How To Improve Your Sex Life With Endometriosis.

Endometriosis is a haunting word when it comes to navigating sex. While this condition can be debilitating and takes many years for most individuals to be diagnosed, there are ways to improve your sex life and wellbeing when suffering from this condition.

With help from our resident Pepper expert, we’re going to deep dive into all things sexual health and endometriosis, from what it feels like to how to make it less painful.

First thing’s first: what is endometriosis?

Endometriosis is an often painful condition that is diagnosed when the endometrial lining of the uterus grows outside of the uterus. Sometimes the endometrial tissue will grow on the outside of the uterus, but in more serious cases it may also grow and infiltrate around the pelvic organs, digestive tract, or up into the thorax and lungs.

The most common symptoms someone with this condition may experience includes painful periods, pain with intercourse, pain with bowel movements and urination, excessive bleeding during menstruation, and infertility. This is a condition with no known cause that is also the leading cause of pelvic pain in women worldwide. This condition should be taken very seriously as it can be life threatening in certain cases.

Can you have sex with endometriosis?

As painful and debilitating as this disease can be, you can most certainly have sex safely when living with this condition. Most individuals have the most pain during their period, so avoiding sex during this time is recommended. 

During other times of the month, it is all about developing the right pain management skills to optimize not only your sex life but living well throughout the day too so you can feel energized for time between the sheets. 

A medical doctor or naturopathic doctor can help manage medications and remedies to reduce pain and inflammation. A pelvic OT or PT can help improve movement patterns and tissue restrictions in the pelvis and abdomen that are likely present from inflammation. Other practitioners that can be helpful on your care team may also include a massage therapist and acupuncturist.

What does sex feel like with endometriosis?

The goal for anyone living with endometriosis is that sex should feel good and desirable! During a pain flare or prior to any disease management this may not be the case. Sex may be painful and nauseating. For most individuals with endometriosis, insertion is tolerable, but deep thrusting is the painful part of sex because this stimulates deeper tissue movement close to the uterus. If endometriosis has progressed and infiltrated surrounding organs to the uterus, then even insertion may feel uncomfortable.

When having sex with endometriosis, positions are key. As you may already be thinking, having a partner laying on top with increased pressure on the abdomen and pelvic organs can easily flare symptoms. Find fun and creativity in side-lying and doggy style to relieve potential pressure on the abdomen. Creating comfort with other Pepper tools like (pajamas, satin sheets, etc) can pump up the desire and sensual vibes during sexual intimacy.

Why is sex with endometriosis painful?

When tissue is inflamed, additional pressure and sensory input has the potential to increase pain and inflammation. If you had a large bruise on your arm and began rubbing it vigorously, this would cause more bruising and discomfort. But if you alternatively spent time letting an inflamed part of your body rest, gave it nourishing circulation with heat with gentle massage, managed the pain with prescribed medicated, and moved slowly, then you have the capability of creating a comfortable experience. 

Chronic disease and pain can feel like there is no end in sight. But it is important to know that the organism of your body is always shaping and shifting to the input and forces that we offer it. Nothing in our body is ever fixed, but the healing process takes patience and diligence.

Tips for having sex with endometriosis.

1. Foreplay. 

The world is infinite with foreplay options. Stock your bedside drawer with lubricant and massage oil. Light candles that heighten your sensory system. Read sex quotes to each other from The Little Book of Sex or draw cards from the Foreplay Game. Take a bath with your partner and practice synchronized breathing while gazing at each other. Make sure to communicate with your partner what feels best and what to avoid.

2. Lube.

We can all agree that when sex organs are wet, everything feels better. If inflammation is present in the deep pelvic floor, this tissue may be working harder to promote circulation, which can ultimately dry out tissue. Lube will ensure a smooth experience that is comfortable for both you and your partner.

3. Pain medication.

This should be prescribed by your doctor who has evaluated your individual symptoms. Ask your doctor dosage and timing of pain medication for sexual intimacy so that you can better manage a potential pain flare from sex.

6. Diaphragmatic breathing. 

When engaging in sexual activity, diaphragmatic breathing is one of your best tools. This helps calm the nervous system and lengthens pelvic floor tissue, making entrance during penetrative sex more comfortable. 

I said it before but I’ll say it again for everyone in the back, because this exercise deserves an encore. Breathing simply cannot be overstated in how powerful it is as a tool. Practicing diaphragmatic breathing can help reduce pain and should be practiced on a regular basis.

7. Use a dilator, vibrator, or heat pack.

Using a dilator or vibrator prior to penetrative sex can also help lengthen pelvic floor tissue prior to entrance, such as the Deia: Hot & Cold, the OhNut, or a Dilator Set. Using a heat pack on the abdomen while laying down can be another beneficial tool for reducing inflammation and bringing healthy circulation to the pelvis and abdomen.

8. Abdominal massages.

Making more time in the bedroom by trying gentle massage on the abdomen with small circles along all sides of the abdomen to help relax and lengthen tissue prior to sex is also beneficial for reducing pain and inflammation. Making time for yourself and locking in a routine that works for you is key to managing pain flares that may arise from sex.  

The bottom line is that if you are in pain, it is always ok to stop what you are doing. Respect your body’s physical and emotional cues. Create a routine and honor your boundaries regarding self-care. Find what works best for you and use tools like vibrators, lubricant, and sensory candles. 

Having sex with endometriosis can be painful, but it can also be managed. Managing chronic pain and working towards comfort, work in baby steps that feel manageable and celebrate small victories. Putting a drop in the bucket each day may feel insignificant, but eventually the bucket will be full.

Claire is a pelvic floor therapist with a distinct specialty certification in pelvic rehabilitation (PRPC). She is the private clinic owner of Rooted Pelvic Health & Hand Therapy in Sun Valley, Idaho. She treats all gender diversities for pelvic floor-related conditions including sexual dysfunction, gynecological cancer recovery, and chronic pelvic pain. Claire's mission is to improve overall function and quality of life with lasting results for her clients. As a contributing writer to Pepper Together, Claire seeks to provide education about a subject that deserves more attention. She hopes that by spreading the word about pelvic floor conditions she can break the stigma about conversations around sex, and provide simple solutions to improve sexual intimacy.