5 Reasons You May Experience Painful Sex During Pregnancy

Having penis-in-vagina sex is an entirely different experience when pregnant. Some claim that heightened sensitivity leads to better-than-ever orgasms, while others complain about discomfort ranging from cramping to searing stabs. Painful sex during pregnancy has a host of different causes—some normal and some worrisome—so it's important to talk to your prenatal care provider about the issue.

Here are five reasons that intercourse might be not-so-comfortable when expecting a baby, with tips on how to make pregnancy sex enjoyable again.

1. Your Body Is Changing

Your belly isn't the only thing that changes during pregnancy. You can also expect tender nipples, swollen legs, an inflamed uterus and vagina, and other annoying (but normal) symptoms that make sex feel unpleasant.

To avoid pain, "partners need to communicate to find the best positions," says Mary Jane Minkin, M.D., a clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale University School of Medicine. For example, side-lying positions can take the pressure off your stomach.

2. Your Blood Flow Has Changed

During pregnancy, it is possible that your vagina will become swollen, thanks to increased blood flow to support the growing uterus, fetus, and placenta. That's a lot of blood! This increase can leave you feeling pressure down there, which can either enhance sexual pleasure or lead to discomfort.

Blood flow can also put pressure on the vascular system leading to vulvar varicosities or vaginal varicose veins. This typically happens around month five and can affect 18% to 22% of pregnant people.

Luckily, in most cases, pain during sex that is caused by increased blood flow will resolve a few weeks after delivery.

3. Your Vagina Is Dry

Dr. Belotte adds that vaginal dryness is rare during pregnancy. However, when it occurs, it may create uncomfortable friction during intercourse. One reason why vaginal dryness may happen is related to estrogen levels. Estrogen is the hormone that helps keep the vaginal canal lubricated, but if levels fall, it can lead to vaginal dryness that can irritate the skin making sex painful.

According to the American College of Obstetricians and Gynecologists (ACOG), there are a few other possible causes of vaginal dryness including:

• Dehydration: Being dehydrated can accelerate all-over dryness, including in and around the vagina.
• Some medications: Some studies suggest that antidepressants and cold and allergy medications may cause vaginal dryness.
• Certain health conditions: Autoimmune diseases such as Sjögren syndrome may also lead to vaginal dryness.

To solve the problem of vaginal dryness, try using a water-based lubricant and talk to your doctor or midwife about what may be the root cause of your dryness, including hormone levels, medication safety, and any other health concerns you may have.

4. You Have an Infection

In some cases, painful sex during pregnancy could reveal certain vaginal infections, like cervicitis, vaginitis, and chorioamnionitis, says Jimmy Belotte, an OB-GYN in the Department of Obstetrics & Gynecology and Women's Health at Montefiore Health System and an associate professor in the Department of Obstetrics & Gynecology and Women's Health and the Albert Einstein College of Medicine. You may also have a pelvic inflammatory disease (PID) or a vaginal or pelvic mass, he adds.

According to the Centers for Disease Control and Prevention (CDC), bacterial vaginosis is the most common vaginal infection, affecting 21.2 million people each year. And vaginal yeast infections are also very common, affecting three in four people throughout their lifetimes. Since pregnancy hormones can create an imbalance in vaginal yeast, infections are very common, but thankfully easily treatable.

Because some of these conditions can harm the fetus, it is important to rule them out with your doctor if you're experiencing symptoms (including pain or discomfort during pregnancy sex).

5. You Have an STI

Dr. Belotte says that sexually transmitted infections (STIs) may also cause painful sex while pregnant. STIs sometimes have other symptoms as well, ranging from genital sores to painful urination. Many STIs can impact the fetus—for example, herpes can cause neurological problems, and gonorrhea is associated with premature birth and stillbirth—so you should see a doctor if you think you may have an STI.

The CDC recommends that pregnant people get tested for STIs as early in the pregnancy as possible. Many STIs can be treated with either antibiotics or antiviral medications, but a bigger concern is that the STI is not passed from the pregnant person to the fetus. To reduce the risk of spreading or exposure to an STI while pregnant, the CDC also recommends the use of latex condoms during intercourse.