Painful Sex During Ovulation: Why It Happens & What You Can Do About It
When painful sex starts out of nowhere, it can be alarming — but most of the time, you do not need to worry about experiencing ovulation pain during sex. Ovulation pain that does not come with other symptoms (such as heavy bleeding) and that is not unusual for you can be considered normal.
Usually, ovulation pain lasts less than 48 hours. After that, you should be able to resume having sex normally without discomfort. For most women, this poses only a minor problem. They can simply work around their fertile window to have sex when it is more comfortable for them. But what if you are trying to conceive?
Women are only fertile for 24 hours after the release of an egg, meaning that it is critical to have sex during that window if you want to become pregnant. When you suffer from painful sex during ovulation, however, this can make the idea of having sex during your fertile window feel less than sexy.
Thankfully, there are a few things you can do to improve dyspareunia during ovulation to make sex more comfortable while you are trying to conceive. Read on to learn why sex may be painful during ovulation, when to worry about painful sex during ovulation, and how to cope with it when you want to become pregnant.
Causes of Ovulation Pain
Ovulation pain — also known as mid-cycle pain or mittelschmerz — occurs in approximately 20 percent of women. If ovulation pain lasts less than three days, is not accompanied by other symptoms, and is not out of the ordinary for you, there is no reason to worry about ovulation pain.
During ovulation, one of the ovaries releases an egg, which travels down the fallopian tubes until it reaches the uterus. Some women feel one-sided pain or soreness in the lower abdomen when the ovary releases an egg. It may switch sides between cycles, depending on which ovary releases the egg during ovulation. You might experience it every month or only occasionally.
Ovulation pain can feel like a sharp twinge, uncomfortable pressure, or intermittent cramps. In some women, it is accompanied by pain during sex. This pain can last anywhere from a few minutes to 48 hours. If it lasts longer than two days, it is more likely that your dyspareunia is due to a medical problem or sexual pain disorder, rather than ovulation.
The exact cause of ovulation pain is unknown, but there are some theories. Before ovulation, hormones prompt your ovaries to grow up to 20 follicles. Any of these follicles can swell and release an egg during ovulation. When the egg travels through the fallopian tubes to the uterus, the fallopian tubes may contract, which could be one possible cause of ovulation pain.
There are other possible causes of ovulation pain, too. Some people believe ovulation pain may occur because the growing follicle stretches the membrane covering the ovary prior to ovulation. Others think that ovulation pain occurs due to irritation from the slight amounts of blood or fluids released into the abdomen when the follicle ruptures to release an egg.
Unfortunately, it’s also unclear why some women suffer from ovulation pain, while others do not. Still, it may comfort you to know that ovulation pain is usually nothing to worry about. If you experience ovulation pain, make sure to keep an eye out for other symptoms of ovulation, such as stretchy cervical mucus (much like the consistency of an egg white) and breast tenderness. If you do not experience other symptoms, it may be more likely that your pain is due to another cause, rather than ovulation.
Other Causes of Mid-Cycle Pain
Ovulation pain can be normal, but cramping and dyspareunia in the middle of your cycle may not always be due to mittelschmerz. There are other potential causes of mid-cycle pain during sex, including:
Implantation occurs when the sperm fertilizes the egg. Sometimes, implantation can cause cramping and/or light pink or brown vaginal discharge. Pay attention to when you feel mid-cycle pain. If you are trying to conceive and you experience pain a few days before your period, rather than two weeks into your cycle, you might be experiencing implantation instead. Ovulation pain is not usually accompanied by bleeding, while implantation can be.
Normally, when a woman becomes pregnant, an egg travels through the fallopian tube to the uterus, and the sperm fertilizes the egg while it is in the uterus. Sometimes, however, sperm can travel up the fallopian tube to fertilize an egg when it has not yet reached the uterus. This can cause a fertilized egg to implant in the fallopian tube, known as ectopic pregnancy. Rarely, an ectopic pregnancy may also implant in the ovary, cervix, or a C-section scar.
Ectopic pregnancy can cause pelvic pain and dyspareunia. Unlike ovulation pain, it may also cause mid-cycle bleeding. You may also miss your menstrual period or receive a positive pregnancy test, as an ectopic pregnancy still releases the same hormones as a normal pregnancy. Your risk of ectopic pregnancy is higher if you become pregnant with an IUD in place, have had previous pelvic surgery, or become pregnant via in-vitro fertilization (IVF).
Many women develop an ovarian cyst after the dominant follicle releases an egg. Because this process happens around ovulation, you may confuse pain from an ovarian cyst with ovulation pain. The follicle fills with fluid and becomes the cyst, known as a functional ovarian cyst. You may experience other types of cysts — for example, if you have polycystic ovarian syndrome (PCOS) or endometriosis — but functional ovarian cysts are the most common.
Ovarian cysts may cause cramping, nausea, and/or bloating. Most ovarian cysts are harmless and will resolve without treatment after your menstrual period. However, if a cyst is abnormal or continues to grow, it may need to be removed. Cysts can also burst, which can become a medical emergency. Always see a medical provider if you experience a sudden, severe surge of pain that is out of the ordinary for you — even if it occurs during ovulation.
Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) results from inflammation of the pelvic organs. PID results from an untreated vaginal infection, such as bacterial vaginosis, or sexually transmitted infection (STI). When harmful bacteria from the vagina travels through the cervix, it can spread to the uterus and fallopian tubes, resulting in PID. PID may cause mild to severe pelvic pain and deep dyspareunia. Ovulation pain can definitely hurt, but it should not cause unusual vaginal discharge or fever. If you experience these symptoms, you should see a medical provider as soon as possible. Untreated PID can lead to scarring and infertility.
