Endometriosis and Anal Sex: It’s Really Okay to Have this Conversation

Medically 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. 


Anal Sex. Let’s be honest. It can be uncomfortable to have a conversation about it.

But it’s really okay. We’re all about destigmatizing conversations about sexual health.

If you’re here, you or your partner are probably living with the invisible condition of endometriosis. 

It’s also likely that vaginal sex is painful so you’re looking for alternatives. Or maybe you’re interested in anal sex but don’t know if someone with endometriosis should participate.

Whatever your reason, we’re glad you’re here. We’ve designed this guide to address the topic of anal sex and endometriosis without judgment.

Sex with Endometriosis - Pain is Common

In the gynecological world, painful intercourse is referred to as dyspareunia. It is one of the hallmark symptoms of endometriosis. 

There are two types of dyspareunia: entry and deep. Entry dyspareunia refers to pain experienced with initial penetration. Deep dyspareunia refers to pain experienced with deep or full penetration.

If you have endometriosis and you are experiencing pain during vaginal intercourse, you’re not alone.

Research shows that 50% of women with endometriosis experience deep dyspareunia.

Dyspareunia can cause women to develop a negative relationship with sex. This can be extremely hard to overcome, especially with an underlying cause like endometriosis.

Endo Pain During Sex Can Lead to ‘Sexual Avoidance’

If you have endometriosis, it is highly likely that it impacts your daily life in one way or another. 

All women are different and experience endo symptoms differently. But, 69% of women with endometriosis report avoiding intercourse at some point, due to pain.

Sex is a healthy part of many relationships. Avoiding sex can affect your relationship, not only with your partner but with yourself

Physical intimacy is something we crave. It’s human nature. If you’re experiencing pain due to endometriosis, it’s important to be open with your partner and find other ways to practice intimacy.

There are Alternatives to Vaginal Intercourse for Endo-sufferers

Research of general population surveys shows that the “prevalence of anal intercourse among heterosexuals has increased over time.” In fact, according to one study, 36% of women reported having anal sex at least some of the time.

Now, we’re NOT here to suggest that anal sex is the best or only alternative if vaginal sex is painful for you or your partner due to endometriosis.

It might be one option for you (in addition to a plethora of other ways to be intimate without vaginal penetration). 

The fact is if you Google ‘endometriosis and anal sex,’ very little direct results populate.

It is a valid option to explore, but no one seems to be talking about it. So, here we are.

Can Endometriosis Sufferers Have Anal Sex?

In short, yes.

Having endometriosis doesn’t change your anatomy. If you AND your partner are open to anal sex, simply living with endometriosis shouldn’t stop you from moving forward. 

We already know that vaginal intercourse can cause pain if you have endometriosis. The biggest concern with having anal sex with endometriosis is that it might also be painful.

The key is to have open communication and tread slowly and cautiously.

If Anal Sex With Endometriosis is Painful During or After Sex, What Can You Do?

It is generally accepted that, for many women, the location of endometriosis lesions can contribute to the level of pain you will feel during or after sex.

We can assume that the same would apply to anal sex. If you have endometrial lesions that would be inflamed by anal sex, pain may occur.

The penetrative and thrusting motions of sex can exacerbate endometriosis lesions by stretching the lesions or pushing against them.

Once the endometrial lesions have been irritated, some women report having pain even 24-48 hours after having sex.

As I mentioned, there is not a ton of information out there about engaging in anal sex with endometriosis. 

But, let’s look at a few things you can do to alleviate pain during and after vaginal sex that also applies to anal sex.

Endometriosis Pain During Sex: Suggestions

If you or your partner’s endometriosis is causing pain during anal sex, there are a few things you can try:

  • Different positions
    • Did you know the missionary position often causes endo women the most pain? Try switching it up.
  • Explore different times of the month 
    • Some women experience more pain during intercourse around their period.
  • Actively communicate
    • If something starts to hurt, stop immediately and try to find a solution. Don’t “push through the pain.”
  • Use a natural lubricant
    • If you or your partner’s pain is associated with initial penetration or vaginal dryness, try a natural lubricant.

Endometriosis Pain After Sex: Suggestions

If you or your partner’s endometriosis pain remains after engaging in anal sex, there are a few things you can try:

  • OTC Medications
    • If your pain is not excruciating, it can often be managed with over-the-counter anti-inflammatories like Ibuprofen.
  • Apply Heat
    • Try a heating pad, rice bag, or a warm bath.
  • Drink plenty of water
    • This can help with bloating and cramping.
  • Schedule with a pelvic floor physical therapist
    • The muscles of the pelvic floor that sling around the rectum could be contributing to the pain. This can cause significant anal pain following bowel movement or intercourse. A pelvic floor PT will provide treatment to alleviate the issue.

