athletes who are undergoing significant strength and endurance work, and their pelvic floor muscles end up being really tight," 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."

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. 

Don't overlook a history of emotional or sexual abuse as a reason for your pain: The mind-body (somatic) connection is powerful, and it's the previous experience of emotional pain or trauma that can sometimes cause the physical issue to endure. 

"We're learning more and more that the inherent link between our emotional and psychological well-being is deeply rooted in our bodies," says Kiana Reeves, somatic sex educator, pelvic care practitioner, certified doula, and chief brand officer at Foria. "Our emotional experiences are literally held in the body, and the body is essentially where the subconscious lives," she notes. 

"Relationship issues, stress, and sexual trauma are all potential psychological causes for experiencing pain [and deriving less pleasure] from sex," confirms Nazanin Moali, a Los Angeles–based sex therapist and the host of Sexology Podcast. 

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.

Once you're equipped with that information, pelvic floor physical therapy is a cornerstone of 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. But the exact techniques and tools used may depend on two factors: what type of pain you're having and when it occurs. 

Is your pain right at the moment of climax? Some preemptive manual therapy may be helpful, like using a dilator to help release muscle spasm or using yoga-based poses before having sex, such as a deep squat or happy baby pose, which can help stretch those hard-to-reach pelvic and hip muscles. 

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." 

If you have a hunch that your pain may stem even partly from emotional or sexual abuse, don't hesitate to reach out to a sex therapist who can help you heal. 

Even something as seemingly insignificant as being raised in a sex-negative household can mean you're holding on to internalized shame around sex, and that can make it hard for the mind to relax. That closed-off mental-emotional state can be translated into tension or tightness in your pelvic muscles when you're having sex. "A sex therapist can help people change the negative thoughts that might contribute to or amplify the pain," Moali says. Sex therapists can also offer tools such as relaxation exercises and guided meditations or visual imagery that can help with pain management. 

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."

While you're looking for answers to the root cause of your pain, there's no harm in taking an over-the-counter anti-inflammatory medication—orally or vaginally, Gersh says. "These include drugs like ibuprofen and naproxen, plus compounded suppositories. Cannabidiol (CBD) suppositories and oral gel caps or sublingual drops can help too," she says. "Warm compresses [applied to your abdomen], with or without essential oils such as lavender, castor oil, or others can also be beneficial."

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.

If you have a hunch that dysorgasmia is happening to you, too, speak to your doctor. Painful orgasms aren't something you should just shove under the covers—you deserve to have satisfying sexual experiences that aren't uncomfortable or painful.

"People should be able to achieve orgasm without pain," DuFlo says. Painful orgasms aren't normal, period. If your pain is recurring, tune in to your body's signals and get a checkup. 

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.