Pain during sex before your period isn’t normal and should be addressed by a doctor. It may be caused by one of the following conditions:
Pain in the pelvic area that occurs right before and during your period may be due to a low level of estrogen. A prescription tablet, cream or flexible ring can deliver a small amount of estrogen to reduce pain symptoms.
Endometriosis
Endometriosis is a condition where cells similar to those lining the uterus grow elsewhere in the body. During the menstrual cycle, hormones cause the lining of the womb to increase in preparation for a fertilized egg. Each month, this lining will break down and bleed. However, the blood is unable to leave the body and is instead absorbed by the organs surrounding the womb, causing pain and creating scar tissue.
Women with this condition may find that sex is painful at certain times of the cycle, such as during ovulation or just before the period starts. They may also find that the pain is worse during deep penetration.
It is important to communicate with your doctor about pain during sex. They may suggest that you try timing sex during the window of pain before your period, or they may recommend laparoscopic surgery to remove the areas of endometriosis that are causing pain. The good news is that many women who have had this procedure experience significant improvement in pain levels and quality of life.
Ovarian cysts
Ovarian cysts are fluid-filled sacs that grow in or on an ovary. They can cause pain, heavy periods, and infertility. They can also be the cause of pelvic pain during sex before period, especially if they’re large.
Ovulation pain usually occurs 14 days after the start of your menstrual cycle, when sperm fertilize an egg. It’s sometimes accompanied by cramping and light vaginal discharge that can look like your first period. If you’re trying to conceive, implantation pain may be a sign of success.
If you have ovarian cysts, your primary care provider or an OB/GYN can diagnose them by asking about your symptoms and doing a physical exam, including a pelvic one. Your healthcare provider might also order a blood test to check for low iron (anemia). An ultrasound of your ovary will help your doctor see the size, shape and location of the cyst. They may also want to do a biopsy of the cyst to get a sample of its contents and check for cancer cells. You can also take a medication that stops ovulation to reduce your risk of getting new ovarian cysts.
Interstitial cystitis
Pain and pressure in the bladder and pelvic area is a typical symptom of interstitial cystitis or bladder pain syndrome (IC/BPS). This condition is not well understood, but it’s thought to be caused by inflammation in the lining of the bladder.
The symptoms of IC can vary from person to person. They may be mild to severe. They can also come and go. The pain and urgency to pee usually gets worse during menstruation.
According to urologist Joan Meaney, women often experience irritation of the bladder and urinary tract a few days before their period starts. She says that this is likely due to cyclical hormonal changes, particularly in the luteal phase.
There is no cure for IC, but there are treatments that can help relieve its symptoms. These include changing your diet, avoiding acidic foods and alcohol. Your doctor can prescribe medications that reduce inflammation and spasms in the bladder. These can be taken orally or as injections. In some cases, your doctor may recommend pelvic floor physical therapy. Another treatment is a procedure called bladder instillation, where the bladder is filled with liquid medicine and held for a short time.
Fibroids
Fibroids are common, non-cancerous growths that form on the walls of or inside your uterus. They are typically rounded, and they can vary in size. Some women may have them and not even know it. Symptoms can range from heavy periods to pain during sex, and the severity of these symptoms depends on the number, size, and location of your fibroids.
Fibrooids can interfere with the normal balance of estrogen and progesterone in your body, which can lower libido and make sex less pleasurable for both partners. They can also cause bleeding, which can interrupt intimate time with your partner.
Talking with your doctor about the problem and getting a diagnosis is important. There are many options for treatment, including medication that shrinks fibroids without surgery. A specialist can help you determine which option is best for you. In the meantime, try to enjoy other forms of intimacy with your partner. It can be helpful to find a position that doesn’t hurt during penetration or to practice extended foreplay. This will help you and your partner reconnect while you wait for a fibroid treatment to take effect.
Uterine adhesions
Many women with endometriosis, ovarian cysts, interstitial cystitis, fibroids, or other conditions that cause pain around the time of their period have lower abdominal and pelvic pain that intensifies during sexual activity. For some, this pain is disabling and can last long after menstruation.
Uterine adhesions are scar tissue that causes parts of the body that are not normally connected to stick together. They can be caused by a surgical procedure called dilation and curettage or C-section surgery, infection, uterine fibroids, pregnancy complications, or certain infections such as chlamydia and gonorrhea.
Dyspareunia is genital pain that occurs just before, during or after sexual intercourse. It can feel like a pulling sensation and radiate from the vulva surfaces to the deep pelvic structures. Dyspareunia is usually triggered by the release of prostaglandins during menstruation or sexual intercourse and may be aggravated by vaginismus (involuntary spasms of the introitus).
