Endometriosis and Sexuality
on 14 Jul 2022
Endometriosis is a disease which affects one in ten menstruating women. Its symptoms vary from one person to the next, but it can have a very significant impact on the daily lives of those who suffer from it. One of the main areas where it can have an impact is within their intimate lives, as it can cause severe pain during sexual intercourse. Is it possible to be sexually fulfilled when suffering from endometriosis? Let’s take a look.
What is Endometriosis?
The cause of endometriosis isn’t really known, and it’s only recently that it has started to receive real attention. Endometriosis is a complex chronic disease that often takes a long time to be diagnosed –around 8 years on average in the UK. Because the diagnosis is so slow, the disease has time to progress, making it more difficult to treat later on. This slow diagnosis also means that many women get discouraged from seeking help despite the pain they go through on a daily basis.
Endometriosis occurs when fragments of endometrium (the uterine lining) grow in places other than the uterine cavity (the central part of the uterus). It’s a hormone-dependant disease - its symptoms are affected by the different phases of the menstrual cycle.
There are three types of endometriosis:
Superficial Peritoneal Endometriosis, which affects the peritoneum (the membrane that covers the abdominal cavity)
Endometriomas (or Chocolate Cysts), which leads to the growth of ovarian cysts
Deep Infiltrating Endometriosis, where the endometrial tissue has penetrated the organs deeper than 5mm under the surface of the peritoneum. These organs can be, for example, the ovaries, the vagina, the intestine, the bladder… Organs outside of the pelvis can also be affected.
It’s important to note that these types of endometriosis do not determinate the intensity of the pain experienced by the patient. Simply because an endometriosis is called superficial does not mean it’s any less painful.
Hormones cause the endometrium to bleed during menstruation, which tends to result in an increase of pain. This pain, called dysmenorrhoea, is the main symptom of 70% of endometriosis cases.
Endometriosis has many other symptoms, such as pelvic and back pain, urinary disorders, infertility and dyspareunia (ie pain during intercourse).
It’s this last symptom we are going to focus on today.
What Impact Can Endometriosis Have On Sexuality?
Endometriosis can have a significant impact on the sexuality of those that suffer from it and their partners.
One of the solutions very often suggested by doctors to try to reduce the pain linked to endometriosis is a hormonal treatment, such as the contraceptive pill. However, as it is commonly known, the pill does not come without side effects. It can, for example, lead to a drop in libido and arousal disorders, which can cause vaginal dryness.
However, the pill isn’t the only culprit. The pain caused by endometriosis is intensified during sexual intercourse, which can create a mental block to those affected.
This pain experienced during and after intercourse is called dyspareunia.
Deep dyspareunia is defined as chronic pain during sex. It’s the third most common symptom among people suffering from endometriosis.
The lesions, adhesions and cysts present in the pelvic area of some people living with endometriosis can be ‘hit’ by the penis during sex, which is – of course – very painful.
This deep dyspareunia, which is tied to the sexual act itself, can also lead to entry dyspareunia, ie pain experienced with initial or attempted penetration of the vagina, around the external genitalia. This type of dyspareunia is very often a direct reaction to pain anticipation. It’s a vicious circle: sexual intercourse is painful, this pain leads to an apprehension before intercourse, which results in even more pain, which in turn increases the apprehension…
However, even when penetrative sex itself is not a source of pain, endometriosis can manifest itself during and after an orgasm, as the muscular spams and contractions created by the orgasm can pull on the lesions and adhesions present in the pelvis and cause severe pain.
How can people with endometriosis want to engage in sexual activity when even the orgasm, climax of sexual pleasure, often seen as the pinnacle of our well-being, can inflict so much pain?
For those with a partner, communicating and talking about those things isn’t always easy. And yet, endometriosis can impact the person who suffers from it as much as their partner.
For those without a regular partner, it can lead to a fear of dating and having to explain why they are reluctant to engage in penetrative sex - or even intimacy in general.
It even seems that many people with endometriosis simply give up on having a sex life.
Minimising Pain and Maximising Pleasure During Intercourse
If you suffer from endometriosis, here are some tips on how to work towards minimising pain and maximising pleasure during sex.
It’s not always easy, but the most important thing (and we can never stress this enough) is to communicate with your partner. Sex happens with two – or more – people, so do not suffer in silence. Whether you are with a long-term partner or someone you’ve just met, talk to them about your endometriosis and how it affects you.
If you experience pain during intercourse or have no sexual desire, it is neither your fault nor your partner’s. The disease is the only responsible party.
You may experience an increase in pain depending on which phase of your menstrual cycle you’re going through. For many women, it seems that the time when sex is the least painful is just after their period has ended. On the other hand, menstruation - and the pain it can bring on its own - will mean that: one, you will be reluctant to being touched and two, the pain you will already be feeling will be exacerbated.
