Reviewed by Dr. Melissa Thompson, PT, DPT, MTC
Dr. Thompson is board certified and the owner of Louisiana Pelvic Health. Her expertise is in alleviating bladder, bowel, and sexual pain symptoms during pregnancy, postpartum, and throughout a woman's life.
Pain after sex is common among women that suffer from endometriosis.
Depending on where the endometrial tissue is located, sex can cause some women more pain than others.
While there are factors about having sex that can make endo symptoms worse, luckily, there are some things that you can do to help lessen the symptoms and enjoy your sex life.
Why is sex painful for women with endometriosis?
While pain after sex in common with endo, it can be even worse if the endometrial tissue growth that causes endometriosis is located in the uterus or behind the vagina.
When you have intercourse that tissue is pulled and stretched causing the pain.
Another reason for painful intercourse is vaginal dryness. The friction caused by intercourse can cause inflammation which equals pain. Tightness in pelvic floor muscles that won't relax is also a common side effect of endometriosis.
What causes endometriosis pain?
Inflammation is the name of the game with pain associated with endo sufferers. So try and do the things needed to reduce inflammation, like eating a special endometriosis friendly diet that is designed to reduce inflammation.
There are both physical and mental pieces that may be reasons endometriosis is affected by sex.
Types of Pain During Sex
Each person will be different in their experience, but some common types of pain felt during intercourse are; stabbing pain, mild to severe abdominal pain or even vaginal pain from friction.
While some women don’t experience pain, for those that do, different positions and types of intercourse can change the outcome of the type of pain felt.
Bleeding After Sex
Beware that there is a potential of bleeding after sex. If you are concerned, always consult your doctor, but know that this is a common symptom.
Tissue that is already inflamed and tender can become even more irritated during sex causing the bleeding.
If this is something you experience, although it can be an annoyance, try to put down a towel or have wipes handy just in case.
Believe it or not, anxiety is often a culprit of sex making the endometriosis symptoms worse.
There are a lot of stresses that are born from not having the sexual life that you want for you and your partner. You can feel like you don’t want to let your partner down in the bedroom but can’t get over how painful the experience is to you.
The tension built up by worrying can make this problem can make it exponentially worse. The anticipation of pain takes a physical toll on your body in addition to the mental one. Tensing up in anticipation of painful sex is the last thing that you want to do.
Try to take steps to prevent going down this rabbit hole.
So, does sex make endometriosis worse?
Sex can make endometriosis worse because it can pull on the endometrial tissue, increase inflammation that already exists in the vagina, and increase stress-responses (such as anxiety leading up to sex) that all can make endometriosis symptoms worse.
But, there are things you can do to help this.
6 things you can do to help prevent endometriosis pain during sex
1. Talk with your partner about it
Don’t be embarrassed to talk about your needs. I know, this is easier said than done for some people, but it will be worth it.
Remember, sexual function is part of life and you aren’t the first or the last that may need to bring issues up to your doctor or even your partner.
If you are in a relationship with someone, send them articles and inform them about what you go through with endometriosis. This will help them understand why you may communicate certain things in the bedroom.
You aren’t asking them to stop because you are rejecting them, but because it is causing you pain. And, there are other ways that you can have a sexually healthy relationship that doesn't always mean penetration.
2. Track ovulation cycle for the least painful times
The week after ovulation (or a two weeks after your period) seems to be the best time for sex since symptoms for endo seem to increase closer to the start of ovulation.
This might be a good time to have open conversations with your partner during intercourse when pain in minimal. You can figure out what is working and try it during other times of the month.
If you know that you are in a window for painless (or less painful) sex, send a reminder to your partner to get ready for when the kids go to bed and see if the anticipation helps to spice things up.
3. Prevent vaginal dryness by using a long-lasting lubrication
This is where communicating with your partner is key. Even if you don’t think that you need it, use more. Reducing the friction will go a long way in making sure that you are able to enjoy sex both physically and emotionally.
There is science backing up that lubrication can make for a better sexual experience in general and this is especially true for those with endo.
4. Find a good position
Experiment with different types of positions.
Many women say that the traditional missionary position causes a lot of pain. However, the best positions will vary from person to person based on the stage of endo that they have and the location of the tissue growths.
One thing that seems to help is to pick positions that don’t have quite as deep of penetration like spooning or face-to-face.
5. Engage in other types of sexual activity
If you are having a really bad month pain wise with your endo, try to experiment with other types of sexual activity.
Make a game out of trying new things and be sure to keep the communication open with your partner before, during and after the interaction.
6. Work with a Pelvic Floor Physical Therapy
A pelvic PT can help you learn to relax your muscles and assess if there is muscle tension contributing to the pain.
Sex doesn’t have to make endometriosis worse
While there is no complete cure for endometriosis, sex doesn’t have to make endometriosis inherently worse. There are better times of the month and positions to help reduce the symptoms.
But this may take some effort on your part to track and learn the patterns unique to your body.
Again, communicate with partner what worked and what didn’t. See the trend here?
You know how your body feels and what it likes. Your partner, especially one without endo, can’t read your mind so it is up to you to be frank about your needs.
If you have the same partner for an extended amount of time, I bet that each time you have this talk with them, they will learn your preferences and be able to perform without quite as much direction in the future.
While the first few times having a talk dissecting the things that were good and the things that were not so good during a previous interaction may not be sexy, it is necessary to your sexual happiness. Which I bet most partners are eager to obtain.