9 Tips for Tolerable Sex When Everything Hurts

I’ve put off writing this for a long time because my mother reads this blog.  That’s why this post will not discuss my personal experiences on this topic, thanks all the same.  However, sex is a thing and people with endometriosis generally still want to have it, so I feel duty bound to complete this post, however embarrassed my conservative upbringing may make me feel about it.


I realise this post has a very depressing title.  Tolerable sex?  Don’t most sex advice posts offer you “great” or mind-blowing” sex, or something like that?  Yes.  However, for people with endometriosis there can be all sorts of hurdles in the way of an enjoyable sex life.  To start with, those of us on the pill or other forms of hormonal contraception are very likely to have an extremely reduced libido.  One of the most common side-effects of the pill is to reduce the sex drive of the person taking it, and in some cases eliminate it completely.

When you get past that problem, many people find that vaginal intercourse is intensely painful even when they are keen for it.  The fancy name for pain caused by sex is dyspareunia, in case it comes up at your next trivia night.  This can be for a number of reasons.  For some people it is simply a lack of lubrication, as hormonal medication has a tendency to dry you right out down there.  For others, it is the motion pulling and pushing on endometrial growths, causing pain and sometimes bleeding.  This generally causes pain deep in the abdomen that can be achey or stabby.  Still others may suffer from vaginismus, which is the involuntary tightening of the vaginal muscles, making penetration extremely difficult and painful.  As far as I know there is nothing to suggest that endo can cause vaginismus, but it certainly doesn’t help.

For those that do manage to have painless sex, some may find that pain strikes later.  Some  suffer from anorgasmia (the inability to orgasm), which, whilst not necessarily painful, is extremely frustrating.  Others have dysorgasmia, which is a painful orgasm.  Others may orgasm without pain, but find that post-intercourse they suffer awful cramps.  Many people with endometriosis may find that they bleed after intercourse regardless of pain.

All in all, it’s easy to see how your standard penetrative vaginal intercourse, even when given much sexier names than that, can quickly become a desperately unappealing prospect for people with endometriosis.  Of course, this can have negative impacts on any relationship, including frustration by the healthy partner (and the partner with endo where sex drive exists), and horrible guilt by the one with endo.  It also is especially difficult for those desperate to conceive, given that sex tends to be a necessary step in that process.

That’s why I’m not trying to convince you that anything I say here will restore anyone to a state of “mind-blowing” sex.  Some people with endometriosis may have amazing sex lives and put rabbits to shame.  However, that’s not the reality for many, so I don’t want to get anyone’s hopes up unnecessarily.  This is a survival guide, not an improvement manual.  For mind-blowingness, go to Cosmo (but take their advice with a grain of salt because some of it is WHACK).

So, what are some ways to deal with these very frustrating aspects of endometriosis?

1)  Try other things

There are alternatives to vaginal intercourse.  Slow down.  Explore each other’s bodies.  Touch each other gently.  Experiment.  See what works for you as a couple to give you satisfaction without pain.  As a bonus, even slow sex drives may start to find themselves emerging from hibernation given the right stimulation.

Alternatively, if dysorgasmia is your problem, experiment with sexual contact that gives you fulfilment and satisfaction without orgasm.  Reframe sex in your head so that an orgasm is not the goal and you’ve failed if you don’t reach it; aim instead for feelings of pleasure, or emotional and physical closeness, or even making your partner ecstatic.

However, if this is unsatisfying and you really want to have vaginal intercourse…

2)  Try other positions

For those experiencing pain during intercourse, try some different positions.  Some positions may be horribly painful, others may be less difficult for you.  Some women (not many) say missionary is easiest because it allows them to lie still and relax (something literally everyone recommends when trying to achieve either an orgasms or easier penetration), whilst others prefer cowgirl as it gives them control over the depth, speed and angle of penetration (all important factors in pain levels).  Many find doggy style easiest as they are braced and stable and the position of the uterus is such that is causes less pain.

3)  Try other times

Some people may find that the pain is worse right around their period or when they are ovulating.  Track it.  I’m serious.  Write down what part of your cycle you are going through and how painful the sex was, and see if there is a pattern.  Then you’ll know your safe times vs your painful times, if that applies to you, and you’ll be able to plan for a less painful sex life.  Sure, it’s not glamorous or sexy and totally lacks spontaneity, but on the other hand, you have something to look forward to each month.

4) Use lots of lubricant

As I said, hormonal medication dries things out.  Use bucketloads of lubricant for less friction and thus less pain.

5)  Try dilators

If you have an extremely tight or tense vagina or suffer from vaginismus, many specialists may recommend vaginal dilation to try and teach your muscles to expand and relax.  You can start really small and work your way up gradually to sizes that might represent your partner’s accoutrement.

6)  Resort to painkillers

Again, this takes away any sort of spontaneity from the occasion, but endometriosis does a lot of things that aren’t sexy, so this probably isn’t terribly unexpected.  Popping some panadol about half an hour to an hour prior to sex may help reduce the pain during and after.

7)  Plan for afterwards

Are you a heavy bleeder?  Put a towel down first.  Know you will cramp up?  Have a quick shower to get clean, then get in a warm bath pronto to help keep yourself relaxed, or get your partner to grab you tea and a heat pack whilst you tidy up.  Take painkillers afterwards too, if you need.  Make sure you don’t have any big plans for afterwards so you can lie down and have a cuddle whilst you rest and recover, and get into comfy clothes.

8)  Keep talking

Talk with your partner about everything to do with this topic.  Let them know how you feel about sex.  Reassure them that pain or lack of drive is not a lack of love or desire and isn’t necessarily anything that they are doing wrong.  Ask them to be patient and gentle with you.

Talk beforehand.  Let them know what you will need them to do, ensure that they will listen to you, and ask them to get things ready to help you recover afterwards.

Talk during.  If something hurts or is uncomfortable, say so.  Suggest a position or rhythm that you think will work better.

Talk afterwards.  Discuss what you loved and what might be done differently next time.  I’m not saying you have to get coldly analytical, but it is worth debriefing so you are both on the same page for next time.

9)  See a professional

Did you know that sex therapists are a thing?  They are.  If sex is just not working for you but you really want it, go and see a sex therapist.  They will be able to suggest different methods and techniques, as well as deal with the emotional and mental consequences you and your partner may be suffering.

If your problem feels muscular, it may also be worth seeing a pelvic physio.  They will be able to give you exercises to help strengthen the muscles and the muscular control in the pelvis, which should help you be able to deliberately relax as well.


That about sums it up.  Nothing here is terribly ground-breaking and I’m sure much of it repeats what other people have to say, but hopefully it is of help to some.

If you feel comfortable sharing – do you have any tips I’ve missed?  Any problems I haven’t listed?  If there is something that helps you that isn’t here, please let me know in the comments.



One thought on “9 Tips for Tolerable Sex When Everything Hurts

  1. Hello! I see you mentioned dilators in your article. We offer Vaginal Dilators and we ship all over the world. Made in the USA. This company was started by a Vulvodynia and Vaginismus patient as well. Also, if you need to find a pelvic floor pt or a doctor, she can help you find help in your area. Have a great day and thank you for sharing pelvic pain awareness. https://www.vuvatech.com

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