An intrauterine device (IUD) is a small, T-shaped device inserted into the uterus to prevent pregnancy, making it one of the most effective long-term birth control methods available. While IUDs are generally safe and well-tolerated, pain after intercourse can cause concern. Although sex with an IUD should not be painful, discomfort can arise from mechanical, temporary, or more serious medical causes. Understanding these potential reasons helps determine the appropriate next step.
Temporary and Mechanical Causes of Pain
The most common reasons for post-intercourse discomfort are related to the physical act of penetration. Pain can occur if deep thrusting causes the penis or a sex toy to strike the cervix. Although the IUD sits inside the uterine cavity, this physical impact can transmit pressure and cause brief, sharp pain or deep cramping. This is especially true if the uterus is naturally tilted.
Another frequent mechanical issue involves the IUD’s retrieval strings. These are thin nylon threads that extend a few centimeters past the cervix into the top of the vagina. While designed to be soft, they can sometimes feel sharp or prickly to a partner, or irritate sensitive vaginal or cervical tissue during vigorous sex. If the pain is localized to the entrance of the vagina or felt by the partner, a healthcare provider can trim the strings shorter to resolve the issue.
It is also important to distinguish IUD-related pain from typical uterine contractions that follow orgasm. The uterus naturally contracts during climax, and these contractions can feel like mild cramping. This cramping may be more noticeable with an IUD inside the cavity. If the IUD was recently inserted, pain and spotting are common side effects for the first few weeks, sometimes lasting up to a few months. This initial adjustment period typically resolves on its own.
Serious Medical Conditions and IUD Complications
Pain after intercourse can signal a more serious issue related to the IUD’s position or an underlying medical condition. One complication is IUD displacement, where the device has shifted from its correct placement in the upper uterus. If the IUD has partially moved down into the cervix or if expulsion is occurring, the device itself can be hit during penetration, causing significant pain and cramping. A healthcare provider can confirm the IUD’s placement using an ultrasound.
Another concern is Pelvic Inflammatory Disease (PID), an infection of the reproductive organs that causes deep, persistent pelvic pain, often worsened by sex. While the IUD does not cause PID, the insertion process can introduce bacteria into the uterus. This makes the risk of infection highest within the first three weeks after placement. Recognizing symptoms like fever, chills, or unusual discharge along with pain is important, as untreated PID can lead to long-term issues.
Though rare, a uterine perforation occurs when the IUD punctures the wall of the uterus, usually during insertion. If an undiagnosed perforation is present, it can cause sudden, severe pain, especially if the IUD has migrated outside the uterine cavity. Conditions like endometriosis or ovarian cysts also cause painful sex and can sometimes be misattributed to the device. The physical impact of intercourse can exacerbate the pain from these pre-existing conditions.
Recognizing Red Flags and Seeking Medical Advice
While minor discomfort can often be managed at home, certain symptoms should prompt an immediate call to a healthcare professional. If the pain is sudden, severe, or escalating, and cannot be managed with over-the-counter pain relievers, it warrants urgent medical evaluation. Systemic signs of infection, such as a fever over 100.4 degrees Fahrenheit or chills, along with pain or an unusual, foul-smelling vaginal discharge, could indicate PID and require prompt treatment.
Monitoring the IUD strings is an easy way to check for potential displacement or expulsion. If you cannot feel the strings at all, or if they suddenly feel much shorter or much longer than before, the IUD may have shifted position. Additionally, any new onset of heavy, persistent bleeding or spotting that occurs throughout the month should be investigated. These red flags suggest the IUD may no longer be correctly positioned or that a more serious underlying issue needs to be addressed.