How to Manage Endometriosis Pain During Sex

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doctor talking to a patient pointing to a model of a pelvis

Chronic pain can be hard to talk about. 

Especially when it’s down there. 

Especially when it comes to sex.

We may even try to convince ourselves that it’s all in our head. Or unfortunately we’ve been told that by unsupportive medical professionals

But if you’re experiencing painful sex in addition to extra-painful and heavy periods, it might be time to talk about a tricky diagnosis: Endometriosis.

If you’ve already been diagnosed with endometriosis, or if you’re seeking a diagnosis because of pain you’re experiencing, please know you’re not alone. And there are things you can do to manage endometriosis pain during sex to help get your sex life back on track.

Let’s dive in together.

Why Does Endometriosis Cause Painful Intercourse?

Plenty of people have sexual concerns as a part of their experience with endometriosis. 

During deep penetrative sex–when a penis, finger, or sex toy enters the vagina–the associated motions can irritate sensitive tissues and restricted muscles, leading to pain and pain. 

Sometimes, penetrative sex is so painful it becomes impossible. It could feel like sudden, stabbing, or deep abdominal pain ranging from mild to severe. This pain most often occurs around ovulation or prior to your period, because the endometrial tissue is already irritated as it gets ready to shed and regrow, but it can also occur at any point during the menstrual cycle.

Vaginal dryness is also a common reason for painful sex with endometriosis. Some endometriosis treatments, like hormonal therapies, can decrease natural vaginal lubrication. This causes increased, painful friction and even tearing of those sensitive vaginal tissues.

How to Help Relieve Endometriosis Pain During Sex

#1 Increase communication around the endometriosis pain experienced during sex.

Increased anxiety around sex can make things difficult. If we’re anticipating pain, we’re more likely to tense up. Ultimately, this creates more pain! One way to decrease this sex-related anxiety is to talk about it. (Seriously.)

Talking about painful sex can feel awkward and vulnerable. But communication, especially with sexual partners, is key to making things more enjoyable.

Discussing the tough stuff–like fears and frustrations around sex–is obviously hard. Starting in a neutral place outside the bedroom can help. You can also communicate your needs more effectively by:

  • Using “I Statements”
  • Checking in without distractions or interruptions
  • Writing down your thoughts before your discussion
  • Focusing on specific solutions to the issue

You can do it!

#2 Pay attention to timing.

Intercourse may be less painful during certain times of the month. Mid-cycle pain, when you ovulate, is common. Try experimenting with different times around your menstrual cycle or tracking your ovulation to get started on a better sex schedule.

#3 Experiment with different sex positions. 

The “missionary” position puts quite a lot of pressure on your abdomen which can often feel bloated or sore. But positions contributing to deeper penetration may also cause pain from pressure on tender muscles. So experiment a bit to find a comfortable position:

  • Spooning
  • Raised hips on a pillow
  • Modified “doggy style” using an Oh Nut sized to comfort
  • A position where you’re on top to control depth and speed of penetration

Finding the right rhythm is also important. Deep penetration and quick thrusting can make pain worse. Going slow and more shallow can help to prevent pain and make the experience more pleasurable for everyone.

#4 Avoid (penetrative) intercourse.

There’s nothing wrong with exploring other types of sexual activity, what I like to call “outercourse.” When penetration is a non-starter for you, try:

  • Oral stimulation
  • Clitoral stimulation
  • Massage anywhere on the body
  • Foreplay that doesn’t lead to intercourse

#5 Try vaginal dilators.

Anxiety and fear can cause our muscles to tense up. To densensitize your pelvic floor muscles and assist with relaxation, try a vaginal dilator. These cylindrical wands gently and progressively soften the pelvic floor muscles, making penetration easier and more comfortable. Try these from Intimate Rose.

#6 Explore CBD products.

CBD lubes, oils, and suppositories can help the pelvic floor muscles and tissues relax while also providing all-important lubrication. I love KUSH Queen Water Based CBD Lube, which is compatible with latex condoms and silicon sex toys. It’s also extra gentle on sensitive skin.

I also like Foria Awaken Arousal Oil with CBD. While not compatible with latex condoms (oil causes latex to break down), using it before sex it can enhance “tactile sensation and pleasure while decreasing tension, discomfort, and dryness.” They also have a line of CBD suppositories. Check out the full range of Foria Wellness products here.

#7 Ask about endometriosis treatment options. 

Working with a specialist in endometriosis is key to managing your symptoms and your treatment. Treatment options include hormone therapy, pain management, dietary changes, anxiety and stress management, and surgical excision. To find a medical provider skilled in working with folks with endometriosis, check out   

#8 Work with a pelvic floor physical therapist to reduce endometriosis pain during sex.

A pelvic floor physical therapist should absolutely be part of your care team if you are experiencing symptoms related to endometriosis and/or pain with sex. Treatment may include releasing tight muscles and tissues, releasing tense  pelvic floor muscles to decrease pain with sex, and coaching you on stretches and relaxation techniques to manage pain. 

You CAN manage endometriosis pain during sex. Let’s get you back on track. 

Did you know you can start pelvic floor PT from the comfort of your own home? The V-Hive Relaxation Series may be especially helpful if you’re struggling with endometriosis and/or painful sex. Find relief starting today when you join the V-Hive for online, on-demand workouts and stretches for your pelvic floor and core. 

Sources and Additional Reading

Johns Hopkins Medicine. (n.d.). Endometriosis. Johns Hopkins Medicine. Retrieved from 

Wasson, M. (2018, July 24). Endometriosis. Mayo Clinic. Retrieved from 


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