There's no denying that pregnancy is a transformative experience in so many ways. While some changes that you will experience are well-known and talked about often (like a growing belly and wild food cravings), other pregnancy symptoms can be unexpected and frankly mysterious.
Every time I’ve been pregnant, I’ve noticed some weird tweaks and twinges in my pelvic area during those early weeks that I couldn’t quite figure out. If you’re like me, you might find yourself glancing toward your nether regions every so often and asking, “What the hell?”
Because you’ve already had enough awkward conversations with your doctor to last a lifetime, I’m here to demystify all those uncomfortable early pregnancy symptoms to finally answer the question, what’s going on down there?
Getting to Know Your Pelvic Area
At the root of most of the “down there” symptoms is the fact that the bones, muscles, and organs in your pelvic area are all experiencing some kind of change during pregnancy, starting in the earliest weeks.
Everything from your uterus and vaginal canal to your hip bones and your bladder are being affected as early as day one of pregnancy. What that means for you is that your pregnancy may be full of a lot of confusing or even startling twinges. (Is it TMI to share that the mysterious butt cramps during my first pregnancy were caused by being pregnant?) Symptoms can range from pain and cramping to tightness and dryness. According to Dr. Amanda Andrade, an ob-gyn at UTHealth Houston, it’s all because of the increased blood flow, stretching, and pressure that starts at implantation.
So, now that you know why your pelvic region is so active during pregnancy, here's a breakdown of what's normal for you to experience, what's not—and what isn't a symptom of pregnancy at all.
Pelvic Pain and Cramping in Early Pregnancy
The fabled pregnancy glow is a welcome side effect of pregnancy; the more painful symptoms, not so much. While no one is excited about pregnancy pain, it’s important to be on the lookout for anything unusual. There are a few common pain points (literally) you may experience as your pelvic organs grow and shift throughout pregnancy and your hormones fluctuate—a stinging sensation in your vulva, for instance, isn’t out of the ordinary, and don’t get me started on third-trimester lightning crotch. But even as common as they are, certain types and levels of pain warrant a chat with your healthcare provider.
Is painful sex a symptom of early pregnancy?
If you’re experiencing painful sex, you may wonder if your pregnancy is to blame. “[Pain with sex] is a common symptom that people who are pregnant may report,” says Rachel Gelman, physical therapist and owner of Pelvic Wellness and Physical Therapy. “however I work with many patients who are not pregnant that report it. It's not necessarily a symptom of pregnancy."
So what's causing it? According to Gelman, painful sex can be due to pelvic floor muscle dysfunction, which can be caused by a number of things, including heavy lifting, chronic coughing, or straining during bowel movements.
Pain during sex could also be due to vaginal dryness, Andrade says, which isn't usually a symptom of early pregnancy. Normally, the higher levels of estrogen during early pregnancy lead to increased vaginal lubrication, so if you're experiencing sudden dryness, you should talk to your healthcare team.
According to Gelman and Andrade, if you do experience painful sex and vaginal dryness in early pregnancy, it’s more likely caused by dehydration, a urinary tract infection, a vaginal infection (like a yeast infection), or an STD rather than the pregnancy itself.
No matter the cause, the key thing to know is that "pain with sex is never normal," Gelman says. Rather than write it off as a typical symptom, talk to your healthcare provider about it, especially "if other symptoms are present or the pain is severe," Andrade says. Gelman recommends working with a pelvic floor specialist, as they'll be able to guide to the right exercises and tools to help relieve the pain, as well as pinpoint the cause.
Pelvic cramps after sex in early pregnancy
As if pain during sex wasn't enough, you may also experience cramping after the fun times end. Cramping after an orgasm isn't typical in early pregnancy since your uterus hasn't grown much yet, but you may start to feel post-orgasm twinges during the second trimester.
Here's what's going on: an orgasm triggers the release of oxytocin, which stimulates contractions in your uterus. This may sound unnerving—especially if you're nowhere near your due date yet. I was only 13 weeks pregnant when I first experienced cramps and contractions after sex, and to be totally honest, I freaked out. But don't panic—post-orgasm contractions are totally safe and normal. They won't bring on labor (and I can say they don’t feel anywhere close to real labor contractions, now that I’ve been through labor twice), and they should go away after a few minutes of rest. But if the cramping doesn't stop or gets worse even after resting, call your healthcare provider.
Tailbone pain and butt cramps in early pregnancy
That's right, the backside of your pelvic area might be feeling things, too. Early pregnancy can be a literal pain in the butt, and “the most common cause is a growing uterus that [displaces and puts pressure] on other organs or causes stretching of muscles or ligaments," Andrade says. But since your uterus is typically still pretty small during the first 12 weeks of pregnancy, you're more likely to feel these symptoms as your uterus grows up and out of your pelvic area after the first trimester.
So if tailbone pain or butt cramps are cropping up during the earliest weeks, especially before week six (the earliest that your uterus might start pushing on other organs), it's likely not due to pregnancy. Here's what Gelman says might be causing pain in your tailbone and/or glutes:
Pelvic floor muscle dysfunction
And it may not be just one of those things. "There may be more than one cause," she says, "which is why it’s important to consult a medical provider to determine what is going on."
When I was pregnant with my second kid, I experienced a combination of all four causes Gelman mentions—I had weak pelvic floor muscles from the birth of my first child (pelvic floor therapy is really important, I’ve since learned), I was chronically dehydrated thanks to morning sickness, and my remote job meant I was sitting (slouching) on the couch for hours every day.
That’s why it’s important to talk to your doctor about all your aches and pains and not write them off as just “part of being pregnant.” There may be other underlying causes that can be easily fixed.
Increased sex drive in early pregnancy
Feeling more in the mood lately? Here's one fun symptom that actually is associated with early pregnancy. "Increased sex drive can be caused by increased levels of circulating hormones during early pregnancy," Andrade says. Estrogen is the culprit here, the same hormone responsible for increased vaginal lubrication.
Estrogen increases the blood flow all over your body, but especially in your pelvic area. That extra blood flowing to your vagina, vulva, and clitoris, plus the extra lubrication, means your sex drive may be higher than you're used to.
As good as this might feel, it won't nullify all the other symptoms you might also be feeling. Yes, horniness is an early sign of pregnancy, but so is morning sickness, sore breasts, fatigue, and frequent urination—so it's totally normal to feel like your body is battling itself.
The Lowdown On Down There
The early weeks of pregnancy bring a lot of changes to the pelvic area, even before your uterus begins to grow. Implantation and the first stages of fetal development mean hormonal changes and all kinds of odd sensations—both pleasant and unpleasant.
Whether or not your pelvic symptoms are related to pregnancy, it's crucial to know what to look out for and how to tell if things aren't normal. Pelvic floor specialists can help relieve any mild to moderate symptoms. If you experience any pelvic pain, cramping, or bleeding that's severe or doesn't get better with rest, tell your provider right away.
As weird and unnerving as some of these symptoms can feel, I promise they won’t last forever. While they might last for your whole pregnancy—I was still feeling all kinds of tweaks and pops in my tailbone up until I gave birth—your pregnancy will eventually end, even though it starts to feel like it won’t around month eight. And buckle up, because once your baby arrives, you get to welcome a whole new set of pelvic sensations during your postpartum journey!