Endometriosis and Sex

Pain with sex is a potential symptom of endometriosis. Associated conditions such as pelvic floor dysfunction or painful bladder syndrome can worsen pain with intercourse.

Over time, you can come to associate sex with pain, plus fear of pain can lead to sexual dysfunction and frustration.

This article discusses the connection between endometriosis and pain with sex, plus tips that may help improve your sex life.

Pain Generators From Endometriosis and Sex

When you have endometriosis, endometrial-like tissue grows outside the uterus. The resulting lesions can appear anywhere within the pelvis, leading to chronic pelvic pain and pain during or after sexual intercourse. Factors that affect how you might experience that pain includes:

• Location of lesions: Endometriosis lesions occur around the reproductive organs in the pelvis or abdomen. They can also grow in the bladder, rectum, vagina, or vulva. The lesions lack elasticity, so the external force of sexual intercourse becomes painful.
  
• Presence of adhesions: Adhesions are bands of "sticky" scar tissue associated with advanced endometriosis. The lesions can stretch and pull during intercourse.
• Co-occurring conditions: Pain during sex can also be due to coexisting conditions such as pelvic floor dysfunction, painful bladder syndrome, ovarian cysts, vaginitis, and pelvic inflammatory disease (PID).
• After surgery: Recovering from any surgery can be painful until you're fully healed. Following tubal, ovarian, or uterine procedures, there's a particularly high risk of developing adhesions. You can also develop adhesions after endometriosis surgery.

You might have more pain with endometriosis if you've recently given birth. During childbirth, an episiotomy or tears to the perineum can cause painful sex. It can take several months to heal fully. Perimenopause and menopause can also play a role because hormonal changes can lead to vaginal dryness.

How Does Endometriosis Pain Feel With Sex?

The pain is different for everyone and is variously described as:

• Cramping
• Pulling, stinging, burning
• Stabbing sensations
• Spasms or convulsions

It's also more than a physical problem. A painful sexual experience can affect emotional and mental health and quality of life. Sex is something that should be associated with pleasure, but in some cases can lead to:

• Poor self-esteem, guilt
• Lack of arousal, loss of libido (sex drive)
• Inability to orgasm, lack of sexual satisfaction
• Anxiety, depression

When Does Pain From Endometriosis and Sex Come On?

Not everyone will experience pain the same way, and it can range from mild to quite severe. It's most common with deep penetration. It can also happen at the beginning of intercourse, during the first penetration, or with an orgasm. Some women still feel the pain well after intercourse, for hours or even days.

Symptoms of endometriosis can fluctuate with the hormonal changes of the menstrual cycle. You might find that sex is more painful before and during your period.

Overcoming Pain: Endometriosis and Sex 

Some people may choose to stop having sex altogether. There's nothing wrong with that if it's your choice. But if that's not for you, there are several treatments you can try.

Treating Endometriosis 

Sometimes, treatment for endometriosis can help improve your sex life. If you're already in treatment, your healthcare provider may be able to recommend something different. This may include:

• Hormone therapy
• Pain management
• Surgical procedures

Each case is different, so it's good to let your provider know how endometriosis affects you.

Pelvic Floor Physical Therapy

Research suggests pelvic floor physical therapy can help improve sexual dysfunction and pelvic pain. Designed to improve the strength of your pelvic floor muscles, this type of therapy may involve:

• Education about your anatomy and how it works
• Exercises that teach you how to contract and relax pelvic floor muscles
• Breathing and timing techniques
• Hands-on massage or stretching to improve posture, circulation, and mobility
• Biofeedback to help you see how the pelvic floor muscles work
• Electrical stimulation to show you how to coordinate muscle contractions
• Vaginal dilators to help you learn how to relax pelvic muscles

Sex Therapy

Sex therapy is a form of talk therapy. If you go with a partner, a qualified therapist can help improve communication so you can overcome obstacles to sexual intimacy together. But you don't need a partner to get sex therapy. A therapist can help you work through your sexuality related to endometriosis, including improving solo play.

Communication

Research suggests that endometriosis can affect relationships. Open communication is important, and not just during sex. Your partner may be unaware or confused by what you're experiencing. Some things you might want to discuss with your partner:

• Start with a brief primer on endometriosis and why it can be painful.
• Identify the sexual acts or positions you find most painful.
• Identify the ones that seem to work better for you.
• Tell your partner how they can help.
• If you're unsure how your partner can help, suggest experimenting together.

Whether you have a partner or not, it's important to prioritize good communication with a healthcare provider or therapist.

Sexual Wellness Tips With Endometriosis 

Even if you have pain during the deep penetration of intercourse, it doesn't mean everything sexual hurts with endometriosis. With a little trial and error, you should be able to find something that works for you, such as:

• Try different positions for intercourse. Don't hesitate to stop and change positions when it hurts.
• Be intimate without penetration. Try oral sex and mutual masturbation.
• Spend more time on foreplay.
• Use vaginal moisturizers and lubricants so that penetration is easier.
• If your endometriosis tends to be more painful before or during your period, avoid intercourse at those times.
• Try some deep breathing and meditation techniques to cope with nervousness in anticipation of sex that might be painful.
• Experiment with penetration devices, such as Ohnut, which are designed to let you customize the depth of penetration and avoid pain during intercourse.

Summary

For some people with endometriosis, sex can be painful. Over time, the physical pain of sex can take an emotional toll. It can even affect your overall quality of life. If you're having endometriosis-related pain with sex, consider speaking with a healthcare provider. There may be a treatment that can help.

You can also try experimenting with different sexual positions and activities, doing pelvic floor exercises, or seeing a sex therapist. Whether by yourself or with a partner, sex should be pleasurable, not painful.