Painful Sex: Is the Cervix to Blame?
Going out with a bang. A cervix bang, that is.
CW: somewhat scandalous MRI images
Have you ever heard someone say “my partner bruised my cervix during sex and it was super painful” or “when I have pain during sex, it’s because my partner hits my cervix.” Maybe you’ve said it yourself?
Well pack your sleeping bags, campers, because we’re about to go on an adventure. Today’s all about unmasking the culprit behind painful sex—is it the cervix… or something else?
So, what is the cervix anyway?
Ahhh, the cervix. So cute, so pink, so round. It’s a spongy little donut that separates the vagina from the uterus. It moves around depending on your level of arousal or what the ol’ hormones are doing—which is why sometimes you can feel it with a finger, and sometimes it seems like it’s disappeared completely into the Deep Vagina (not an actual anatomical term).
What happens to the cervix during penetrative sex?
Since it’s attached to your uterus, it pulls a Peter Pan and moves up, up, and away in a process called “tenting.” If you’re curious about what this feels like in your own body, find your cervix when you’re unaroused (it might feel firm like the tip of your nose, or a little softer and spongier depending on hormones). Then try to feel for it again (this time while you’re feeling a little frisky)—and surprise! You’ll probably notice that your cervix has moved—taken a vacation to the warm beaches of Majorca. Ideally, this is what happens in preparation for penetration to be able to accommodate an object going inside.
Dr. Corey Hazama, PT, DPT, OCS, CFMT, PRPC, WCS of Beyond Basics Physical Therapy in New York helps explain the mechanics of this. “The uterus needs to be able to move up and back during arousal. The penis [or object being inserted] actually goes in between the uterus and bladder (thank you scientist who filmed sex in an MRI machine—seriously if you haven’t seen it, watch it), so there’s a lot of organ movement that occurs during penetrative intercourse.”
Here are those images from that 1999 study. Nice.
For context: “Midsagittal image of the anatomy of sexual intercourse (experiment 12). P=penis, Ur=urethra, Pe=perineum, U=uterus, S=symphysis, B=bladder, I=intestine, L5=lumbar 5, Sc=scrotum .”
Is hitting the cervix usually the cause of pain during sex?
Nopeity nope nope nope.
As Dr. Karen Brandon, DSc, PT, WCS says, “The native state of the cervix is not tender or sensitive, but we know [that certain procedures or events like] colposcopies and LEEP procedures can cause cervical pain.” This basically means that the cervix isn’t usually super prone to pain unless something else is going on. In fact, cervical stimulation can even be pleasurable.
Some people have reported that cervical stimulation contributes to their orgasm—describing it as feeling like “a shower of stars” or “images of universal spaciousness .”
Let’s linger on that for a moment.
Images. Of universal. Spaciousness.
Okay okay, so if the cervix isn’t the culprit, what could it be?
In the words of Dr. Rachel Gelman, DPT, owner and operator of Pelvic Wellness and Physical Therapy in San Francisco: “There are times when the pain a person is experiencing is not from [hitting the cervix] but from the pelvic floor muscles being dysfunctional. If they are tense, guarded, spasmotic or irritated in some way, then having a penis or something else thrusting into or against them can be painful. If a person has a retroverted uterus that can also lead to pain. Other medical conditions like fibroids, endometriosis or PCOS can make penetrative sex painful.
“It can be hard to tell the difference, but a specialist can help figure things out. As a pelvic floor PT, if I palpate a muscle and someone says ‘that’s my pain,’ then most likely the muscle is causing the pain, not the cervix. However, it can be both or multiple things causing a person’s pain.”
But what about when it is the cervix?
The experts agree: if it does feel like there’s some cervical pain during penetration, it probably means there are restrictions/adhesions or prior sensitivity.
Dr. Hazama explains further: “If the muscles of the pelvic floor (or the fascia or muscles specifically between the rectum and the uterus) are restricted, then the uterus can’t move up and back and this may contribute to some of the pain during deep penetration. It’s not ideal for the cervix to not be mobile.”
To add a little bit of scientific literature to the mix, a 2017 study among 548 reproductive-age cis-women with pelvic pain found that 31% had a tender cervix and uterus . And a whole host of conditions might be responsible for cervical tenderness during sex. A super comprehensive literature review on deep dyspareunia (deep pain during penetration) cited these diagnoses as possible underlying causes :
- Endometriosis (when tissue similar to the lining of the uterus grows outside the uterus)
- Pelvic Inflammatory Disease (an infection that has traveled up the reproductive tract, causing chronic pelvic pain)
- Pelvic Congestion Syndrome (when veins in the pelvis aren’t functioning normally, causing them to become enlarged or congested)
- Fibroids (usually non-cancerous growths inside or on the uterus and/or cervix)
- Adenomyosis (when the lining of the uterus starts growing into the deeper wall of the uterus)
Dr. Heather Jeffcoat, DPT of Femina Physical Therapy in California provides some additional explanations: “The cervix could be the cause of pain during penetration if someone is not aroused, or if a position is facilitating strong impact with the cervix. Uterus retroversion could also make this more likely.”
What can you do if it feels like your cervix is getting gut-punched?
Whether it’s your cervix or not—it still hurts. But you have options!
“If someone thinks their cervix is indeed being hit, they can try different positions to limit this from happening—the person with the cervix can be on top, for instance. They can also try Ohnut to decrease the depth of penetration,” Dr. Gelman suggests.
For more sexual positions suggestions, check out Pelvic Gym’s Painful Sex: Deep program.
We also recommend going to a pelvic specialist if you can, so you can receive individualized care. Not sure how to find the right provider for you? Try this free resource.
Painful sex isn’t easy—to experience or to diagnose. But the more we know about our bodies, the more power we have to make informed choices, from the bedroom to the doctor’s office.
- Schultz, W. W., van Andel, P., Sabelis, I., Mooyaart, E. (1999). Magnetic resonance imaging of male and female genitals during coitus and female sexual arousal. British Medical Journal 319:1596-1600. doi: 10.1136/bmj.319.7225.1596
- Jannini, E. A., Wise, N., Frangos, E., Komisaruk, B. R. (2018). Peripheral and Central Neural Bases of Orgasm. In I. Goldstein, A. H. Clayton, A. T. Goldstein, N. N. Kim, S. A. Kingsberg (Eds.), Textbook of female Sexual Function and Dysfunction: Diagnosis and Treatment (pp. 179-195). Hoboken, NJ: John Wiley & Sons Ltd. https://www.loyalhomecare.com/wp-content/uploads/ObGyn-Library/Textbook-of-Female-Sexual-Function-Dysfunction-2018_Moh-Sabry_Sexual.pdf#page=181
- Yong, P. J., Williams, C., Yosef, A., Wong, F., Bedaiwy, M. A., Lisonkova, S., Allaire, C. 2017. Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia. Sexual Medicine 5 (3):e184-e195. doi: 10.1016/j.esxm.2017.07.001
- Orr, N., Wahl, K., Joannou, A., Hartmann, D., Valle, L., Yong, P. 2020. Deep Dyspareunia: Review of Pathophysiology and Proposed Future Research Priorities. Sexual Medicine Reviews 8 (1):3-17. doi: 10.1016/j.sxmr.2018.12.007
This article got me to take action and see a gynecologist. I have a feeling I may have a reverted uterus. Being on top and deep thrust feels like a penis is hitting something inside. Hopefully I can get some answers! Thank you for writing this.