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OB-GYN-Approved Tips for Better Sex With Endometriosis

Don't let chronic pain stand in the way of intimacy.
Courtney Johnston
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Courtney Johnston

Endometriosis is a chronic disease that can impact every part of a woman's life. It is both incredibly common—1 in 10 women are believed to suffer from endometriosis—and difficult to diagnose, and as a result, leaves many women questioning if their cramps, pelvic pain and heavy bleeding are normal.

There is no cure for endometriosis, and there is no proven treatment. In fact, every woman's experience with endometriosis is different, which is why it's so complicated for doctors to diagnose and treat.

"Endometriosis is a condition where tissue that normally lines the uterus grows outside the uterus—potentially resulting in infertility, pelvic pain, scarring, heavy painful menses, dyspareunia and poor quality of life due to pain," said Kecia Gaither, M.D., an OB-GYN at NYC Health & Hospitals/Lincoln in the Bronx. Gaither noted, however, that "each woman impacted by endometriosis has different symptomatology."

Because of this, women diagnosed with the disease often learn to treat their symptoms as they come with pain medicine, heating pads, ice packs and, when needed, trips to the ER. In addition to the chronic pain that this disease brings, endometriosis can also bring a woman's sex life to a screeching halt.

Women with endometriosis can suffer from painful penetrative sex, even with only the slightest bit of penetration. For some women, this pain occurs just about every time they attempt to have sex. For others, it can sneak up and kill the moment.

This disease already takes so much from women—it's estimated women with endo can lose 10 hours of work per week to the disease, which can cause them to lose jobs and insurance benefits—and it also threatens their ability to enjoy intimacy.

What can be done? I talked to a couple of gynecologists to find out more.

Endometriosis and sex: Why does it hurt?

I was curious to learn more about the pain some women with endo experience during sex. I myself was diagnosed with the disease in 2016, but have been fortunate enough to not experience this particular side effect.

"Pain is caused by the inflammation of the endometriosis implant. It causes swelling and can cause adhesions and scar tissues," said Tara Scott, M.D., chief medical officer of Revitalize Medical Group, and medical director of integrative medicine at Summa Health System. "A common place for endometriosis is the pelvic lining (peritoneum) and cul de sac behind the uterus. This is often an area that can be felt during sex."

The severity of your endometriosis isn't the culprit here. You could suffer from debilitating cramps, but if your endometriosis is located higher up, it might never impact your sex life. Likewise, you could have mild endometriosis, yet because of the placement of it, you experience pain during penetrative sex.

It's also important to note that it may not be endometriosis causing pain during sex. "Other causes could be pelvic infection, vaginal infection, vaginismus, pelvic floor spasm/dysfunction or hormonal issues," Scott added. "A visit with your gynecologist can rule out most of those."

5 tips for pain-free sex

If you are one of the unlucky endometriosis sufferers who experiences painful sex—don't fret! There are ways to improve the situation for you and your partner. The first thing to remember is that it isn't your fault. Painful sex is an unfortunate side effect of many conditions, and you're not alone in the situation. Beyond that, here are five OB-GYN-approved tips for improving your sex life.

1. Communicate openly with your partner

If you have a supportive partner who wants to help improve the way sex feels for you, there are a few things they can do. Scott advised you speak openly with your partner and ask them to be patient and understanding. Let them know if you need extra foreplay, or if that position feels bad (or good!) or if you need a break. A good sexual partner is an understanding one.

It can be difficult sometimes to be the partner of someone with endometriosis in that they may not know what is best for you and what feels good. Just as in any relationship, honest communication is key.

2. Plan for sex based on your cycle

If you experience pain only some of the time, pay attention to where you are in your cycle when this pain occurs. "Pain from endometriosis is typically worse at ovulation and before the period," Scott advised. "Some women feel poorly from ovulation until their period starts. Generally, the week after your period is the best."

This may be different for you, so keep a journal of your menstrual cycle and the symptoms you experience day by day. Once you have a good amount of data (sexy, am I right?), you'll have a better understanding of your condition and when you can comfortably have sex.

3. Don't skip foreplay

If you tend to rush right into penetrative sex, this may not give your body enough time to warm up. Try extending foreplay before engaging in intercourse. This can help your body relax and may ease your pain. And kissing releases the feel-good hormones: oxytocin, dopamine and serotonin.

If you've never spent much time on foreplay, it can be difficult to know what exactly to do. This is where your creativity comes in. Foreplay can involve kissing, oral sex and touching—and it can also include talking, massage, dancing or watching each other undress. Whatever it takes to get you there, it's worth it.

4. Experiment with different positions

Try switching up your positions. You can adjust the angle of penetration this way and may find a position that's easier to relax in. "For endometriosis, the most common location is the cul de sac, which is behind the uterus," Scott said. "That means that missionary position may be the most uncomfortable and doggy style or woman on top could be less painful."

Gaither noted that every woman's endometriosis is located in a different spot, which means the positions that are the most comfortable will vary from woman to woman. Your OB-GYN may be able to help you determine which positions might be the best to try.

You can also ask your partner to try slow, shallow movements that are less likely to cause pain. The woman-on-top (also called "cowgirl") position will allow you to grab the reins and control the depth and speed of penetration.

5. Think outside the box

Endometriosis sufferers typically experience painful sex only from penetration. You can try different positions, but remember, you don't need to engage in penetration to have sex.

Sensual touching, oral sex and outercourse can all be just as exciting as penetrative sex. Just be sure to communicate with your partner and stop if you begin to experience pain or discomfort.

Most importantly, talk to your doctor

If you're continuing to battle painful symptoms, it's key that you speak openly and honestly with your doctor. It may feel embarrassing or awkward to discuss sex while sitting in a sterile white room, but it's an important step in establishing a treatment plan.

"Medical or surgical treatment options exist, but again, every woman reacts differently to the options offered," Gaither said. Because endometriosis is such a case-by-case condition, you have to find out what is best for you and your sex life.

If you've been living with painful sex for a while, you might also be experiencing psychological pain, brought on by your anxiety about sex. Your doctor can help diagnose this and offer other recommendations.