When you have endometriosis, sex can hurt. But that doesn’t mean you have to give up being intimate with your partner. You just need to make a few tweaks in your approach to sex. There are ways to lessen or even get rid of the pain.
About two-thirds of women with endometriosis report some kind of sexual issue. Every woman is different, of course. Some report no dyspareunia, or pain during intercourse. Others hurt during and after. The pain may last for hours after sex and even up to a few days.
Women describe the discomfort differently, too. Reports range from mild pain to sharp, stabbing pain to deep, aching pain. Some say any penetration hurts, while others say that only deep penetration brings discomfort.
The Link Between Endometriosis and Painful Sex
The reason women describe and experience the pain differently is because endometriosis can grow in different places around your uterus, fallopian tubes, and the back of the vagina.
Sex may be most painful if the endometriosis is behind your vagina in the lower uterus. Sometimes endometriosis can even adhere the vagina to the rectum. Penetration can pull or stretch the irritated tissue, causing pain.
If the endometriosis is elsewhere, such as on your ovaries, then you may have no pain or less pain during sex. And if endometriosis is in many places, sex may be painful no matter what.
If you've had surgery
for endometriosis but you still
have pain, your doctor
may recommend pelvic floor
The long-lasting pain
can make your pelvic floor
muscles too tight.
And because it can change
there are physical therapists
who specialize in endometriosis.
Physical therapy can ease pain
and help with coordination
and core strength.
It can also improve your sexual,
bladder, and bowel functions.
Your therapist may begin
with meditation or breathing
exercises to help you relax.
Specific muscles that spasm
or are too tense
may need to be retrained, which
can be done using
special sensors placed
on your muscles.
To release trigger points,
your therapist may massage
your pelvic floor muscles.
This is called
visceral manipulation therapy.
This may happen internally,
through the vagina,
Finally, you'll learn several
gentle exercises you can do
at home that will help with
coordination and moving --
like self-massage, stretching,
Emotions Play a Role
Endometriosis doesn’t just interfere with intercourse -- it can affect sexuality in general. Sex is supposed to be about two people enjoying each other physically. If sex causes pain, you can’t have a good time. This will probably lessen your desire to have sex.
Some women cite endometriosis as the reason their sex drive is lower. Some couples say they enjoy less sexual intimacy because of endometriosis. That can cause tension and turmoil in a relationship.
Some male partners may feel anxious about having sex. Or they may have trouble getting or keeping an erection. Help your partner understand that you may be avoiding sex because of your condition, not because of them.
How to Ease the Pain
Communicate with your partner. Sexual activity is a deeply personal topic. While you may feel awkward talking about it with your partner, that discomfort is probably less than the pain you’ll continue to feel if you don’t speak up. Talking to your partner about dyspareunia will help them understand your situation better. To make it easier:
- Set aside time when you and your partner can chat without distractions or interruptions.
- Explain what endometriosis is. If you need a starter definition, try this: It’s when tissue that normally grows inside my uterus grows outside it. This irritates the organs around it and makes me hurt.
- If you’re comfortable, tell them how the condition makes you feel physically and emotionally.
- Only offer as much information as you want to.
- If you want to, take your partner with you to a doctor’s appointment so they can ask questions and feel included in your support system.
Communicate with your doctor. You may not want to discuss painful sex with your doctor, but you need to. Sexual health is part of your physical and mental well-being, so it’s worth working up the courage. Your doctor may recommend medications to control endometriosis, or they might suggest laparoscopic surgery, which is a common treatment. The surgeon will remove as much of the tissue as possible growing outside of the uterus. Most people who’ve had it say their quality of life improves and sex is less painful.
Think about timing. The pain may get worse around your period. You might try to avoid sex during this time.
Experiment with positions. Some women say any sex position causes pain, while other women find only certain positions hurt. It can help to find one where penetration is shallow or where you have control over the depth, like a side-by-side spoon position with penetration from behind.
Consider other forms of pleasure. Intercourse isn’t the only way to be close to your partner, of course. Try foreplay, oral sex, or mutual masturbation.
Use a lubricant. Some women with endometriosis use a type of hormone therapy to treat their symptoms. But this can lead to vaginal dryness, which also makes sex uncomfortable. A vaginal lubricant can help with that. They work better than petroleum jelly or other products that aren’t specifically designed for vaginal dryness.
Oil-based and natural lubricants can damage latex on condoms and diaphragms.