Medically Reviewed by Dr Danae Maragouthakis
Engaging in penetrative sex if you have endometriosis can be extremely painful and may deter you from engaging in any form of sexual activity. But, listen up ladies: you can still have a fulfilling sex life with endometriosis!
By taking certain steps to manage pain felt during or after sex, women with endometriosis can still have intimate relationships and engage in pleasurable sexual activities. In this article, learn about endometriosis and why it causes pain during sex, plus read our top tips on how to avoid painful sex to get your sex life back on track.
What is endometriosis?
Endometriosis is a condition where tissue similar to that of the womb lining (a.k.a. endometrial tissue) begins to grow outside of the uterus, often around the ovaries, fallopian tubes or elsewhere in the pelvis. This tissue reacts to the natural rise and fall of hormones throughout the menstrual cycle in the same way as the tissue that lines the uterus, causing it to build up and shed monthly. However, shedding of this misplaced tissue results in bleeding outside of the uterus, which can cause pain, inflammation, swelling and the formation of scar tissue. Endometriosis is a common long-term condition that affects approximately 1 in 10 women of reproductive age - so you are not alone!
Common symptoms of endometriosis include:
- Pain in the pelvic area which can worsen around the time of your period
- Severe period pain and heavy menstrual flow
- Pain when going to the toilet
- Pain during sex or after sex
- Diarrhea, constipation or nausea
- Difficulty getting pregnant
These symptoms can be experienced in varying severity and will differ between individuals.
How can endometriosis impact your sex life?
Unfortunately, the symptoms of endometriosis can have a significant impact on a woman's life. Especially when it comes to sex. Not fair, right? As many women with endometriosis experience painful sex, this can understandably have a negative impact their sex life and libido. After all, sex is supposed to feel good!
The reality is that sex is heavily present in our everyday lives, whether it’s on TV, in music, or the topic of conversation amongst friends. Whilst sex is a normal and a natural part of life, it can be disheartening not being able to do the thing that everyone else seems to be doing. Not to mention the feelings that can accompany a lack of intimacy, such as low mood or self-esteem, and the effects on your sex drive. Challenges surrounding sexual intmacy can also cause or compound relationship stress, especially if there is a lack of communication.
Why is sex painful with endometriosis?
Penetration can be painful because it stretches and pulls at the misplaced endometrial tissue, especially if it has grown behind the vagina, lower uterus or rectum. Irritating this tissue can sometimes result in bleeding, which is not only inconvenient, but can also be embarrassing. Women are all wonderfully unique, and so the perception of pain can vary between individuals. Some may experience acute stabbing pains or deep aching pains during sex, whilst others only experience pain after sex.
Are you experiencing painful sex or unusual vaginal bleeding and think you might have an STI? Don’t worry, we offer at-home STI testing kits which can be delivered straight to your door, and give you your results within a few days!
If you’d like to know more about sexually transmitted infections (STIs), check out our STI information page that’s packed with useful knowledge.
How to avoid painful sex
Change up your positions and rhythm
Certain sex positions can cause more pain than others, so it’s important to find the position that’s most comfortable for you. Missionary is often reported to be the most painful position for women with endometriosis, because the uterus is tilted and penetration is deep. Deep penetration can be painful, as it puts more pressure on the sensitive areas nearest misplaced endometrial tissue. Positions with shallow penetration tend to be more comfortable, and include side-by-side spoon, modified doggy style, face-to-face or raised hips.
Quick thrusting is also likely to cause more pain than a gentle rhythm. Talk to your partner(s) about what is most comfortable for you, and try a position where you have control over the speed and depth of penetration.
Check out our handy infographic on four positions that can ease pain during sex:
Try other sexual activities
Far from being all about penetration, sex encompasses an array of other activities which can be just as pleasurable and intimate! In fact, according to one study on women’s sexual pleasure, only 36% of women claim they can reach orgasm through penetration alone.
If penetrative sex is too painful for you, why not try kissing, foreplay, oral sex, erotic massage or mutual masturbation? There are also a whole host of toys out there that don’t involve penetration. Experimenting with different activities can bring you and your partner(s) sexual satisfaction, whilst also optimising your comfort level.
Read our blog article on safe oral sex.
Avoid having sex at certain times of the month
You might find that penetrative sex is more painful at certain times of the month; often being more intense around the time of your period, and less painful following ovulation or just after your period. Tracking your cycle and when you have sex can help you identify times of the month that are least so you can plan accordingly.
Use plenty of lube
Vaginal dryness will only exacerbate discomfort felt during sex. If you are tense or anxious about the prospect of having sex, you may find it harder to become physically aroused. This is compounded by the fact that endometriosis is often treated with hormones, which are known to cause vaginal dryness as a side effect. Using a vaginal lubricant can help reduce friction and discomfort during penetration - one less thing to worry about!
Communicate with your partner(s)
The key to improving your sex life is to communicate with your partner(s) about endometriosis and how sex feels for you. While it may feel extremely personal and a bit awkward at first, openly communicating can help them better understand what you are going through. Let them know what it feels like and which sex positions are most comfortable. Or, if you’re not comfortable having penetrative sex, tell your partner know what else turns you on and have some fun exploring sexual fantasies or kinks!
Although painful sex is a common symptom of endometriosis, there are a few things you can try to help minimise it. Start by communicating with your partner and fostering a safe, open environment to explore what forms of sex are most pleasurable for you. Always be sure to use plenty of lube and try to have sex at times of the month that are least painful. And don’t be discouraged if penetration is just too painful, because there are countless other sexual activities that you can take part in. With these tips in mind, you should be well on your way to a journey of sexual enjoyment and discovery.