What could be causing my painful cervix during sex 16 days post ovulation with no pregnancy?

Painful Cervix During Sex at 16 Days Post-Ovulation (Non-Pregnant)

You should undergo testing for cervicitis caused by sexually transmitted infections, specifically Chlamydia trachomatis and Neisseria gonorrhoeae, as these are the most common infectious causes of cervical pain with intercourse in reproductive-age women.

Primary Diagnostic Considerations

The timing at 16 days post-ovulation places you in the luteal phase of your menstrual cycle, when the cervix normally becomes firm, low, and closed under progesterone influence 1. However, pain with cervical contact during intercourse (deep dyspareunia) suggests an inflammatory or infectious process rather than normal physiologic changes.

Most Likely Causes to Evaluate

Cervicitis (Cervical Inflammation)

• When cervicitis is present, the most commonly identified organisms are C. trachomatis or N. gonorrhoeae 2
• Cervicitis can also accompany trichomoniasis and genital herpes, particularly primary HSV-2 infection 2
• In many cases, no organism is isolated, and other factors such as bacterial vaginosis, Mycoplasma genitalium infection, or chemical irritants may be involved 2

Testing Strategy You Need

• Nucleic acid amplification tests (NAATs) for C. trachomatis and N. gonorrhoeae are the preferred diagnostic tests and can be performed on cervical or urine samples 2
• Evaluation for bacterial vaginosis and trichomoniasis should also be performed 2
• If vaginal fluid shows >10 white blood cells in the absence of trichomoniasis, this suggests endocervical inflammation specifically from C. trachomatis or N. gonorrhoeae 2

When to Treat Presumptively

You should receive presumptive antibiotic treatment if:

• You are under age 25, have new or multiple sex partners, or have had unprotected sex 2
• Follow-up cannot be ensured to receive test results 2
• You are in a high-prevalence area for gonorrhea (>5% prevalence) 2

Recommended presumptive treatment regimens:

• Azithromycin 1 g orally as a single dose, OR
• Doxycycline 100 mg orally twice daily for 7 days 2
• Consider concurrent gonorrhea treatment if local prevalence is high 2

Additional Evaluation Needed

Assessment for pelvic inflammatory disease (PID):

• Because cervicitis can indicate upper genital tract infection (endometritis), you should be assessed for signs of PID 2
• PID criteria include uterine/adnexal tenderness or cervical motion tenderness on examination 2
• Additional supportive findings include fever >101°F, mucopurulent cervical discharge, elevated inflammatory markers, or documented cervical infection 2

Important Clinical Pitfalls

Common mistakes to avoid:

• Do not assume symptoms are simply related to your menstrual cycle timing without ruling out infection 2
• Cervicitis often presents with minimal symptoms beyond dyspareunia, so the absence of discharge or other symptoms does not exclude infection 2
• Microscopy for trichomonads has only 50% sensitivity, so negative microscopy requires additional testing if symptoms persist 2

If Initial Testing is Negative

For persistent symptoms after negative STI testing:

• Reassess for possible reexposure to STIs and evaluate vaginal flora 2
• Consider non-infectious causes such as persistent abnormality of vaginal flora, chemical irritants, or idiopathic inflammation 2
• Management options for persistent cervicitis without identified infection are undefined, and the value of repeated antibiotic therapy is unknown 2

Your sexual partner(s) should be notified, examined, and treated if chlamydia, gonorrhea, or trichomoniasis is identified or suspected 2. Avoid sexual intercourse until both you and your partner(s) complete treatment to prevent reinfection 2.