Why Does My Lower Abdomen Hurt the Day After Sex?

Experiencing lower abdominal pain the day after sexual intercourse can be concerning, but there are several common explanations for this discomfort. In many cases, the pain is related to underlying gynecological conditions that become more noticeable due to physical activity during sex. Below are two of the most common causes:

1. Endometriosis

Endometriosis is a prevalent condition among women of reproductive age and is often responsible for pain during or after sex. This condition occurs when tissue similar to the lining of the uterus grows outside the uterine cavity—common locations include the ovaries, fallopian tubes, pelvic peritoneum, uterosacral ligaments, and rectal wall. During intercourse, increased pelvic blood flow can cause these abnormal growths to swell and become inflamed, which may lead to pressure on nearby nerves. The result is often sharp or persistent pain in the lower abdomen, lower back, or a feeling of heaviness in the rectal area. A combination of bimanual or trimanual pelvic exams and transvaginal ultrasound can help doctors evaluate and diagnose endometriosis.

2. Chronic Pelvic Inflammatory Disease

Another possible cause of post-sex pain is chronic pelvic inflammatory disease (PID). If a woman has had an episode of acute PID in the past that wasn't fully treated, it can progress into a long-term condition. This lingering inflammation can flare up during or after sexual activity due to increased pelvic congestion, causing localized lower abdominal pain. Diagnosis typically involves a comprehensive gynecological examination, including bimanual exams, and possibly imaging tests to assess the extent of the inflammation.

If you regularly experience pain after sex, it's important to consult with a healthcare provider to determine the root cause and begin appropriate treatment.