Endometriosis and painful sex

Endometriosis can have a big impact on many aspects of your life, from your energy levels to the way you start a family, but one of the effects it can have that might make some of the most consistent impact on your day to day life is the way it can affect your sex life. Pain during intercourse is one of the most common symptoms of endometriosis, which is a condition that can present itself in different ways and with different symptoms based on where and how extensively the endometrial tissue is growing.

The effect of endometriosis on your sex life can affect romantic relationships, chances of conception for women who are trying to conceive, and can even impact your self-esteem and sense of self. Being aware of the ways you can work with or around your endometriosis for a chance of a more satisfying sex life can help mitigate these effects.

Why does painful intercourse happen?

Pain during sex with endometriosis is usually caused by the same thing that causes other types of pain with endometriosis: endometrial lesions and scar tissue, and where they grow. The adhesions of endometrial scar tissue that can connect internal structures that weren’t previously connected, like the vagina and the lower uterus, can pull and stretch during intercourse, which can cause pain. Lesions in the same areas can also cause pain. This pain sometimes happens at the time of intercourse, or can show up or last as long as two days afterwards, depending on the type and extent of lesions and adhesions.

Because endometriosis pain comes from endometrial cells which usually line the uterus, pain during intercourse may follow a pattern that’s connected with the menstrual cycle. Women who are experiencing painful intercourse may notice that they’re only having painful sex for part of the month, or notice more pain at certain parts of the month. This means that, by charting and knowing their cycles well, they may be able to choose days to have sex when their bodies will be best prepared to enjoy it.

The hormonal changes that come after a hysterectomy or during hormonal treatments meant to mimic menopause can also cause vaginal dryness that can cause pain during intercourse.

What can I do about painful intercourse?

The first – and possibly most fun – way to start to fight against painful intercourse is to try different positions. Which positions end up feeling best often depend on your body and the way it responds, but missionary sex is generally agreed to be the most painful, because of the way the uterus is tilted up. Aside from changing positions, some women only experience pain, or feel the most pain, with deep penetration, so shallower or more gentle sex may be the way to go. Communication with your partner is key for navigating how to best approach pain during sex with endometriosis, and you may have to try a few different things before you figure out what works for you.

Women experiencing vaginal dryness can get past that obstacle by using lube and taking it slow, and women who experience inconsistent pain during intercourse may be able to figure out the perfect timing for sex just by charting their cycles. Many women find that the stretch of time just after menstruation, but before ovulation begins, is a time when pain during intercourse disappears or recedes. Every woman’s cycle is different, so again, it may take some experimentation to work out when the time is right.

If these ideas don’t help, it may be helpful to take a little break from vaginal penetration and explore the other ways you and your partner can enjoy sex. Unwanted pain during intercourse on a regular basis can be discouraging and disheartening, and put stress on a relationship. Taking a step back from trying may not feel like a step in the right direction, but taking some low-pressure time to spend together can help you and your partner get back on the same page.

  • Lone Hummelshoj. “Sex and endometriosis … perhaps not in the morning.” Endometriosis Foundation of America. Endometriosis Foundation of America, 2011. Web.
  • Marta Meana. “Painful intercourse …taking sex seriously.” Endometriosis Foundation of America. Endometriosis Foundation of America, 2011. Web.
  • Elaine Denny, Christopher H. Mann. “Endometriosis-associated dyspareunia: the impact on women’s lives.” Journal of Family Planning and Reproductive Healthcare. British Medical Journal, July 19 2016. Web.
  • S. Ferrero, et al. “Quality of sex life in women with endometriosis and deep dyspareunia.” Fertil Steril. 83(3):573-9. Web. March 2005.
  • “Endometriosis and Sexual Function.” International Society of Sexual Medicine. International Society of Sexual Medicine, 2016. Web.
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