Orgasm Pain? It Might Be Dysorgasmia. Pelvic Floor PT Can Help

In a perfect world, there would be zero downside to having an orgasm. But for some people, that feel-good rush is quickly followed by discomfort or pain. It may show up as a lightning-shot of pain in the clitoris or it could manifest as period-like cramps. If this is your experience, you may have a condition known as dysorgasmia, and it’s a lot more common than you might think.

Painful orgasms can leave you frustrated, confused, and even scared to have sex. But before you swear off orgasms or avoid sexual activity altogether, it is important to know that it could be a sign of pelvic floor muscle dysfunction or an underlying health condition — and it doesn’t have to stay this way forever. Read on to learn more about what can cause dysorgasmia and how you can get some relief.

What is dysorgasmia?

Dysogasmia is pain felt during or after orgasm. This pain is different from pain felt during sex (which is known as dyspareunia or vaginismus), and can be quick — only lasting for a few seconds — or linger for hours after intercourse.

What Does Dysorgasmia Feel Like?

Dysorgasmnia can feel different to everyone experiencing it. The pain experienced during or after orgasm can be felt in the abdomen, deep pelvic area, vagina, or vulva. Pain can also be referred to the inner thighs or even the foot.

According to Alex Bertucci, PT, DPT, a pelvic physical therapist and AASECT certified sex counselor at Origin, symptoms are often described to her as “a dull ache in the vulva, a pain similar to menstrual cramping, or even pins and needles or a lightning bolt sensation to the clitoris.” How long symptoms stick around can differ too. Pain can be quick, only lasting for a few seconds, or linger for hours after intercourse.

How Common is Dysorgasmia

Due to a lack of research, the exact prevalence of dysorgasmia in people with vaginal anatomy remains unknown. We do know that 1 in 4 people with penises will have pain with orgasm at some point in their lives. Given that people with vaginal anatomy are disproportionately impacted by sexual pain, it's likely that the numbers for vagina-owners are similar or higher.

While dysorgasmia is not well studied and poorly understood, painful orgasms are commonly associated with a variety of pelvic health conditions including:

• Pelvic floor muscle dysfunction
• Uterine Fibroids
• Pelvic Inflammatory Disease (PID)
• Endometriosis
• Ovarian Cyst

What causes dysorgasmia or orgasm pain?

While we don’t have a solid understanding of dysorgasmia, we can draw on what we know happens in our body during orgasm, as well as how physical, emotional, and mental factors can impact our sexual function, and draw some strong arguments for what could be causing your symptoms.

Pelvic floor muscle dysfunction:

When it comes to sexual dysfunction, the pelvic floor muscles always seem to be involved. Pelvic floor dysfunction has been associated with sexual pain, orgasm dysfunction, even decreased arousal.

During orgasm, research shows that the pelvic floor muscles contract rapidly to contribute to orgasm by helping improve blood flow, tissue engorgement, and stimulation to the pelvic nerves involved in orgasm. It is likely that overactive pelvic floor muscles have a more difficult time relaxing after orgasm, or may even “cramp up” into a spasm during orgasm and cause pain.

Even though dysorgasmia can occur even when sex is pain-free leading up to orgasm, Dr. Bertucci finds that it is very common for these two pain conditions to occur together: “I often find that those who have pain during sex, may also struggle with dysorgasmia. By focusing on correcting the underlying pelvic floor muscle dysfunction, we can often help to ease their orgasm pain.”

Scar tissue:

By restricting blood flow and limiting tissue flexibility, scar tissue and restricted fascia are commonly associated with sexual pain. In the case of dysorgasmia, if scar tissue is restricting any of the important nerves involved in the sensations of orgasm, you may experience dysorgasmia.

Scar tissue from prior abdominal surgeries (Cesarean or hysterectomy for example), or as a result of medical conditions affecting the reproductive system such as endometriosis, or pelvic inflammatory disease (PID) can impact the structures involved in orgasm and lead to pain.

This case study shows how treatment of a patient’s endometriosis that was impacting their hypogastric nerve (an important nerve that provides sensory information about the cervix and uterus) helped to resolve dysorgasmia symptoms. Another case study shows how the treatment of scar tissue related to a cesarean section, eased orgasm provoked foot pain.

Uterine contractions:

Uterine fibroids are a well known cause of chronic pain, and they may be the cause of painful orgasms as well. Fibroids, also known as leiomyomas, are non-cancerous tumors that can grow within the uterus. During orgasm, the muscular layer of the uterus contracts and when fibroids are present, it may interfere with these contractions, causing pain.

Emotional Pain:

Emotional pain can lead to physical pain, and during sex it can feel hard to distinguish the difference. Stress, anxiety, and even guilt can contribute to sexual pain and dysfunction, and painful orgasms are likely no exception.

Dr. Bertucci adds “I find that guilt is often a common denominator in those that experience painful orgasms. This guilt can come from culturally engrained shame surrounding sex, or guilt related to sexual assault. Guilt also comes from the repeatability of the painful experience, and being let down by the experience of orgasm, every time it happens.”

It’s also likely that similar to development of fear and pain in the vaginismus pain cycle, dysorgasmia can contribute to a negative, self-perpetuating cycle of pain.

How to get relief from Dysorgasmia

If you are struggling with dysorgasmia, the first thing you should do is check in with your healthcare provider to discuss your symptoms. Since medical conditions that impact your gynecologic health are often to blame, your doctor will likely want to assess you for fibroids, PID, or endometriosis.

The next step is to see a pelvic floor physical therapist who specializes in pelvic pain and sexual dysfunction. They will be able to help you treat any underlying pelvic floor dysfunction that could be contributing to your pain, and use evidence-based treatments to optimize your sexual health.

When it comes to issues related to sexual function, a biopsychosocial, multi-disciplinary approach is typically best. This means, not just seeing healthcare providers that can treat the physical causes of your pain, but making sure to find healthcare providers that address the psychological and social causes of your symptoms. Dr. Bertucci recommends incorporating sex counseling as an important aspect of your care for dysorgasmia. She notes “beyond the physical, it’s important to help people explore their motivation behind sex and orgasm. We often explore taking orgasm ‘off of the table’ during sex and figure out what it looks like to have a different outcome of sex that can also be satisfying. It’s also important to take feelings of isolation out of dysorgasmia, so we work a lot on finding the words to better communicate with your partner about your symptoms.”

Bottom line: If painful orgasms are making you uncomfortable or getting in the way of your pleasure during sex, talk to a doctor with experience treating female sexual dysfunction or get in touch with a pelvic floor physical therapist who can discuss your symptoms and help you get the care you need. While there is a lot we still don't know about dysorgasmia, you are not alone — we are here for you at Origin and ready to help.