How to manage endometriosis for a healthy, pain-free sex life

By Nikki Michelsen

Nov 4, 2022

How to manage endometriosis for a healthy, pain-free sex life
Written by Dr. Laura Vowels, a therapist at Blueheart — a digital sex therapy platform designed by experts to tear down sexual taboos and create a private refuge for anyone to overcome any sexual challenges.
Endometriosis and the chronic pain that comes with it can range from seriously annoying to outright debilitating...particularly when it comes to your period and sex. And while treatment and prevention can be tricky, there’s actually a ton of support available, and thankfully, loads of techniques you can use to reduce pain and maintain a healthy sex life with your partner. 

first up: what is endometriosis?

Endometriosis is a disease where endometrial tissue, similar to the lining inside the uterus, grows outside of the uterus, including on the ovaries, fallopian tubes, or bowel. (imagine if your garden started growing carpet instead of grass, and you’ll get a sense of how many problems this would cause…) 
It’s pretty common, too: the WHO reports that endometriosis affects around 10% of women globally (so about 160 million!), causing pain that’s so severe it impacts on quality of life and can even lead to infertility. yikes.. 
If you’re not sure, endometriosis symptoms include chronic pain in the lower stomach, back, and pelvis, as well as heavy or painful periods and moderate to severe pain during sex. And because of these nasty symptoms, women with endometriosis often - shocking! astounding! - report fatigue and depression or anxiety as well.
What’s really tough is that even though we know that there are many factors that can contribute to the onset of endometriosis, we don’t know yet how to prevent it - the best we can currently do is to diagnose it early and manage it properly to slow down its progress. Treatment options like surgery and hormone therapies can sometimes help with the symptoms of endometriosis in the short term.  

how does endometriosis affect your sex life?

One of the main issues described by people with endometriosis is the toll it takes on their sex life, especially because deep penetration can often cause severe pain during sex, or even up to two days later (like a sex hangover). This pain - or deep dyspareunia, if you were curious about the scientific term - can feel different for every woman. some describe it as sharp and stabbing, while others report pelvic pain or aching.
So now that you know all this, you probably won’t be surprised to learn that about two-thirds of women with endometriosis have some form of sexual dysfunction. This often leads to having less sex, reduced sexual satisfaction, or low sex drive due to the pain.
Women with endometriosis won’t always feel confident telling their partners what’s going on, ‘cause they might feel it’s their fault that sex is painful or that they’re doing something wrong. (spoiler: they’re not.) and their partner might feel guilty and think the pain is their fault. (spoiler #2: it’s not.) over time this can lead to a vicious cycle of avoiding sex and feelings of rejection and resentment in the relationship that, if you don’t address them, can start to seep into other areas of the relationship.  
We’d always recommend talking to your doctor or gynecologist if you’re suffering from pelvic pain, painful periods or pain during sex. this way they can take a view of your symptoms, make a diagnosis and monitor or make a treatment plan where possible.
But that’s not to say you can’t do other stuff to improve the problem on your own, too.

how to reduce pain during sex with endometriosis

If this all sounds a bit… ugh, just take a deeeep breath for a sec, ‘cause there are absolutely ways to make sex with endometriosis less painful, from experimenting with different sex positions and techniques, to seeking out medical interventions and diagnoses, so don’t even think about throwing in the sex towel any time soon.
First up, try experimenting with having sex at different times of the month; keep track of your cycle and the common symptoms you experience, and you might find that there are certain times of the month where you experience less pain during sex. and, if it’s something you’re comfortable with, don’t be afraid to use plenty of lubrication if you experience vaginal dryness too.
Different sex positions and changing the depth of penetration can result in different levels of pain too. the missionary position, for example, might be more painful because of the way your pelvis is tilted and the deep penetration it allows for. instead, try positions that encourage shallow penetration for a more pleasurable experience.
Of course - and i’m sure this won’t be breaking news to any of you gals out there - sex doesn’t have to mean penetration all the time: there are many alternatives to intercourse. find ways to connect with your partner through kissing, foreplay, mutual masturbation, oral sex, and any other types of intimacy you enjoy that shouldn’t affect your endometriosis pain at all.

how can mindfulness help?

One other alternative, if you want to be able to continue with penetrative sex, is to find ways to reduce the pain you experience during intercourse with your partner. This might mean taking painkillers or medication a little while beforehand, or - and stay with me here - you could try mindfulness.
Studies have found that mindfulness exercises can help to reduce sexual pain by helping you to focus on sensations within the body and be present in the moment. Plus, not only can mindfulness help with pain during intercourse, it can also improve sexual response, mood, quality of life, and general well-being. Talk about bang for your buck, if you’ll excuse the pun…
If you feel like you need professional support, a good sex therapist can help you out with techniques and exercises to help you get your sex life back on track. As an alternative, the Blueheart app teaches you how to use sensate focus therapy to introduce mindfulness into your sex life through a series of touch exercises.
The app will help you and your partner work together to move past the anxieties surrounding the pain and symptoms of endometriosis. Initially you'll move away from intercourse completely in order to build up trust and focus only on the sensations within your own and your partner’s body.

how can you help your endometriosis-suffering partner?

Partners! step up! the burden of having endometriosis doesn’t just fall on the person experiencing it directly; like almost all challenges in life, having a supportive partner can make all the difference.
As the sexual partner, try to remember that it’s no-one’s fault, everyone is different and has different physical and psychological needs; no-one should ever feel pressured into having intercourse or made to feel guilty for being nervous or concerned about undertaking any kind of sexual activity.
Learn more about the condition (if you’ve made it this far in this article, consider that ticked off!) and help your partner find ways to reduce the pain involved in sex. try to explore ways of being sexual and giving or receiving pleasure by reframing what sex looks like to you – it doesn’t have to be about penetration if that’s painful at the moment. besides, for most women (about 75%!) penetration isn’t the most pleasurable way of having sex anyway.

don’t suffer in silence

If you’re suffering with painful periods or discomfort during sex, don’t ignore it and hope it will go away. (believe me, if ignoring things made them go away i wouldn’t have what can only be described as a sh*t-ton of laundry judging me right now…)
Getting a diagnosis of endometriosis could be the first step to getting the help you need. speak to your doctor and find out what can be done - and if you don’t feel they’re listening to you, sack them off and try again with a new doctor.
For support to help reduce pain during intercourse, consider trying Blueheart as an alternative to in-person sex therapy, helping you to focus on the sensations within your body and reduce the pain and anxiety associated with sex with endometriosis. 
Image credit: @womanizer (Unsplash)