Painful sex before your period? How tracking your cycle could help stop sex from hurting

Painful sex before period, painful sex, pain during sex, fertility awareness method, fertility awareness, cycle tracking, pelvic floor therapy, pelvic floor therapy for painful sex
Medically reviewed by Nicholas Kongoasa, MD, FACOG

Have you ever heard a man complain of painful sex? Me neither. But, among women, it is a common problem. The American College of Obstetricians and Gynecologists (ACOG), says nearly three out of four women experience painful sex at some point in their lives, and many women report painful sex, in particular before their periods start. No matter when a woman experiences painful sex, the experience can trigger a great deal of frustration, dissatisfaction, and even shame.

The good news is that tracking your cycle can offer a practical way to better diagnose and reduce or eliminate painful sex—no matter when in your cycle you may experience painful sex. Women can track their cycles with what’s known in the medical community as Fertility Awareness-Based Methods, more informally called fertility awareness methods (FAM) or natural family planning (NFP).

It should go without saying that painful sex is not normal. If you are experiencing it, there is a cause which merits investigation.

Tessa (whose name has been changed) had suffered from painful intercourse for almost three years when I met her. Her OB/GYN recommended the removal of her Mirena IUD, and that she and her husband learn a fertility awareness method to prevent pregnancy instead of another form of birth control (including hormonal birth control, which is also linked to painful sex). Tessa’s OB/GYN also prescribed use of a topical cream prior to sex, and referred Tessa to a pelvic floor physical therapist. Tessa and her husband attended these sessions together so they could get the help they needed as a couple. Over the course of the next six months, sex became less painful for Tessa—and therefore more enjoyable for both Tessa and her husband.

What causes painful sex

Women may experience pain during sex in a variety of ways. Some women may experience pain during sex as an intense feeling of tightness. Others may experience painful penetration (upon entry), or a feeling of burning or aching. Deep pain during thrusting is another common experience of painful sex. Some women may even experience throbbing in the hours following intercourse.

Those most likely to experience these issues include women having sex for the first time, women who recently had a baby (even if no severe pelvic floor injury was noted), and perimenopausal women. A woman’s method of birth control, whether a device like an IUD, or the Pill, could be the culprit behind her experience of painful sex. 

Certain health conditions can make sex more painful as well. For example, women who have endometriosis or polycystic ovary syndrome (PCOS) may experience pain during sex. With endometriosis (when the uterine lining forms outside the uterus), intense pain during sex may be a result of the presence of adhesions or scar tissue. For those with ovarian cysts, and especially for those with PCOS, swollen cysts can make sex more painful—and sex can even make ovarian cysts rupture or burst. 

Other possible causes of painful sex are pelvic inflammatory disease (PID), an infection and inflammation of the upper reproductive tract, and interstitial cystitis, a chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain. In addition to causing painful sex, PID, endometriosis, and PCOS all may contribute to the inability to conceive or maintain a pregnancy.

Why does sex hurt before your period? 

Urologist Joan Meaney, M.D. frequently sees patients who experience painful sex, including painful sex before a period. Due to cyclical changes in hormones, many women experience irritation of the bladder or urinary tract a few days before their period begins. During that phase of the cycle, estrogen levels are low, which may be the cause of irritation. Simple solutions for painful sex before a period include the elimination of acidic foods (especially if the woman has interstitial cystitis), and using an anti-inflammatory drug for a few days, or taking natural supplements (especially ones that are geared toward supporting healthy fertility).

No matter the cause of painful sex, if it usually happens before your period, it is helpful to be aware of when your period—and therefore potentially painful sex—is coming. “That’s where fertility awareness charting, or the tracking of your fertility, is key: it allows you to know ahead of time when your periods will be here, and to adjust your diet accordingly,” Dr. Meaney advises.

How pelvic floor physical therapy and tracking your cycles can help

Pelvic floor physical therapy is one possible treatment for alleviating painful sex. 

Understanding what’s happening in the body over the phases of one’s cycle can help women understand why they may experience painful sex before their periods. That’s where the benefits of fertility awareness charting can work hand-in-hand with pelvic floor therapy, to help women overcome painful sex and benefit their overall health.

For example, Dr. Chelsea Harkins, owner of Dallas Pelvic Health in Dallas, Texas, recommends tailoring one’s exercise to the phase of their menstrual cycle, to maximize results. “It’s a way of respecting female physiology… and understanding that there are natural periods during the month when your body can go hard, and others when it requires more rest.” 

“Your uterus is one big muscle,” Dr. Jennifer Tippmann, owner of Tippmann Physical Therapy in Fort Wayne, Indiana, adds. “And when your uterus is preparing to shed its liningthe endometriumthat involves contracting. In general, if any muscle is tight, if it has tension, it’s going to be painful when it contracts.” 

