From foreplay to positions, these moves can make sex more pleasurable.

By Claire Gillespie
May 06, 2021
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Endometriosis is a condition in which the endometrial tissue that forms the lining of the uterus migrates to other body parts, such as the fallopian tubes, ovaries, and bladder. In many women, it causes inflammation and swelling, particularly before and during menstruation. It can also affect everyday life in numerous ways—including your sex life.

"Some women with endometriosis do have concerns with painful intercourse," Christine Greves, MD, an ob-gyn at Orlando Health Hospital in Florida, tells Health. "The thought process is that penetration and other movements can pull and stretch the endometrial growths, resulting in discomfort."

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Credit: Getty Images

Not all women with endometriosis experience pain during sex (known medically as dyspareunia). It depends where the endometrial implants are located in the pelvis, Sherry A. Ross, MD, author, ob-gyn, and women's health expert in Santa Monica, California, tells Health.

"If the implants are on nerves, ligaments, and tissue that becomes stretched during sex, the pain can be significant—often unbearable," Dr. Ross explains. "In some cases, it lasts for hours and days afterwards, making sex impossible."

Women with endometriosis who experience painful sex describe it in a variety of ways. Some say it feels like sharp stabbing, while others call it an ache deep in the abdomen. Some women with endometriosis experience pain after sex rather than during it. Wherever and whenever the pain occurs, it may rule out penetrative sex completely, which can have lasting mental and physical consequences on a sexual relationship. While the female sex drive is often challenging to understand, a woman with endometriosis who experiences pain during sex will likely find her sexual desire and libido to be negatively affected.

But having endometriosis doesn't mean bidding farewell to a pleasurable sex life. Here are five expert-backed tips if endometriosis makes sex painful.

Let your partner know what you're feeling

This is crucial, says Dr. Ross. "It can be difficult and challenging to talk about sensitive sexual issues, but it's key in dealing with how endometriosis can interfere with normal intimacy," she says. "The more your partner is informed about the pain and discomfort you are experiencing, the easier it will be for he or she to be supportive and helpful in finding alternative ways to express your sexual concerns."

Sure, it may feel intimidating or embarrassing to speak about sex with your partner, but the key to a healthy sex life is communication. By sharing your concerns with your sexual partner, you can reach a place of understanding and make the experience more intimate and pleasurable for both of you. Your partner may also be worried about how sex affects your endometriosis, and they'll likely be concerned about causing you pain or discomfort.

Keep penetration shallow

Some women with endometriosis say that deep penetration causes pain. If this is the case with you, stick to more shallow sex positions, which put less pressure on areas of the pelvis that contain endometrial tissue, Dr. Greves says. A good starting position is face-to-face with the woman on top, which allows you to control the pace and depth of penetration.

Spooning (lying on your side and being penetrated from behind) is another shallow sex position that lets you dictate the speed and depth of penetration and slow things down if it starts to get uncomfortable.

Many women with endometriosis find the missionary position painful, so that might be one to avoid.

Stick to "outercourse" and foreplay moves

Remember, penetration isn't necessary to have satisfying sex. If penetrative intercourse isn't an option for you due to your endometriosis pain, Dr. Ross recommends exploring other sexual activities. "Couples express their love and passion in many ways," she says. You're only limited by your imagination—mutual masturbation, oral stimulation, massage, foreplay, and non-penetrative sex toys are all fair game.

Lube it up

Though endometriosis doesn't necessarily result in a lack of natural lubrication, anxiety or worry about feeling pain during sex or sexual activity can make it more difficult to get aroused. So Dr. Greves recommends making sure you have a go-to lube on hand in case you need it. Taking a warm bath before sex can also help to ease symptoms and relax your body and your mind.

Schedule sex

Many women with endometriosis find that penetrative sex is easier at certain times of the month. Dr. Greves suggests trying it in the two weeks following your period to see if it's less painful. Some women report that sex feels better in the week after ovulation.

Why would sex be less painful when you're not on or near your period? Dr. Ross explains that with each menstrual period, the endometrial implants will bleed no matter where they are located in the body. "As a result of the bleeding implant(s), scar tissue or 'spider webs' develop in your pelvis, causing pain and all the other symptoms related to endometriosis," she says. This means that as long as you are having monthly periods, endometriosis can return along with all the disruptive and painful symptoms.

Remember, everybody is different, so it might take some time to figure out what works for you. And don't be afraid to discuss your sex life with your ob-gyn, who can help you to figure out an individual plan to relieve symptoms, including painful or uncomfortable sex.

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