Why do I experience lower abdominal pain after every sexual intercourse?

Experiencing lower abdominal pain after sexual intercourse—often described as “pain in the lower belly”—can have several potential causes, ranging from benign and transient to more serious underlying conditions. This symptom, medically termed *postcoital pain*, warrants careful evaluation, especially if it is recurrent, severe, or associated with other symptoms such as fever, abnormal vaginal discharge, bleeding between periods, painful urination, or difficulty conceiving.

Common gynecologic causes include pelvic inflammatory disease (PID), often due to untreated chlamydia or gonorrhea; endometriosis, where endometrial-like tissue grows outside the uterus and may become irritated during intercourse; ovarian cysts (particularly large or ruptured ones); uterine fibroids, especially subserosal or pedunculated types that can twist or press on surrounding structures; and adenomyosis, which involves infiltration of endometrial glands into the myometrium and can cause deep dyspareunia and crampy postcoital discomfort.

Non-gynecologic contributors may include urinary tract infections (UTIs), interstitial cystitis, irritable bowel syndrome (IBS), or musculoskeletal strain involving the pelvic floor muscles or abdominal wall—especially if intercourse involves vigorous movement or positions that stress these tissues. Less commonly, adhesions from prior surgery or infection, or even early pregnancy complications such as ectopic pregnancy, must be considered in appropriate clinical contexts.

A thorough evaluation typically begins with a detailed history—including timing, character, and location of pain; relationship to menstrual cycle; contraceptive use; and reproductive history—followed by a targeted physical examination, including speculum and bimanual pelvic assessment. Diagnostic testing may include urine analysis and culture, sexually transmitted infection (STI) screening, transvaginal ultrasound, and, in select cases, laparoscopy for definitive diagnosis of endometriosis or adhesions.

It is important not to dismiss recurrent postcoital pain as “normal” or psychological. Early identification and management can prevent complications such as chronic pelvic pain, tubal scarring, or infertility. Individuals experiencing this symptom should consult a healthcare provider—ideally a gynecologist—for personalized assessment and evidence-based care.