So many of us with endometriosis experience painful sex. And we aren’t talking discomfort: we’re talking very real pain during and after intercourse. Click here to read the pip blog post all about endometriosis

If pain with sex is such a common symptom of endometriosis – to the point it is always a screening question with doctors – why does no one talk about it?

While sex and intercourse may not be the most comfortable conversation for many people to have with their family, friends and doctors, it’s about time we become sex-positive in our conversations about chronic illness and pain. Those who live with endometriosis deserve to know the who, what, where, when, why and how of painful sex, as do every person they have relations with, because creating boundaries around safe, enjoyable sex isn’t just the responsibility of the person with endometriosis. 

We recognize not everyone will feel comfortable talking about sex, pain or not, with their doctors. Sex is very personal, and can become even more so when pain is associated. Know that if you experience pain with sex, this is valid and so are you. As uncomfortable as it may be, your doctor needs to know your experience with painful sex in order to get you proper care. Know that they will likely ask you during your conversation about your uterine and pelvic pain, and if they don’t, you should bring it up. Tracking when you have pain with sex can help relay to your doctor what you are experiencing. Making note of when the pain occurred, what it felt like, and the pain level on a scale from 1 to 10 can all help in figuring out your endometriosis both with your doctor, and for yourself. 

According to Web MD, about two-thirds of those with endometriosis report to their doctors some kind of pain with sex, “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”.

Here at pip, we recognize that not only people who identify as women have endometriosis, and that sex can look very different depending on sexual orientation, gender identity, and just plain old preferences of what you like and consider sex. That can also mean that pain with sex looks and feels very different for each person and during different forms of sex. Where your endometriosis is also plays a big factor in where and how you experience pain.

Experiences of painful sex can range from discomfort, mild or sharp pain, stabbing pain, deep, aching pain during penetration (vaginal and anal), stimulation, and/or pressure. Penetration of any kind and depth may hurt, or only during deep penetration. Further, where you are in your menstrual cycle can play a large role in when you feel pain. 

Pain can also happen after sex. This can feel like a dull, achy pain around your low abdomen and back, in your groin, and/or pelvis; mild, moderate, or sharp cramping; pain during urination or bowel movements post-sex; and even nausea and dizziness. The pain can last a few seconds or minutes, or can last hours and even days. 

Why does pain with sex occur in endometriosis?

The main reason pain with sex is a common symptom of endometriosis is because of the endometrial lesions that spread throughout the body. These lesions can be in and around your uterus, on your fallopian tubes, the back of the vagina, the rectum, the bowels, your bladder, and more. Endometriosis at any place in the pelvic area can become inflamed and irritated during sex due to being stimulated, pulled, or even stretched. If you have endometriosis in the rectum, vaginal penetration may cause the rectal-lesion to become angry due to pressure from laying on your back during sex. Depending on where you experience endo and sex pain, trying different positions may be helpful in finding what lessens the pain for you.

Depending where your endometriosis is, it can also have no pain or effect during sex. This could be when the lesions are on your ovaries, which are not stimulated the same way during sex. However, this could result in pain leading up to and during ovulation. 

Another reason for pain during sex could be vaginal dryness. Vaginal mucus fluctuates throughout every cycle depending on hormones and which phase you are in. Endometriosis and its hormonal therapies may cause vaginal dryness during your cycle, which can exacerbate the pain you already experience during sex. If you’re affected by vaginal dryness, try a lube!* Not only can it help with the dryness, but it may help lessen some of the pain you experience from penetration. 

Building Safe Boundaries

Painful sex can take a toll emotionally, both on you and your partner. They may be afraid of hurting you and become unsure when to approach you about being intimate as a result. You yourself may feel less libido and sexual desire because you are anticipating the pain it will cause. Being open with your partner about your pain and what endometriosis is can not only help ease these emotional tolls, but can also be empowering. 

Don’t be afraid to let your partner know that any apprehension or avoidance of sex is due to the pain you are experiencing. Remember that consent is ongoing: just because you’ve been with your partner for a long time doesn’t mean they can have sex with you at any time. It also means you can stop sex at any point if there is pain. 

If you are unsure how to bring up your endometriosis with someone you have just met or are still getting to know, you don’t have to tell them every single thing about your endo if you don’t want to. You can share as little or as much as you want. We suggest letting them know that sometimes, you experience pain or discomfort with sex, so ongoing check-ins on how you are feeling is important. We know that this may not seem like the most sexy thing, but it can be! Taking breaks from penetration can allow time for other forms of sex, connection and intimacy. You can also change positions at any point if you feel relief in them. Stopping sex at any point completely is always available to you as well. 

Ways to Find Relief

Sex is meant to be enjoyable for each person. This can become hard when you experience pain with sex, and we want you to know that these feelings are valid. We know first hand the physical and emotional toll pain with sex can take. Here are some of the ways we find relief from pain during sex:

We want to note that pain with sex will feel different for every person, and that while the following allow us to find some relief from endo pain during sex, it by no means makes the pain obsolete. 

• Be vocal about when you are experiencing pain 

This goes for during sex but also before the notion of sex is even there. If we are having a day filled with pain, we make sure our partner is aware of this. If the pain subsides, or we feel like having sex with this pain, it is our decision and proposition to our partner. 

• Use the bathroom before sex 

Because of where our endometriosis is in our bodies, we find that having an empty bowel and bladder before sex can alleviate some of the pain we experience. 

• Use pillows

Depending on where the pain is, the use of pillows use your low back, head, spine, and even sacrum may help alleviate some pain. 

• Avoid certain positions 

When we are experiencing a flare and/or pain during sex, some positions are off limits because we know they exacerbate the pain. Our partners are aware of this and know to not suggest or pressure us into using that position. 

• Take pain relief prior 

If NSAIDs, Advil, or Tylenol help you feel pain relief, consider taking some prior to sex. You can also take this after sex if you experience pain afterwards. For many with endometriosis, pain relievers don’t work for flare pain or sex pain. If they do though, don’t be afraid to take some. 

Pain relief can also come from CBD*. CBD can be a very helpful tool for managing all endometriosis pain, including prior to and after sex. It can also help relax the mind if smoked, inhaled or ingested, so the apprehension of the pain does not impact you as much. If you find relief in any substance, be sure to do so responsibly, and seek out help if you experience misuse. 

• Use lubricants 

As already noted above, the use of lube can help relieve pain from endometriosis as well as vaginal dryness.