Try (gently) experimenting in order to find out which phase of your menstrual cycle you find most suitable for sexual activity. It can be tedious, but it will be worth it in the end. Consider using a Cycle Tracker App - they are very helpful to take notes and monitor your cycle.
Another important thing to consider is how we define sexual intercourse. The pain associated to sex is usually related to penetration. However, penetration is not an end in itself, and there are plenty of other ways to experience sex and enjoy yourself in bed.
Alternatives To Penetration
For example, you can decide to focus on external stimulation and target the clitoris. Did you know that most women need clitoral stimulation to have an orgasm? Don’t overlook its importance and its ability to satisfy you sexually!
Other alternatives to penetration can be mutual masturbation– during which both partners masturbate each other – or oral sex.
Be careful, however, if you suffer from post-orgasmic pain, as an orgasm from clitoral stimulation can hurt just as much as an orgasm following vaginal penetration.
If this is the case for you, try focusing on massages, strokes and other activities sometimes referred to as “foreplay”. The feeling of intimacy and pleasure they provide will be just as powerful as during sex in its traditional sense.
Positions To Try
If you are keen to give penetrative sex a go, try to find a position where the angle of penetration means that the penis doesn’t hit your endometriotic lesions. This includes positions where the depth of penetration is minimal, such as the Sexy Spoon. You can also choose positions where you are on top, as you’ll be able to control the depth and pace of penetration with more ease and remain in control.
Some people with endometriosis recommend slow sex, because it makes penetration less intense.
Be Generous With Lube
Whatever you decide, remember to be very generous with lube, especially if you suffer from vaginal dryness.
Keep Your Body Moving
To ease pelvic floor pain, experts recommend working on keeping your body mobile. Exercises like Yoga, Pilates and stretches can help relax the perineum and loosen up the adhesions on the pelvic floor.
Sex Toys and Accessories
There are many clitoral sex toys that can provide great pleasure if you have endometriosis and wish to avoid vaginal penetration.
Bullet Vibrators, such as the Magic Bullet, target the clitoris with precision and, despite their small size, can really satisfy you. They’re also reasonably priced, which make them perfect for beginners (but you can also find more powerful models if you invest a bit more).
When it comes to clitoral stimulation, we have to give a special shout out to Clitoral Suction Vibrators, which stimulate the clitoris via pulsating waves, without making direct contact with the clitoris. If you’ve never used one before, check out the Lovehoney X Romp Switch. If you’re looking for a more powerful toy with more vibrating functions, we recommend the Womanizer X Lovehoney Pro40.
Finally, we cannot discuss clitoral stimulation without mentioning Wand Vibrators. These vibrating massagers are entirely intended for external stimulation. They can be used on the clitoris, but not only - they are designed to massage the whole body. These versatile vibrators make great couple’s sex toys and are suitable for all genders (they’re great at stimulating the perineum, for example). The Lovehoney Deluxe Mini Massage Wand Vibrator makes a great first wand.
You could, for example, try the Lovehoney Slimline Suction Cup Dildo. Its 5 inch long shaft is thin and smooth, and will give you a gentle internal massage.
In the mood for both vaginal and clitoral stimulation? A Rabbit Vibrator is what you need. A Rabbit Vibrator Slimline like this little number from Happy Rabbit will satisfy your desire for vaginal penetration while stimulating your clitoris.
Speaking of dildos, we highly recommend choosing a Glass Dildo. Glass toys can be cooled, and coolness can help soothe a sore pelvis. Win-win! Our top pick? The Lovehoney Marbled Sensual Glass Prober.
Sex Toys Top Picks
There are several accessories that can be used to help relieve pain during penetrative sex.
The Penis Bumper Set, by Lovehoney Health, is composed of padded rings that help reduce the depth of penetration during sex. They are stretchy and can suit most penis sizes. They can be used separately or together, and will make penetration much more comfortable.
To help control the angle of penetration, you can use a Sex Position Enhancer. A cushion such as the Liberator Wedge will raise your hips, which has been reported to reduce pain during penetrative sex, so you can enjoy it more.
No matter what you decide to go for, make sure you have a big bottle of lube to hand.
When it comes to lubricants, we usually recommend using a water-based lube, because they’re compatible with all sex toys and condoms. Enjoy, by Lovehoney, is a safe bet. Please note, however, that water-based lubricants dry out quite quickly, so you will need to reapply them frequently. Silicone lubes last longer, but need to be used with caution - they aren’t compatible with silicone toys and condoms.
Intimate Well-Being Products
Endometriosis can impact women in so many different ways that it’s unfortunately very hard to find a solution that suits everyone.
The most important thing is listen to your own body, only do what feels good to you and not to pressure yourself to do anything you don’t want to do. Don’t hesitate to seek help from a professional, such as a sex therapist, who will be able to give you tailored advice based on your personal situation.
Lots of forums and other online support platforms are available, where you can talk to other patients who are currently going through or have gone through similar experiences to yours.
There is still a long way to go in terms of research about endometriosis, but things are moving forward all around the world, and you are not alone.