Abdominal Pain After Intercourse: A Guide for Women

Q: Abdominal Pain After Intercourse: A Guide for Women

Hello： Women experience sexual arousal and orgasm during intercourse, during which the autonomic nervous system and sensory motor nerves are activated. <br>The excitation of the parasympathetic nervous system can lead to gastrointestinal motility and flatulence. <br>If there has

Abdominal pain during and after intercourse. Gastroesophageal reflux?

Hello Doctor: Eight years ago, I had pelvic inflammatory disease and was treated with antibiotics, which resolved the issue.
However, since then, I have frequently experienced abdominal pain.
I surprisingly improved after seeing a traditional Chinese medicine practitioner, but I still occasionally have abdominal pain and lower back discomfort when not taking herbal medicine.
During these eight years, I have had sexual intercourse less than ten times.

On September 27, 2015, I experienced pain during intercourse, followed by four days of persistent lower abdominal heaviness, back pain, frequent urination, and pubic pain.
On October 1, I went to the hospital for an ultrasound, blood tests, urinalysis, pelvic examination, Pap smear, and Chlamydia screening, all of which were normal.
The doctor suspected adhesions and recommended laparoscopic surgery, but considering I had never given birth, surgery was not performed.
Instead, on October 15, the doctor prescribed Lidaixin (Lidocaine) and a gastric medication.
I felt about 80% better after the first day, but after four days, I experienced severe abdominal pain again after intercourse.
After a follow-up on the sixth day, the doctor advised me to take one more day of medication, and after completing the seventh day, I inexplicably felt completely better, with all symptoms disappearing.
On October 24, 2015, after intercourse, I experienced lower abdominal pain again.
I took an antispasmodic medication, which helped for half a day, but then the pain returned severely for ten days.
On November 3, I returned for a follow-up and was prescribed Lidaixin and a gastric medication again, but the effect was not as good this time, and it took ten days to improve.

Subsequently, during intercourse, I would only go halfway, experiencing lower back pain and abdominal pain for two days, which would resolve on its own, but I began to experience nausea and reflux.
On December 2, 2015, I developed a sore throat, and after an endoscopy, I was diagnosed with mild gastric mucosal erosion combined with gastroesophageal reflux and esophageal burns.

This continued until June 1, 2016, when I had been taking PPI (proton pump inhibitor) medications for four months, but the symptoms kept recurring.
I noticed that abdominal pain occurs whenever I am sexually aroused, and after orgasm, I also experience abdominal pain.
The next day, I would have acid reflux up to my throat.
For the past three to four months, whenever I have intercourse, I feel a pain as if my intestines are being hit, my stomach makes noises, and afterward, it feels heavy and stiff as if filled with stones, leading to heartburn the next day.

Currently, my esophagus has become more severely burned.
Sometimes, the heartburn can be relieved by orgasm, while at other times, orgasm triggers the heartburn.
I am very puzzled about the correlation between these symptoms.
Which specialist should I see? How should I be treated? Please help me, I would be very grateful!

Pelly, 30~39 year old female. Ask Date: 2016/05/31

Dr. Yang Wangjun reply Obstetrics and Gynecology

Hello: Women experience sexual arousal and orgasm during intercourse, during which the autonomic nervous system and sensory motor nerves are activated.
The excitation of the parasympathetic nervous system can lead to gastrointestinal motility and flatulence.
If there has been a history of pelvic inflammatory disease causing intestinal adhesions, normal peristalsis may be disrupted during intercourse, resulting in twisting pain or abdominal distension.
Additionally, parasympathetic stimulation can increase gastric acid secretion and relax the sphincters, exacerbating symptoms of gastroesophageal reflux.
Your symptoms of pain during intercourse suggest gastrointestinal issues; it may be worthwhile to consult a gastrointestinal surgeon to investigate potential adhesions.
Thank you for your message!

Reply Date: 2016/05/31

More Info

Understanding abdominal pain after intercourse can be complex, especially for women with a history of pelvic inflammatory disease (PID) or other gynecological issues. Your symptoms, which include recurring abdominal pain, discomfort during intercourse, and gastrointestinal issues, suggest a multifaceted problem that may involve both gynecological and gastrointestinal systems.

Firstly, pelvic inflammatory disease can lead to scarring and adhesions in the pelvic cavity, which may cause chronic pain. These adhesions can result in abnormal connections between organs, leading to pain during sexual activity, as well as discomfort in the lower abdomen. The pain you experience during intercourse, described as a "collision" pain, could be due to these adhesions or possibly endometriosis, which is a condition where tissue similar to the lining inside the uterus grows outside it.

Your experience of abdominal pain after sexual activity, along with symptoms like frequent urination and pelvic pressure, could also indicate bladder irritation or a condition known as interstitial cystitis. This condition can cause pelvic pain and urinary symptoms, often exacerbated by sexual activity. The fact that you have experienced nausea and gastroesophageal reflux symptoms, particularly after sexual excitement or orgasm, suggests a possible connection between your gastrointestinal and reproductive systems. The increase in abdominal pressure during orgasm can lead to reflux symptoms, especially if there is a pre-existing condition like gastroesophageal reflux disease (GERD).

Given the complexity of your symptoms, it is advisable to consult with both a gynecologist and a gastroenterologist. A gynecologist can evaluate for conditions such as endometriosis or pelvic adhesions, while a gastroenterologist can assess your gastrointestinal symptoms, including the esophageal irritation and reflux you are experiencing.
In terms of treatment, managing your symptoms may require a multidisciplinary approach. For gynecological pain, options may include hormonal treatments, pain management strategies, or even surgical interventions if adhesions or endometriosis are confirmed. For gastrointestinal symptoms, lifestyle modifications such as dietary changes, weight management, and medications to control acid reflux may be beneficial. Proton pump inhibitors (PPIs) can be effective for GERD, but they should be monitored by a physician to avoid potential long-term side effects.

Additionally, pelvic floor physical therapy may be beneficial in addressing pain during intercourse and improving pelvic muscle function. This therapy can help alleviate tension in the pelvic area, which may contribute to both abdominal and sexual discomfort.

In summary, your symptoms are likely interconnected, involving both gynecological and gastrointestinal factors. A thorough evaluation by specialists in both fields will be essential in developing an effective treatment plan tailored to your specific needs. It is important to communicate all your symptoms clearly to your healthcare providers to ensure a comprehensive approach to your care.

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