When it comes to muscle tension, pelvic floor therapy can be immensely helpful. “While some women experience weakness of the pelvic floor muscles (causing things like incontinence), in general, pelvic pain is a muscle tension condition,” says Dr. Tippmann. She notes that for women with conditions like endometriosis, the scar tissue and adhesions cause chronic tension in the muscles of the pelvic floorand therefore chronic pain, especially during sex. “When I do see patients with intense uterine or pelvic pain who are on birth control,” says Dr. Tippmann, “I help them with exercises to alleviate that pain, and I also encourage them to look deeper, to get to the bottom of their issue.” She also notes that women who experience painful menstrual cramps often have chronic tension in their pelvic floor muscles, and can therefore benefit considerably from pelvic floor therapy. 

Dr. Harkins notes that reducing stress can be helpful to mitigating painful sex in between visits to your pelvic floor physical therapist. 

“I really try to help my clients with strategies to calm down their nervous system,” Dr. Harkins explains, “like adequate rest, reducing EMF (electric and magnetic field) exposure, healthy eating (eliminating sugar), and improving their gut health with probiotic supplementation (the gut produces serotonin which has a role in pain control). If the gut is unhealthy from prolonged stress, poor diet, or antibiotic use, the body will have a heightened pain response.”

Stop painful sex in four steps

1. Consider getting off of birth control.

First, if you are affected by painful sex, consider getting off of your current form of birth control or having your IUD removed. It’s important to discuss the discontinuation of any medication with your doctor.  

Dr. Harkins notes that the topics of fertility and sexuality are delicate topics and that “no matter what the conversation is, I always try to tread respectfully and gently.” But, regarding birth control options that could be affecting a woman with painful sex symptoms, her goal is to educate. “I’m very passionate about truly informed consent, and I believe often women are utilizing interventions when they aren’t truly aware of all the side effects. I do my best to educate and suggest other options while still respecting boundaries.” 

If you do decide to discontinue pharmaceutical birth control, your body can begin cycling naturally, and you can then begin the process of learning a fertility awareness method from a trained instructor. And if you started birth control because of painful or irregular periods, endometriosis, or PCOS, you can also seek the help of a physician trained in restorative reproductive medicine, such as a Natural Procreative Technology-trained physician, to begin the process of healing the root cause of that health disorder. 

2. Learn to chart your menstrual cycle using a FAM, and track when you experience painful sex.

Remember Tessa? Her OBGYN recommended tracking her cycle with a FAM because it could provide important information about her health. All fertility awareness methods have a way to record acts of intercourse in addition to tracking the biomarkers of each day. It is significant whether the pain happens during every act or during a particular part of your cycle, which can be noted on your chart. 

Endometriosis-related intercourse pain characteristically occurs right before (and during) your period, while ovarian cyst pain would be prevalent mainly after ovulation, during what is known as the luteal phase. General pelvic pain (outside of intercourse) is worth tracking as well.

3. Note the type of pain you experience during sex, and where you felt it. Be as specific as possible.

Dr. Tippmann says this is especially important, because it allows your doctor or pelvic floor physical therapist to determine where the source of the pain is. “There are actually three different layers of pelvic floor muscles,” says Dr. Tippmann. “If a patient is experiencing pain with insertion, that lets me know that the tension lies in the superficial pelvic floor muscles. If the pain is deeper, if it feels like it’s hitting something, then I know that the deeper muscles are the ones being affected.” These details help Dr. Tippmann know what kind of stretches she needs to perform with her patient to help alleviate tension—and therefore help with painful sex. 

An example of some of the words you could use to describe painful sex in good detail for your healthcare provider are:

  • Stinging
  • Burning
  • Dull
  • Aching
  • Cramping
  • Shooting
  • Throbbing
  • Tender
  • Mild
  • Moderate
  • Severe

4. Discuss the patterns of painful sex with your health provider.

Together with your doctor, make a plan of action for treatment. There is a wide variety of treatment options, including food and lifestyle changes and medications. 

It’s also worth considering seeing a pelvic floor physical therapist for assessment. As discussed above, a pelvic floor physical therapist will be able to provide you with treatment for your issues with painful sex and give you home exercises to do in between appointments. 

In some cases, healthcare providers may suggest surgery to resolve the root cause of painful sex. As you make these lifestyle changes and/or undergo treatment, make a note of improvements on your cycle chart over time to track progress.

Sex shouldn’t and doesn’t have to hurt.

Additional Reading:

Libido in the Time of COVID-19

How Fertility Awareness Can Help with Healthy Libido

Dreaming Bigger About Sex, Love and Birth Control

Sex is a party and my hormones ARE invited

How I Overcame Resentment toward NFP for Less Frequent Sex

What the U.S. Soccer Team Players Discovered by Tracking their Periods

When this article refers to fertility awareness methods (FAM), or natural family planning (NFP), we are referring to Fertility Awareness-Based Methods, evidence-based methods of cycle charting which can be used as effective forms of natural birth control when learned by a certified instructor.

This article was originally published on April 1, 2017 as written by Liz Escoffery. It has since been updated by Natural Womanhood to offer more resources. Last updated September 25, 2020.

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  1. Great article!
    Some patients with Interstitial Cystitis have a “Pre Menstrual” flare in pain and increase in urgency to urinate…
    If patients have these symptoms, please see a Urologist who treats IC.
    It’s very treatable!!! Have a Happy, Healthy New Year! 😉

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