Endometriosis and Sex: What Helps

If you live with endometriosis, you already know that it's about far more than bad periods. For many people, it means sex that hurts, sometimes deep inside, and sometimes for hours or days afterwards. You might be scared of it, or you might feel guilty, or you've been told by someone that it's "just period pain" when it clearly isn't. About one in seven Australian women and people assigned female at birth are estimated to live with endo, and pain during sex is one of the most common symptoms. You deserve to be taken seriously, and you deserve to enjoy your body, however that looks for you.

Why does sex hurt?

Endometriosis is when tissue similar to the lining of the uterus grows in other places in the body, often in the pelvis. It can cause inflammation and scarring, and it can make your organs stick together. Deep penetration can press on those areas, which is why many people describe a deep, aching or stabbing pain. The pain can also make your pelvic floor muscles tighten over time, causing pain at the entrance as well. Hormonal treatments can also lead to dryness. Your pain may also change during your cycle.

Get some support

You shouldn't have to work this out by yourself. See your GP, a gynaecologist or a pelvic pain specialist. If you feel dismissed, you're allowed to see someone else. Many people with endo take years to get a diagnosis, so keep pushing. Treatment might include medication, hormonal therapy, surgery and pain management. Tell them that sex is painful, as it's a very relevant symptom, and not at all embarrassing to them.

A pelvic health physiotherapist can be very useful for muscle pain, and our guide explains what they do. Endometriosis Australia, EndoActive and Jean Hailes for Women's Health have good free information. Our guide to painful sex covers other causes too.

Things that can help

• Timing. Keep a note of your pain over a few months. Many people find that some parts of their cycle are much better than others, often the week or two after their period. There's no shame in planning for it. Our guide to scheduling intimacy might help.
• Less depth. Pain's usually from going deep, so being able to control this is very important. Our depth guide has some ideas, and shallow penetration can feel fantastic in its own right.
• Lube. Lots of it, particularly if hormone treatments have made you dry. Wicked Simply Natural is gentle and fragrance free.
• Getting very aroused first. When you're turned on, the vagina lengthens, and the uterus shifts. It really does help.
• Heat. A warm shower or a hot water bottle before or after can help relax your muscles.
• Pain relief. Ask your doctor if it's suitable to take something beforehand, so you're not chasing the pain afterwards.
• A plan for afterwards. Keep your heat pack and pain relief close, and let your partner know how they can help.

Positions that may be easier

• Spooning. It generally goes less deep, and there's no weight on your pelvis.
• Being on top. You control the depth, and you can grind instead of bouncing.
• Coital alignment. It's a grinding, shallow version of missionary, and it's good for your clit.

Avoid anything that drives deep, particularly doggy or with your legs up. Everyone's different, so go with what your own body tells you. There are also soft rings you can put around a partner's penis or a toy to limit how far it goes in. A good way to do the same is simply for your partner to wrap a hand around the base.

Sex doesn't have to mean penetration

On a bad day, or for a long time, penetration might be off the table. That doesn't mean sex has to be. Remember that the clitoris doesn't usually have anything to do with deep pain. Mouths, hands and toys can all give you a great time. Our guide to non-penetrative sex has lots of ideas, and an external toy gives you a lot of pleasure without going near the painful areas. The Fun Factory MEA works on air pulses, and it's gentle and easy to hold. Orgasms can sometimes cause cramps for people with endo, too, so be guided by your body. If that happens, you're not doing anything wrong, and you may find some kinds of orgasm are better than others.

Some people find they've got no desire at all, whether because of pain, medication or fatigue. That's OK too. You don't have to have sex.

Talking to a partner

You might try: "This isn't about you. Deep penetration really hurts me because of my endo. Here's what feels good." A good partner will ask what helps, and they won't take it personally. They'll learn how to read a bad day, and they won't make you feel guilty about it. They should never ask you to push through the pain. It doesn't make you less of a partner. If someone's pressuring you, you can talk to 1800RESPECT on 1800 737 732.

You're not broken

Living with chronic pain can wear you down, and it can affect how you feel about your body. It's OK to grieve. If you're struggling, talk to your GP, or call Beyond Blue on 1300 22 4636. A sex therapist can help you and your partner, too.

This is general information, not medical advice. Please see a health professional about your own situation.