1 in 10 women has endometriosis, a condition where tissue similar to that of the uterine lining grows outside the uterus. This tissue bleeds during menstruation just like the endometrium, which can cause disabling pelvic pain and deep dyspareunia. Many people assume endometriosis pain occurs only during menstruation, but it can affect you at any time throughout the menstrual cycle. Endometriosis pain occurring in the middle of your cycle can be easily confused with ovulation pain, especially if it happens to you every month.
Unfortunately, endometriosis goes undiagnosed for years in many women; the average woman with endometriosis waits eight years between the onset of symptoms and diagnosis. Mid-cycle pain due to endometriosis can be treated via excision surgery, a laparoscopic procedure where a skilled minimally-invasive gynecologic surgeon removes endometriosis lesions through small incisions in the abdomen.
Sexual Pain Disorders
Occasional discomfort during sex, especially during ovulation, is usually nothing to worry about. In many cases, dyspareunia can be caused by inadequate lubrication during sex (often due to skipping foreplay), anxiety about sex, or deep thrusting, which, in some positions, can lead to the penis hitting the cervix, causing pain. These problems are easily fixed by using a water-based sexual lubricant, engaging in plenty of foreplay (which helps you relax as well as increasing arousal), and changing sexual positions.
However, sometimes, dyspareunia becomes chronic or even constant, which can indicate the presence of a sexual pain disorder. If dyspareunia occurs outside of ovulation or lasts longer than 48 hours during ovulation, you may actually have a sexual pain disorder. You are also more likely to have a sexual pain disorder if you also experience pain in other situations, including gynecological exams or tampon insertion.
Sexual pain disorders include vaginismus (painful, involuntary contraction of the vagina upon penetration), vulvodynia (chronic pain and irritation of the vulva with no clear cause), and interstitial cystitis (painful irritation of the bladder, which can cause dyspareunia in certain positions). Your OB/GYN can help you determine if your dyspareunia is due to ovulation or a sexual pain disorder.
How to Cope with Painful Sex During Ovulation
Dyspareunia during ovulation is probably nothing serious — but that does not mean it will not affect your sex life. Ovulation pain presents an obstacle to having sex during your fertile window. This is especially impactful if you are trying to conceive, as you will need to have sex when you are most fertile to increase the likelihood of conception.
So, what can you do to make sex more comfortable during ovulation? Making small changes may help, such as:
- Over-the-counter pain relievers, especially NSAIDs, can relieve pain and inflammation associated with ovulation. Check with your doctor to make sure they are safe for you to take. Try taking them 30 minutes before having sex to give them time to work before getting busy in the bedroom.
- If sex is most painful for you during the 48 hours surrounding ovulation, you may benefit from tracking your menstrual cycle and timing sex so that you can still be comfortable while utilizing your fertile window for conception. Because sperm can live in the vagina for up to seven days, you may be able to have pain-free sex in the days leading up to ovulation, while avoiding having sex during your ovulation pain.
- Experiment with different sexual positions to find out what feels most comfortable for you during ovulation. If you experience deep dyspareunia, positions like doggy-style may aggravate your pain. Try having your partner penetrate you from behind while laying down (i.e. spooning) instead, as this position limits the depth of penetration. Many women also benefit from trying the woman-on-top position. This position allows the woman to control the angle and depth of penetration to make it more comfortable for her.
- Sexual aids. Adding a specialized toy to your bedroom routine can help alleviate sexual pain. One toy designed to help with deep dyspareunia is the Ohnut. The Ohnut is a set of flexible rings worn around the penis. The Ohnut provides a cushion that prevents your partner from thrusting too deeply into the vagina, which can minimize sexual pain. You might consider using an aid such as the Ohnut during ovulation if you suffer from dyspareunia.
- After sex, taking a warm bath with Epsom salts may help to soothe any residual pain. It will also encourage you to relax, which is important for pain relief. You may also try using a heating pad if having sex during ovulation triggers abdominal pain for you. Most heating pads can be microwaved for 30-90 seconds for a quick solution to ovulation pain.
What if I’m Not Trying to Get Pregnant?
If you are not trying to get pregnant but still want to be intimate with your partner despite ovulation pain, there are other sexual activities that may be less painful than penetrative sex. You may want to try mutual masturbation or oral sex during ovulation instead.
You may also consider visiting your doctor for a prescription for oral birth control pills. The combined birth control pill, containing both estrogen and progesterone, may prevent ovulation, and therefore prevent your pain.
✔️ Medically Reviewed by Banafsheh Kashani, MD, FACOG
Banafsheh Kashani, M.D., FACOG is a board-certified OB/GYN and specialist in reproductive endocrinology and infertility at Eden Fertility Centers, and has been treating couples and individuals with infertility since 2014. Prior to joining Eden Centers for Advanced Fertility, she was practicing as a top fertility specialist at Kaiser Permanente in Orange County and Reproductive Fertility Center. Dr. Kashani has received numerous awards throughout her years of study and medical training.
Dr. Kashani has conducted extensive research in female reproduction, with a specific focus on the endometrium and implantation. Additionally, Dr. Kashani has authored papers in the areas of fertility preservation, and fertility in women with PCOS and Turners syndrome. She also was part of a large SART-CORS study evaluating the trend in frozen embryo transfers and success rates.
Dr. Kashani is a fellow of the American Congress of Obstetricians and Gynecologists. In addition, she is a diplomat of the American Board of Obstetrics and Gynecology and an active member of the American Society of Reproductive Medicine (ASRM) and Pacific Coast Reproductive Society (PCRS). She is also a member of the Society of Reproductive Endocrinology and Infertility (SREI).