Endometriosis occurs when cells that resemble the uterus lining grow elsewhere in the body, including the ovaries, fallopian tubes, or bowel. Sometimes, these growths can get in the way during sex, which can be painful.

Symptoms of endometriosis include heavy menstrual bleeding, painful periods, and sometimes, pain during sex.

Dyspareunia is the medical term for pain during sex. It frequently occurs in people with endometriosis because penetration and other movements associated with intercourse can stretch and pull the endometrial growths.

In this article, we look at the ways that endometriosis can lead to painful sex. We also discuss tips for managing this pain, including positions, toys, timings, and how to talk to a partner about the condition.

Woman on her bed looking anxious worrying about endometriosis and sexShare on Pinterest
Movements related to sex may stretch the endometrial tissue.

Pain during sex is a common symptom of endometriosis. Penetration and other movements related to intercourse can pull and stretch endometrial tissue, particularly if it has grown behind the vagina or lower uterus.

Vaginal dryness can also cause this pain. Some means of addressing endometriosis, such as hormonal treatments or a hysterectomy (surgical removal of the uterus), can cause dryness.

Not every woman with the condition experiences pain during sex.

Those who do may experience the following:

  • pain that is acute or feels like stabbing
  • pain deep in the abdomen
  • pain ranging from mild to severe

This pain varies from person to person and may depend on the type of intercourse. Some experience pain only during deep penetration, for example, while others experience pain after sex, rather than during it.

Some positions put less pressure on areas of the pelvis that contain endometrial tissue. An individual should experiment with their partner to discover the positions that are best for them.

However, many people find that certain positions are better than others. For example, when the person with endometriosis is on top, they can control the depth and speed of penetration, allowing them to determine a comfortable pace.

Also, comfortable positions often involve shallow penetration. Some of these positions include:

  • face-to-face
  • spooning
  • raising the hips of the person with endometriosis
  • a modified doggy style

The missionary position is often painful for women with endometriosis.

Sometimes any form of penetrative sex is painful, and a person may prefer to engage in other types of sexual activity, including:

  • oral stimulation
  • massage
  • foreplay
  • using toys

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When the person with endometriosis is on top, they can control the depth of penetration to prevent pain.

Anyone experiencing pain during sex should talk to their doctor to determine a pain management plan.

Below are some additional steps a person with endometriosis can take to reduce pain during sex:

  • having penetrative intercourse at certain times of the month. It may be less painful in the week after ovulation, or in the 2 weeks following a period.
  • extending foreplay to increase the amount of natural lubrication before penetration
  • practicing gentle and slow penetration
  • using plenty of lubricant during sex
  • communicating with a partner about what does and does not feel good
  • having a warm bath or taking a painkiller to ease symptoms before sex
  • trying different positions
  • practicing forms of sexual activity that do not involve penetration
  • attending counseling or sex therapy to deal with consequences of endometriosis and improve communication

It may feel intimidating, embarrassing, or otherwise uncomfortable to speak about sex with a partner, but communication is key for a healthy sex life.

Telling a partner when sex is painful and talking about what is and is not pleasurable can make sex more enjoyable for everyone involved, as well as increase feelings of intimacy.

It is important to share feelings, needs, fears, and frustrations around sex. A partner may be experiencing similar feelings, and worry about causing pain or discomfort.

It may be easier to start this conversation in a neutral place outside the bedroom.

The way a person approaches the subject matters. It is best to use sentences that invite dialogue rather than criticize. Sentences should begin with “I” rather than “you.” For example, a sentence beginning with “I really liked when you…” is better than, “You don’t touch me anymore.”

Partners should discuss preferred positions, those to avoid, and their favorite types of physical stimulation.

Overall, dealing with painful sex may be a difficult and emotional task. The goal is to foster genuine and open communication, to ensure that sex is pleasurable and free of pain for each partner.

Endometriosis can cause severe abdominal pain, which often occurs during or after sex.

Although treatment can help to relieve the symptoms of endometriosis, including pain during sex, it is a good idea for partners to foster an environment of understanding and communication about forms of sex that are pleasurable and free of pain.