What causes pelvic pain after sex?
The cause is either an infection that has spread from the vagina or cervix, or a separate gynaecological or physical cause, and the two need different next steps. The table below groups the more common causes; a clinician can usually narrow this down with a few questions and, where needed, a test.
Could it be an STI, and how would I know?
Chlamydia and gonorrhoea are the two infections most likely to cause pelvic pain after sex, and both can be present without any other obvious symptom. Left untreated, either can spread upward from the cervix and cause pelvic inflammatory disease (PID), an infection of the womb, fallopian tubes and ovaries that causes pelvic pain, pain during sex, and sometimes bleeding between periods, fever or feeling generally unwell. Our chlamydia test is £104, with results in 3 days. The gonorrhoea test is also £104 with results in 3 days, and together they are the starting point if an infection cause is possible.
What if my chlamydia and gonorrhoea test is negative but the pain continues?
Mycoplasma genitalium is a less well-known bacterium that can also cause pelvic pain and is not part of every basic screen. Our combined Mycoplasma genitalium test also checks Ureaplasma from the same sample for £156, with results in 3 days, and is worth considering if a first-line screen has come back clear but symptoms persist. If this and an STI screen are both negative, a gynaecological cause becomes more likely and is worth assessing directly.
Could it be endometriosis or an ovarian cyst?
Deep pain during or after sex that follows a pattern with your periods, or pain that has been present for months rather than appearing suddenly after a new partner or unprotected sex, points more toward a gynaecological cause such as endometriosis. A one-sided pain, particularly if it came on suddenly, can suggest an ovarian cyst. Neither of these is diagnosed by an STI swab, and both need a gynaecological assessment, which may include an examination and scan. Our colleagues at Gynae Clinic offer an initial gynaecology consultation for this kind of assessment.
Could it just be dryness or a positional cause?
Yes. Pain concentrated at the entrance to the vagina, especially if it is worse with less lubrication, is commonly dryness rather than infection or a gynaecological condition. Pain only in certain positions, without discharge, bleeding or fever, can be positional and often settles without needing a test. These causes do not rule out an infection alongside them, so if you are at all unsure, testing first is still the safer route.
When is pelvic pain after sex an emergency?
Fever, severe pain, or the possibility that you might be pregnant, alongside pelvic pain after sex, needs same-day medical assessment rather than a routine booking, since these can point to advanced PID, an ectopic pregnancy, or a cyst complication. Call 999 or go to A&E if the pain is severe, or you feel faint or collapse; call NHS 111 if you are unsure where to go. For pain that is uncomfortable but not severe, and without fever or a possible pregnancy, a routine test is a reasonable first step.
How testing works at our Harley Street clinic
Our screening packages for women start with the Bronze package at £250 (chlamydia, gonorrhoea, HIV, syphilis) and step up through Silver, Gold and Platinum to add Mycoplasma genitalium, Ureaplasma, Gardnerella, herpes, trichomoniasis, hepatitis and HPV. Samples are a blood test and a swab, which can often be self-taken, and results come back confidentially by phone or text within 6 hours to 5 days depending on the tests chosen. You can walk in seven days a week at 117A Harley Street, and every package includes a consultation with a doctor. The visit is confidential, as with all of our private STI testing in London.
Book a women's screening package at 117a Harley Street to test for the treatable causes of pelvic pain after sex.
References
- Pelvic inflammatory disease, NHS
- Endometriosis, NHS
- Chlamydia, NHS
- Management of pelvic inflammatory disease, BASHH
- Ovarian cysts, NHS
