Sounds like a cruel joke, right? But it’s true—a roll in the sheets is often far from blissful when you’re suffering from this disease, in which a woman’s uterine lining grows outside of her uterus and causes major discomfort at certain points in her menstrual cycle. “Painful sex is a common symptom because endometriosis implants distort the anatomy of the pelvis, the precise area where the penis contacts during [penetrative] sex,” says Iris Orbuch, MD, an OB/GYN who specializes in treating the condition. “Endometriosis often grows in the area behind the cervix [between the rectum and the back wall of the uterus], causing thickening, scarring, and adhesions. These cause lots of pain during sex.”
However, experts tell me that many women aren’t asking their care teams how to make sex more comfortable when they’re seeking relief from their endometriosis symptoms. “They’re so focused on what they can do to get better that it’s a secondary problem,” says women’s hormone expert Alisa Vitti, a Well+Good Council member and creator of the FLOLiving protocol and app.
But ignoring painful sex—whether you have endometriosis or not—is a source of stress that can potentially come with major consequences. “It takes a huge psycho-emotional toll because sex is a basic human function,” sexological bodyworker Kimberly Johnson points out. Contrary to how it may seem, an endometriosis diagnosis doesn’t mean you need to resign yourself to a life of celibacy. There are things you can do to make your booty calls the euphoric experiences they’re meant to be, which may have a knock-on effect when it comes to relieving the pain of your other symptoms.
To that end, I asked experts to share their most effective sex tips for women with endometriosis. Their answers ranged from bedroom hacks to alt-wellness treatments to suggestions that may seem completely unrelated to sex on the surface. The best part? Many of them don’t even require a partner—just an open mind.
Read on for 6 expert sex tips for women with endometriosis.
Create an “erogenous map” of your body
Rather than focusing on the painful aspects of sex, it’s important to figure out what does feel good to you, says Johnson. “Pain is a circuit, so if you’ve experienced painful sex, that area of your body is associated with being uncomfortable. One way [to counteract this] is developing pleasure circuitry.”
Vitti agrees, suggesting that this is a process that you can engage in solo. “It would be valuable for women to explore vaginally and build an ‘erogenous map,'” she says. “What sections of the vagina feel okay when stimulated internally? Knowing that, you can position your partner accordingly and avoid an area that might be more sensitive.” Sex therapist Vanessa Marin says tools like The Liberator can help you stimulate the feel-good zones during sex while keeping pressure off of the sore spots. “These kinds of supportive pillows and wedges can change the angle of sex positions that are typically painful,” she notes.
“There are plenty of other things you can do in the bedroom that don’t involve penetration.”—Vanessa Marin, sex therapist
On the other hand, you may discover that no form of penetration feels good. But that’s definitely not a deal-breaker, says Marin. “There are plenty of other things you can do in the bedroom,” she points out. “Manual stimulation and oral sex tend to be more pleasurable for most women—even those without endometriosis.”
Johnson also suggests looking beyond the area between your legs for erogenous zones—and don’t be shy about telling your partner what you discover. “Women need to take the reins,” Johnson stresses. “Men don’t feel particularly empowered to make suggestions because women are saying [certain aspects of sex] are uncomfortable, but they’re not saying, ‘Why don’t we try something else?’ Like, ‘I want to explore breast massage and see how that goes,’ or ‘I want to witness you self-pleasuring.’” (And obviously, this goes for same-sex and non-binary relationships, too.)
Don’t skimp on foreplay
Pre-gaming in the sack is a good-sex must for every woman, but it’s especially crucial for those with endometriosis. “Foreplay can be very helpful because it increases lubrication and can help a woman’s pelvic floor muscles to relax,” says Dr. Orbuch. She notes that women with endo tend to have tenser pelvic floor muscles than others—as a result of the body’s default pain response—and this can result in discomfort during sex.
Vitti adds that foreplay causes the vaginal tissue to become engorged, which can create a buffer between the vagina and the painful endometriosis deposits that may be surrounding it. “Don’t skimp on your arousal process, especially if you have endo,” she says. “Without it, your vaginal walls are thinner, which is not helping you.”
