Sex is supposed to feel good, not painful. However, pain before, during or after sex is very common and can vary from person to person.
Usually, the cause of the pain can be found and remedied. Some easy fixes include using more lube, changing positions or having shorter sessions. Other causes may be more serious and could require medical attention.
Muscle strain
A muscle strain is an injury that happens when you stretch a muscle past its normal range and it begins to tear. It’s also known as a “pulled muscle.” You can strain any type of muscle in your body, but they are more likely to happen after vigorous workouts or playing sports.
Muscle strains can vary from mild to severe based on how many muscle fibers are injured. A grade I strain is the mildest, affecting only a few muscle fibers. This causes tenderness and a decrease in strength, but you can still use the muscle.
A grade II strain affects more muscle fibers and is characterized by more pain, swelling and a decrease in strength. A grade III strain is the most severe and requires medical attention. Your doctor may prescribe anti-inflammatory medications and pain relievers to reduce swelling and discomfort. They may also recommend rest, physical therapy and exercises to strengthen the affected muscle. Symptoms typically last a few weeks or less with at-home treatment. You can speed up your recovery by gradually returning to activity and taking steps to prevent strains, like warming up with light stretches before intense exercise.
Cramps
Cramps occur when muscles contract and tighten unnecessarily. They usually feel like the muscles are being pulled by a bowling ball and can be relieved by stretching, drinking water, and taking over-the-counter pain relief medication. Muscle cramps may also be a sign of a serious medical condition, so anyone who experiences them should seek immediate care from their doctor.
For women, cramps that happen during or after sex may be a normal physiologic response to an orgasm. Hormone-like substances that cause muscle contractions are released during an orgasm, and these chemicals can trigger uterine muscles to contract and expelling the uterus lining. The resulting cramps are known as menstrual cramps. Women with conditions such as endometriosis, uterine fibroids, or pelvic inflammatory disease may also experience cramps during or after sexual activity.
In males, STIs including chlamydia, gonorrhea, or herpes can cause pain in the genital area during or after sexual activity. Cramps may also be a symptom of a blockage in the tubes that carry semen from the testicles to the penis called erectile dysfunction or a blocked urethra.
Nerve compression
During sexual activity, certain positions or movements can compress nerves in the legs, causing pain or tingling sensations. This type of leg pain usually occurs at specific anatomical sites and resolves on its own once the positions or movements are adjusted.
If the compression is caused by a condition like herniated discs, this can be permanent and will need physical therapy or surgery to relieve. This is another reason why it is so important to see a medical professional who can diagnose the underlying cause and recommend treatment.
Nerve damage or dysfunction (neuropathy) can also trigger painful sex or dyspareunia. This can occur due to a number of underlying causes, including diabetes, vitamin deficiencies, infections, or trauma. Sexual activity can exacerbate neuropathic symptoms, leading to pain or tingling in the legs and feet. Managing the underlying cause of neuropathy and working with a specialist can help alleviate these symptoms.
Increased blood flow and pressure during sexual arousal may exacerbate pre-existing vascular concerns, such as varicose veins or venous insufficiency. Using a lubricant can enhance comfort during sexual activity and minimize friction, which may lead to aches in the legs.
Vascular concerns
During pregnancy, the uterus increases in size, resulting in increased blood flow and pressure on the pelvic and leg veins. These changes can sometimes cause pain after sexual activity. Often, this is due to muscle cramping. This type of cramping is a result of excessive muscle exertion and can be alleviated with hydration, rest and gentle stretching.
Nerve compression may also occur. This is often caused by certain sexual positions or movements that compress or irritate nerves in the legs. It may be aggravated by preexisting conditions such as neuropathy, peripheral artery disease (PAD) or varicose veins. Managing the underlying condition and taking medications to control nerve pain can help reduce this discomfort.
In men, pain after sex can be caused by a number of factors, including prostatitis, prostate cancer, certain medications (such as beta-blockers), and polycystic ovary syndrome (PCOS). Symptoms of PCOS include decreased libido and difficulty in getting and maintaining an erection. Addressing these concerns through lifestyle changes, medication and hormone therapy can often improve symptoms. Other reasons for male discomfort during and after sexual activity include erectile dysfunction, anal pain and pelvic floor dysfunction.
Deep vein thrombosis
If a blood clot forms in one of your deep veins in the leg, thigh or pelvis, it’s called a blood clot in a deep vein (DVT). DVT causes a clog that limits blood flow and makes the area around the clot swell. If a piece of the clot breaks off and moves to your lungs, it’s called a pulmonary embolism (PE). PE can cut off blood flow to your lungs and cause serious illness and even death.
Anything that keeps blood from flowing or clotting normally can lead to DVT. This includes having an inherited (genetic) condition that increases your risk, surgery or long periods of immobility like a multi-hour plane ride. It can also happen if you have cancer or its treatments, and certain medications such as corticosteroids and some antibiotics.
Sexual activity can temporarily increase blood flow and change your normal body position, which may make you more susceptible to symptoms of DVT such as swelling and pain in the calf or thigh. Get medical help right away if you have these symptoms.
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