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[DO NOT PUBLISH] Endometriosis and Sex

Last updated: September 2022

The subject of sex and pleasure can make anyone feel a little uncomfortable, but then add into the mix a reproductive disease, and it can be pretty scary. It can be hard to open up to a partner about and sometimes even harder to attempt to have sex with someone who also doesn’t know how to approach the situation. It’s difficult to know where to begin when it comes to getting help, and the discouragement can make you wonder if there will ever be a silver lining to help you alleviate pain with sex.

Though there is no cure for endometriosis, and pain can be something that might always be a challenge, it doesn’t mean you can’t find relief or learn ways to make things easier. Here’s a few tips on different things that can help a sex life with endometriosis and the pain that can happen during and after.

Communicating endo & sex pain to a partner

It’s hard enough to explain a disease to someone, but to have to explain the details of your inner organs and why sex would create pain can be super complicated. Of course, we don’t need to explain things that make us sound like doctors, but we definitely need to make sure they understand what can increase our pain. Communication is huge, because we can’t expect someone to know what hurts us if we don’t verbalize it to them. Explaining to them that might need to switch positions, take a break, or even stop sometimes is important.

Expressing to them the emotional side of it is important too. These things are hard to tell someone, and your partner should know the challenges that you face being intimate and how to make you feel comfortable. It’s good for them to ask how they can support you emotionally and physically. It’s emotionally draining to feel inadequate because of pain, but having someone who can listen and help can be extremely beneficial.

Tackling the pain through physical therapy

There’s no instant cure for pain that can happen during and/or after sex. Though there are also different causes for this type of pain, I’ve found that pelvic floor physical therapy has helped me the most. During physical therapy, the therapist will do internal work, which focuses on relaxing clenched muscles from years of pelvic pain. They will also teach you breathing exercises that are super easy to do on your own, as well as some simple yoga stretches that help open up the pelvic floor. The wonderful thing about these stretches and breathing techniques is that you can practice them before or after sex and self-pleasure.

During physical therapy sessions, you may learn to use a dilator, which you insert yourself while you use their help to learn to tighten and loosen muscles so they expand and contract. When your muscles are restricted for so long they almost become like a tight fist that can’t open. Another great thing about dilators is that I’ve noticed a lot of help with insertion. It’s almost like with our tight muscles, it wants to reject anything trying to enter. I was almost shocked when my physical therapist showed me a diagram of pelvic floor muscles. I couldn’t believe how close they were to everything that hurt and also the places that would be touched during sexual pleasure.

When it comes to sex and pleasure that isn’t internal, things can still create pain because some women have pain after an orgasm. I struggled with this a lot and I know how upsetting it can be to run and grab a heating pad after receiving pleasure. Physical therapy is something that can hopefully help to alleviate some of the tension created on those muscles during climax, but it can also help to give you tools to relax them post-sexual activity. Your therapist can talk to you about other suggestions such as Botox for your vagina and Valium suppositories to insert. Though I’ve only used the suppositories, I’ve noticed a huge difference, especially if I put one in before sex or before I used my dilator at home.

Finding what works

Figuring out what is most pleasurable can be difficult when pain is associated with your pleasure. It can be discouraging when positions that used to work for you are now a nightmare to even attempt. It can sometimes make you not even want to try sex at all. For me, sex is almost like a trial-and-error situation, which although seems a bit daunting, it has helped me learn so much about my body. Even with the help of PT and having an understanding partner, we still need to know what our bodies feel best doing during sexual activity. Things like avoiding deep penetration, being on top so you can control what feels good and what hurts, and using lube so insertion is easier, can really help to start off by trying.

Another helpful tip is using self-pleasure as a way to test things out without the pressure of having a partner there. I know there are certain positions that even with pain management techniques, I still have a hard time doing. I’ve noticed that what’s best for me now is continuing to be on top and to take things slow for a while to help my muscles adjust. Practicing the breathing techniques you can learn with a therapist, or even just by researching diaphragmatic breathing, is also easier to do while on top.

When your flare has reached a point where these things are still too painful, and you’ve tried different positions but none seem to be working, try sexual pleasure without insertion! Being able to find a way to be intimate, without worrying as much about your muscles, can help alleviate the stress and disappointment that we can have when things are just too painful. Finding what works can take time, patience, and so much communication between you and your partner. Not only do you need to know what works, but they need to know it too. Making sure you both know what positions to avoid and which ones feel the best is extremely important to make sure you are getting the most pleasure out of each experience.

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