Seek out expert help—traditional and holistic
If you know you’re going to get busy, there are things you can do before the main event to prep for the best sex possible. For a DIY fix, Vitti recommends the regular use of castor oil packs, which have been shown to help reduce inflammation. “These have been used for centuries,” she says. Simply soak a swatch of flannel in castor oil, wrap it in a cotton dish towel, place it on your abdomen, and put a hot water bottle on top. “The heat allows the castor oil to do its job and penetrate,” Vitti explains. “Studies show it gets down to the tissue you’re wanting to affect unlike any other substance.”
Johnson’s clients have seen great results from vaginal steaming for painful sex. “Vaginal steaming can help with inflammation and it’s relaxing,” she says. “A lot of people find it really helpful to steam before sex because more blood flow goes to the genitals and the tissues get engorged.” Many Chinese medicine practitioners and Ayurvedic spas offer the service, or you can do it at home with a steam chair and pre-blended herbs.
From a Western-medicine perspective, Dr. Orbuch often suggests pelvic floor physical therapy for her patients, which usually involves massage-like manipulation of the area. “Most endometriosis patients feel much better with pelvic floor physical therapy over time, as the muscles relax,” she says. And if you’re considering surgery to relieve your symptoms, she recommends a laparoscopic procedure called excision surgery to remove painful endometriosis implants. (But of course, talk to your doctor about what’s best for you.)
Find your hormonal sweet spot
According to Vitti, the first half of your menstrual cycle is usually a more comfortable time for sex if you have endometriosis, so plan your romps accordingly. “From the moment of ovulation to when you start to bleed—which is a good portion of the cycle—your endometrial tissue is going to be stimulated with estrogen and it’s going to be more sensitive,” she says.
This is especially true if you’ve got excess estrogen in your system, as many women do. “We’re living in an environment with a lot of [endocrine-disrupting chemicals], and in many of cases, an inability to detox them through the liver,” explains Johnson.
The answer? “You want to flush the estrogen from your body as quickly as possible to have less of it circulating in your system,” says Vitti. “There’s a lot you can do. Eat fiber-rich foods to make sure you’re moving your bowels daily, take supplements that mitigate [estrogen’s] effects on the body, and make sure that you’ve gotten rid of the endocrine-disrupting chemicals you’re exposed to, from pesticides in food to dry-cleaning chemicals on your clothes.” Do this and you’re likely to feel more balanced all month long, not just in the weeks leading up to your period.
One of the less-obvious triggers for painful sex is stress, according to Johnson. “If your system can’t down-regulate, it’s going to create inflammation,” she says—inflammation being a major cause of endometriosis-related pain.
This stress can come from the usual avenues, like work or toxic friendships, but it can also come from the endometriosis itself. “A lot of women start anticipating being in pain, then start feeling anxiety from that anticipation,” says Marin. “It can turn into a horrible spiral.” That’s why she suggests engaging in mindfulness practices, like meditation. “Mindfulness can help you stop your thoughts before they careen out of control,” she says.
Dr. Orbuch’s preferred form of stress relief is acupuncture. “Acupuncture helps to down-regulate the central nervous system that is revved up due to pain from endometriosis,” she says. “It also can help calm down muscle tightness and spasm.”
But for some women, adding a new wellness practice or standing appointment to an already-packed schedule will just make you more stressed. That’s why Johnson’s a fan of simply doing more of the things that make you happy, rather than the things that you think you should be doing. “It’s about building pleasure into life,” she says. So yes, in a roundabout way, Netflix binges can actually have a positive impact on your sex life, if that’s what helps you to chill out at the end of the day.
Keep it real with your partner
Talking to your partner about your discomfort during sex is never exactly fun, but Marin says it’s vitally important for your happiness and the health of your relationship. “Recent studies have shown that a great number of women experience pain during sex, but are afraid to talk to their partners,” she says. “But if you don’t talk to your partner, the pain will get worse, and you’ll probably start to develop resentment, too.”
And if they aren’t willing to accommodate your needs—say, if you want to take penetrative sex off the table because it’s just too darn uncomfortable and they’re pushing back—it may be time to enlist the help of a sex therapist or reconsider the relationship altogether. “It’s really important that your partner serve as your teammate,” Marin says. “It’s natural for both of you to feel disappointed if your endometriosis is affecting your sex life, but your partner should be supportive and non-pressuring.” Because at the end of the day, sex should feel good for all parties involved. It may just take redefining your definition of sex to get there.
Here are a few more ways to deal if you’ve got a lower sex drive than your partner—or vice versa. And if you’ve decided that you need some expert intervention, this is what seeing a sex therapist is really like.
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