Dear Dr Mitchell,
I am having some womb pains following a night of pretty rough sex. The pain has been constant for three days now, and when I try to have sex it’s unbearable. I should mention that I have an eight- month-old baby, and after birth I got the contraceptive injection at the clinic but it made me bleed too much, so I switched to pills called Ovral28 and the bleeding stopped. I have recently stopped taking the pills and have not been on any contraception since.
The pain that you experience in your lower abdomen after sexual intercourse may be due to several factors. Trauma to the vagina, cervix and floor of the pelvis from sexual intercourse may cause pain in the abdomen, which usually resolves in a few hours and certainly within 24 hours in uncomplicated cases. However, bruising or tears from traumatic sexual activity and infection can cause persistent pain in the lower abdomen. In some cases the entire lower abdomen becomes severely inflamed, and there is associated fever, nausea, vomiting and abnormal vaginal discharge if there is a sexually transmitted infection. The Fallopian tubes, uterus and sometimes even the ovaries can become infected, and admission to hospital with the need for antibiotics to be given by injection has to be undertaken.
Failure to treat this promptly can result in scarring of the Fallopian tubes which can become blocked and result in future inability to become pregnant. This is called Pelvic Inflammatory Disease (PID). In this case your partner will also need antibiotics to reduce the risk of recurrence.
A ruptured or leaking ovarian cyst can also present with pain in the lower abdomen. Torsion of an ovarian cyst can also cause pelvic pain which needs to be dealt with as an emergency to preserve the ovary. The fact is that the blood supply to the ovary can be blocked off in this situation, causing the ovary to become non-functional, and requiring removal to prevent subsequent infection.
It is important for you to seek immediate medical attention. A pelvic examination and ultrasound will be helpful in determining the underlying cause of your pain. The use of OVRAL 28 is not a good choice since this is a high dose combined oral contraceptive pill, and there are other pills containing less oestrogen that are equally effective in preventing pregnancy. The use of the female or male condom will help to prevent infection.
You should consult your doctor about the insertion of the intrauterine contraceptive device or the subdermal implant (Jadelle or Norplant) which offer long-term effective reversible contraception. These methods can be readily discontinued with prompt return to fertility. Your doctor will advise you further.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to firstname.lastname@example.org; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.