Why Does Endometriosis Cause Painful Sex?

Painful sex. Not a rip-your-clothes-off, hubba-hubba topic… but the truth is: sex isn’t 100% perfect, all the time. Sometimes, anticipation of the act ahead can inspire more anxiety than excitement. As a team that spends all day talking about orgasms, condom size and yeast infections, we reckon the more everyone talks about the awkward, ‘embarrassing’ bits, the less awkward it feels. Bingo, it becomes easier than ever to get on with the hot and heavy stuff.

Last month, we tackled the silence and shame around the more-common-than-you-think vaginal health condition vaginismus by putting it on billboards all around the UK, creating a straight-talking digital guide to communicating about the condition and hosted an in-person meet up to bring the conversation to life. When we heard how much you wanted to see visibility of other conditions which are also stigmatised, we caught up with our Co-Founder Dr Sarah Welsh. In her time as an NHS GP and in sexual health clinics, she heard from many patients experiencing endometriosis. Here’s her expert take on why it can negatively impact sex - and how to achieve pleasure when you’re managing pain...

What is endometriosis - and why does it impact sex?

Endometriosis is a condition where cells similar to those in your uterus occur elsewhere in the body. Just like those in the lining of the womb (uterus), these build up, break down and bleed each month. However, there is nowhere for this blood to go - unlike that in the womb (a period). An often misunderstood condition, endo can cause painful periods, bowel conditions like IBS, pelvic inflammation, fatigue and affect fertility. One topic that isn't spoken about so much is painful sex. Penetrative sex can feel sore, thanks to pressure or pulling on endometrial tissue and vaginal dryness. For some, it's quite mild, for others however, the pain can be severe and might occur either/both during sex or afterwards. This can have a real impact on enjoyment of sex, and have a knock-on effect on your pursuit of pleasure - and even cause relationship problems when partners don't understand what it is that you're both navigating.

Why isn't the impact of endo spoken about openly?

Around 1.5million of us with uteruses in the UK are currently living with endometriosis… So, why isn’t it taken seriously? Cultural squeamishness around menstruation has something to do with it, making it harder to speak up to your partner/s, family, friends or doctor if your periods are very heavy or just not ‘normal’. Similarly, it’s not the easiest thing to bring up other endo symptoms such as painful bowel movements, so body taboos really do make it less likely for people to seek help about the condition, full stop.

Props to the names in the public eye who have spoken up about their experiences, including wildlife expert Bindi Irwin who recently revealed she was told by a medic that endo pain was “simply something you deal with as a woman”. Shocking, and not an isolated incident, as many have experienced misunderstanding from the medical profession. In fact, a study by period care pros Yoppie showed that you could travel to the moon 456 times before you get diagnosed with endometriosis. From our community, we’ve heard from those whose extreme pelvic pain was dismissed as 'just' period aches and pains, and upsettingly, more than one person has been advised to push through painful sex with a glass of wine. (Side note: please don’t do this). 

Ultimately, a combination of lack of awareness, symptoms which vary from person to person and resemble other conditions, plus dare we say it, gendered pain stereotypes (especially so for Black women), all make it hard to get treatment which is so dearly needed. In optimistic news, a groundbreaking clinical trial led by the University of Edinburgh is set to explore a potential new treatment which could improve the day-to-day life of those with endometriosis. Watch this space… 

How to advocate for your pleasure when you have endo

Living with endometriosis doesn’t have to mean a sex-free future. Whether you’re planning on partnered pleasure or going solo, here’s how to approach it:

• Use plenty of lube. Lubricant is a great sexual enhancer, especially for penetrative vaginal sex and if you suffer pain from conditions such as endometriosis. Make sure to check the ingredients list of your lube: gentle, pH-balanced and glycerine-free formulas are ideal. Many mainstream brands use unnecessary chemicals which can cause yeast infections such as thrush or bacterial vaginosis. Our top tip: go for a water-based lube, as oil-based lubricants can trap bacteria creating the perfect environment for infections...
• Don’t focus purely on penetration, especially if this causes you discomfort. Clitoral stimulation, using lots of lube and sex toys, sensual massage and a focus on foreplay can be great ways to enjoy sex without focusing on PIV pleasure. 
• Be experimental with positions. Depending on where your endometrial tissue is, you may find that certain sexual positions are much better than others. Try out different methods, positions, rhythms, and levels of penetration. This can be with your hand, a toy or a penis.
• Speak with your partner/s about what feels good and don’t be afraid to direct the action and take control during sex. You are an active participant in your own pleasure!
• Seek help. If you have endometriosis, it’s important to speak to your doctor about the issues you’re experiencing and ensure you have an effective pain management plan. This may include pain relief medications, which you can plan  to take before/ after sex. Some people report that taking a warm bath or practising relaxation methods pre- and post- sex can be helpful. If you’ve been dismissed previously at the GP, or feel your pain has been underestimated, know that you can get a second opinion from another doctor. Endometriosis UK has more information on advocating for yourself, and their Support Network features a helpline and local support groups, too. 
• Endo can also cause more severe period pains, so it’s time to give yourself a hand. Masturbating releases endorphins which can help with menstrual pain, aches and cramps, as these hormones ease soreness, promote relaxation, and reduce stress. Take it slowly, focus on the enjoyment of sensations without the pressure of orgasm as an endpoint. Try Erika Lust’s ethical porn, or Four Chambers’ aesthetic and conceptual exploration of erotica.
• Invest time in yourself and your sexual wellbeing. It’s important to own your body and medical journey, especially if you have endometriosis. Science-rooted audio guide Ferly is designed to help you to be more present during sex and explore intimacy in a non-intimidating way through expert advice, physical touch practice and recordings from trusted therapists.
• Talk about it with your partner/s. Communication is sex is key, with or without endometriosis. However, endometriosis can put a strain on sexual relationships, so being open and honest with the person/people you’re getting intimate with is more important than ever. Some people really benefit from talking with a specialist, such as a sexual counsellor to support this and improve your sex life.
  
  

Want more?

• Let’s Open Up: explore our campaign to tackle stigma and silence around vaginismus.
• What can your vagina tell you about your health? Read our dispatch on discharge.