5 Tips for Having Less Painful Sex if You Have Endometriosis

Endometriosis can affect everyday life in numerous ways—including your sex life. endometriosis lesions can cause pain in the abdomen, lower back, or pelvic area, which can really put a damper on your sex life. However, having endometriosis doesn't mean an end to having pleasurable sex. Learn more about the effects of endometriosis on sex and what you can do to decrease the pain experience.

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 people, it causes inflammation and swelling, particularly before and during menstruation.

Endometriosis and Sex

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

Not all individuals with endometriosis experience pain during sex—known medically as dyspareunia. It depends on 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, told Health.

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

People 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. Individuals with endometriosis can also 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. Thus, people with endometriosis who experiences pain during sex will likely find their sexual desire and libido to be negatively affected.

What You Can Do To Lessen Sex-Related Pain

There are ways to lessen sex-related pain when you have endometriosis. Communication, foreplay, lubricants, and timing are all important. You'll have to find the combination of solutions that work best for you and your partner. But, there is some light at the end of the tunnel.

Let Your Partner Know What You're Feeling

This is crucial, Dr. Ross said. "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," Dr. Ross added. "The more your partner is informed about the pain and discomfort you are experiencing, the easier it will be for [your partner] 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, likely, about causing you pain or discomfort, as well.

Keep Penetration Shallow

Some people with endometriosis say that deep penetration causes pain. Others have found that they can get enjoyment out of sex by engaging in unpainful positions, according to an IJERPH article published in November 2021.

In particular, stick to more shallow sex positions, which put less pressure on areas of the pelvis that contain endometrial tissue, Dr. Greves said. A good starting position is face-to-face with the person with endometriosis on top, which allows that person 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. However, many individuals with endometriosis find the missionary position painful, so that might be one to avoid.

Stick to 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 recommended exploring other sexual activities.

"Couples express their love and passion in many ways," Dr. Ross added. You're only limited by your imagination—mutual masturbation, oral stimulation, massage, foreplay, and non-penetrative sex toys are all fair game.

Use Lubricants

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 recommended making sure you have a go-to lube available 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

Some people with endometriosis have also found that penetrative sex is easier at certain times of the month. Dr. Greves suggested trying it in the two weeks following your period to see if it's less painful.

But why would sex be less painful when you're not on or near your period? Dr. Ross explained 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," Dr. Ross explained. This means that as long as you are having monthly periods, endometriosis can return along with all the disruptive and painful symptoms.

A Quick Review

Painful intercourse in people with endometriosis doesn't have to kill bedroom romance. Communicating about sex and pain with your partner is important. You can also try shallow penetration, lubricants, and scheduling sex around your period. If that doesn't work, sticking to foreplay moves and getting creative can also keep your sex life exciting.

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.