One of the most common symptoms that women with endometriosis report experiencing is pain during sex. This pain is also called dyspareunia. Each woman's experience with dyspareunia can be different. For some, the pain they're experiencing may be upon penetration, while for others, it may be a pain that is experienced deeper in the pelvis. The severity and characteristics of a woman's pain during sex can also vary greatly.
There are several reasons why an individual with endometriosis may experience pain during sex. In some cases, it may be endometriosis lesion tissue stretching inside the pelvis, especially near the lower uterus or behind the vagina. Another potential reason may be due to vaginal dryness that occurs as a result of common endometriosis treatment options such as hysterectomy or hormone-altering medications. Additionally, a woman's libido (also known as her sex drive) may be impacted. As an example, a woman who constantly experiences pain during sex may start losing her desire to continue attempting intercourse. A woman's pain during sex may be a result of one or all of these potential causes, or it may be related to something different. If you're experiencing pain during sex, it's important to talk with your healthcare provider to determine if the pain is caused by your endometriosis or another underlying condition.1,2
How to talk to your partner
Although it may be difficult, talking about your sexual experiences with your partner is key to maintaining a healthy relationship across all aspects of life. Hiding your pain and discomfort from your partner may cause you to retreat or lose interest, which your partner may perceive as something they've done wrong. A kind, compassionate partner will understand what you're going through and will want to work with you to find what's best for the two of you. If your partner is confused or needs more information on what you're going through and how to best support you, it may be a good idea to take them to a support group meeting with you or a healthcare appointment with your provider. These actions may make your diagnosis and symptoms more concrete for your partner, and give them a space to ask questions and learn more.
Conversations with your partner about your intimate life can happen outside of your sexual encounters or during them. Letting your partner know what feels good, what hurts, and what you need during sex can keep communication lines open when you need them the most. Being open with your partner may also encourage them to share what they're feeling and what they need from you, too.
Reducing pain
Although many women with endometriosis experience pain during sex, sex is not always impossible. Learning what your body needs and trying new things may help decrease pain and increase your desire to continue to try having sex with your partner. Specific ideas that may reduce pain include, but are not limited to, the following.
- Track your cycle: Try tracking your menstrual cycle and having sex at different points throughout it to see if a specific time is less painful for you. Some women experience the most pain when trying to have sex right before or during their period. Others may report better pain outcomes when having sex early in their cycle. Each individual's relationship to their pain levels and their cycle can be different.
- Change positions: Some positions, such as the missionary position, may cause more pain than others. Trying positions, that allow the woman to control the depth of penetration and the speed may reduce pain and improve comfort.
- Practice other sexual activities: Participating in other sexual activities such as oral sex, massage, or using sex toys, among other options, may provide you and your partner with the intimacy you desire, without the pain.
- Increase foreplay time: The longer you and your partner engage in foreplay, the more natural lubrication might build. This natural lubricant may help make sex easier and less painful.
- Use lubricant: Even with increased foreplay time, additional lubricant may be helpful.
- Try pain relievers: Utilizing pain relief options such as heat, warm baths, or over-the-counter pain medications before sex may help relieve pain. It is important to consult your healthcare provider before using over-the-counter pain medications on a regular basis, or if you are utilizing other medications.
- Check in with your healthcare provider: Your healthcare provider may be able to recommend additional pain relief options in your specific situation.1,2