Sex shouldn’t hurt, but endometriosis — a condition where tissue similar to what lines the uterus grows where it shouldn’t, most often on organs in the pelvic cavity — made my first few attempts at penetrative sex a no-go. After that, just the anticipation of a painful experience often killed the mood before I could even get started. But when I sought medical help, timed sex with my cycle, and added some props to my sexual toolkit, my sex life improved dramatically.
It took years to get a diagnosis, but at 24 years old, a laparoscopic procedure showed I had endometrial cysts on my ovaries and a giant mass of scar tissue covering my appendix. After the surgery, sex became possible — but not painless. My endometriosis persisted even after a second surgery.
While dyspareunia — or pain with sex — occurs in about 7.5 percent of sexually active women, those with endometriosis are nine times more likely to experience it. Penetrative sex can put direct pressure on the inflamed endometrial lesions, especially if you have recto-vaginal endometriosis, says Lone Hummelshoj, the chief executive of the World Endometriosis Research Foundation. The multitude of nerves in the pelvic region, which become irritated because of endometriosis, can also cause pain, she says.
I married the guy who I was dating when I had my first surgery, so I’ve had more than 10 years to experiment in a safe, loving relationship. It might not seem romantic, but scheduling our sex based on my cycle has helped take the guesswork — and anxiety — out of getting it on. Here’s what else you can do.
Take advantage of the good days
There are certain times of the month when sex feels better. I track my period with an app, so I tell my husband exactly when the window of opportunity is — after my period starts up until ovulation. Endometriosis is estrogen-dependent, and I experience less pain during the first couple weeks of my cycle when estrogen is lowest. After my egg releases, sex becomes more problematic.
“From ovulation onward, everything swells because it’s preparing for pregnancy,” says Hummelshoj. “There’s clearly endometrial lesions or adhesions that are swelling during that period, making penetrative sex difficult.”
While the uterine lining is thickening, so is the endometrial tissue that can attach to organs in your pelvis — including the ovaries, fallopian tubes, bladder, vagina, appendix and rectum. Penetration can irritate these lesions, causing pain.
Calm down and don’t skip foreplay
Sex became possible after my surgery, but I still worried that it would hurt. If I couldn’t relax, I noticed my body wouldn’t lubricate as much and it sometimes felt like my vagina wanted to block the penetration from happening. It turns out, women with endometriosis can experience a pelvic floor spasm or develop vaginismus — when vaginal muscles involuntarily contract, says Dr. Katy Vincent, a gynecologist and pain researcher at the University of Oxford.
“Their vaginal muscles contract down to inhibit sex unconsciously,” says Vincent. “This is a natural protective mechanism of the body to prevent further pain — stopping something which is going to be painful happening — but is unhelpful in this context.”
If you’re anxious and your body is tense, it can make both penetration and having an orgasm difficult, says Laurie Mintz, a professor of psychology at the University of Florida and author of Becoming Cliterate.
When a woman is properly aroused, the vagina “tents” and becomes narrow in the front and extends in the back, pulling the uterus up and out of the way in the process. Mintz says having sex before you’re sufficiently aroused will lead to a painful experience.
“Your uterus won’t be out of the way and it’ll hurt,” says Mintz.
She suggests building in 20 to 45 minutes for direct and indirect clitoral stimulation before having sex. While a half hour of foreplay sounds nice, some of us just need an extra five minutes. The point is: don’t skip the fun part.
Get some lube and a vibrator
Natural lubrication levels change throughout the month, so it’s a good idea to always have some lube at the ready. I also like to add a small vibrator — like this one from the Rabbit Company — to the mix. Most women need direct clitoral stimulation to orgasm, and using a vibrator increases my sexual pleasure and decreases my pain — especially if it’s during the weeks when my endometriosis is inflamed.
Mintz supports the use of a clitoral vibrator (she recommends the Lelo Brand) because one cause of female sexual pain is not getting enough of the right kind of clitoral stimulation. Learning what feels best for you and relaying that to your sexual partner is absolutely essential. “It’s easier to learn to sexually communicate than have a partner read your mind,” says Mintz.
Switch positions or avoid intercourse
Pretty much anything goes during my good weeks, but later in the month I have to avoid any position that leads to deep penetration. I also use a pillow — The Liberator — to tilt my pelvis to a more comfortable angle. Some women have good success when they try positions that lead to shallow penetration, says Hummelshoj.
“I’ve had couples tell me that if the woman is on top, she can sometimes control the depth of the penetration better,” said Hummulshoj. “Pause if it doesn’t work and shift. It’s down to experimenting, because we’re all different physiologically.”
If intercourse is uncomfortable, have sex another way. Having pleasurable experiences that don’t involve penetration can be fun and increase desire and arousal.
Seek professional help
If having penetrative sex hurts, talk to a specialist. Surgical, hormonal, or pelvic floor treatment can help relieve pain from endometriosis, and Hummelshoj suggests talking to a psychologist or sexologist if you’re suffering from anxiety that’s putting a strain on you and your relationship.
Above all, communicate. “Sex is something that should be enjoyable for both people,” says Mintz. “It’s not something that you have to do for your partner and endure the pain.”