    When Should Endometriosis Sufferers Avoid Anal Sex?

    Here at Chiavaye, we do not claim to be doctors. We are not providing medical advice, but rather facilitating a conversation.

    Because of the lack of research regarding endometriosis and anal sex, we can’t say for certain if there are instances in which women with endometriosis should absolutely avoid engaging in anal sex.

    But, we do know that there are certain stages of endometriosis that can affect the bowels and rectum. It is possible that participating in anal sex may not be wise in these situations because of the potential of increased pain.

    Deep Infiltrating Endometriosis

    Deep infiltrating endometriosis (DIE) occurs in the most advanced stage (stage IV) of endometriosis. 

    It can be characterized by lesions found in:

    • The space between the vagina and the rectum
    • The rectum
    • The rectovaginal septum
    • The vagina
    • The bladder

    DIE is often diagnosed when endometriosis has penetrated deeper than 5mm under the layer of tissue that lines the pelvic cavity.

    Bowel Endometriosis

    One form of deep infiltrating endometriosis is bowel endometriosis. Most instances of bowel endometriosis are found in the final 20cm of the large intestine (between the rectum and the sigmoid colon).

    Symptoms of bowel endometriosis include:

    • Severe pain during a bowel movement
    • Rectal bleeding during menstruation
    • Diarrhea
    • Constipation
    • Cramps and bloating

    Two common forms of DIE are bowel endometriosis and rectovaginal endometriosis.

    Rectovaginal Endometriosis

    Rectovaginal endometriosis is another form of deep infiltrating endometriosis. It can affect the:

    • Vagina
    • Rectum
    • Recto-uterine pouch
    • And more

    In addition to typical endometriosis symptoms, women who experience rectovaginal endometriosis may also suffer from:

    • Bleeding from the rectum
    • Swelling of the rectum
    • Painful bowel movements
    • Symptoms of irritable bowel syndrome

    New to Anal Sex? Educate Yourself First - Especially if You or Your Partner Has Endometriosis

    If you and your partner decide to give anal sex a try, be informed. Know that there are some risks associated with anal penetration, but they’re all easily managed and preventable.

    As we’ve discussed, women with endometriosis often experience pain during intercourse and anal sex might not be any less painful. Using a healthy lubricant can help to alleviate pain. 

    Read up on anal sex before jumping in for the first time - especially if you or your partner has endometriosis. 

    Check out this guide compiled by Prevention or these tips compiled by Cosmopolitan as a start.

    Improve Your Overall Endo Sex Life: Natural Treatment Methods for Endometriosis

    Endometriosis is an incurable disease. But that doesn’t mean you can’t manage your symptoms and treat the inflammation that can cause painful endometriosis flare-ups - and painful intercourse.

    Improvements won’t happen overnight. Keep with it, start small, and find support in endometriosis community forums like Reddit.

    To start, implementing some simple, but effort-intensive changes can improve daily life with endometriosis and, in turn, your sex life - vaginal or otherwise.


    An endometriosis diet should focus on eliminating foods that can cause inflammation and implementing foods that are anti-inflammatory. 

    Our starting point for a solid endo-friendly diet is: 

    • Gluten-free 
    • Dairy-free
    • Soy-free

    Anti-inflammatory foods include:

    • Olive oil
    • Fatty fish
    • Most fruits
    • Most vegetables

    It may seem daunting to make drastic changes to your eating habits, but you could be amazed by the results. Check out my story and my endometriosis diet for tips and recipes.


    There are a few simple lifestyle changes that can help you navigate the endo life with a bit more peace. 

    Make every effort to:

    • Manage your stress
    • Exercise everyday
    • Maintain hydration

    These simple steps can help keep your physical and mental health in their best form which facilitates easier endometriosis management.


    Herbs have many healing and pain management properties. One Chinese study shows that some herbs have a positive effect on endometriosis - including relieving painful menstruation and shrinking endometrial tissue.

    Some of the most beneficial herbs for endometriosis management include:

    • Evening primrose oil
    • Turmeric
    • Ginger
    • Peppermint
    • Yarrow

    Incorporating herbs into your daily life can take time and possibly involve a little trial and error. But the symptom relief they can provide can improve your daily life - IN and out of the bedroom.

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