Pain during sex is a common symptom of endometriosis. Penetration and other movements during sex can pull & stretch endometriosis adhesions & tissue. More commonly if it has grown in the area behind the vagina or lower uterus.
Sex can hurt more at different times of your cycle. Tracking your cycle can help you work out when it is the best time of the month to have sex. Include pain with sex in your pain diary/period tracker.
Spend more time enjoying foreplay for both of you and not so much time on deep penetration. When you do move to intercourse find a position that is comfortable and stay in that position as long as it feels comfortable.
Communicate what you need at any point during sex. Be open and honest with your partner. You both need to communicate how you feel physically and emotionally. It helps you both know what is going on, what works and what doesn't.
Although symptoms vary from person to person, there are things you can do to reduce pain during sex. Trying different positions. Using lube. Exploring alternatives to intercourse. Open communication. Are just a few things.
Let's talk sex positions that can be helpful when you have endometriosis.
Get on Top
Being on top gives you the power to control the depth and speed of penetration. You can place pillows under your knees to give you even more space to control the depth of penetration.
Being in these positions also gives you space to use a bullet vibrator in your clitoris for extra pleasure.
In this position, you’re on top but instead of being face to face with your partner, you’re facing their feet. Because you are on top you can control the depth, speed, and intensity that works best for you. The angle of penetration may avoid some trigger spots.
You would be the small spoon. For some, the “doggy style” position is unbelievably painful because of deeper penetration and angle. The spoon position reduces the depth of penetration and changes the angle. It can be done in the spoon position, or it can be face to face so it’s more of a sideways position.
Modified doggy style
To do this, lie on your stomach and add pillows under your torso or your hips (or not at all) whichever is more comfortable for you. Then have your partner lie on top of you and enter you. This again reduces the depth of penetration and changes the angle. You can have your legs together to reduce the depth of penetration even more - the tops of your thighs with lubricant create some of the friction and pressure around the penis.
Note: Intercrural sex is a type of non-penetrative sex where the penis is placed between the receiving partner's thighs and friction is generated via thrusting.
69 or oral on each other
If intercourse hurts then don't do it, be it at a certain time of the month or always. Sex doesn’t always have to mean penetration, yes even in heterosexual couples. Instead try oral, try 69 or take turns to perform oral on each other. Orgasms are known to relieve pain because of all the good the hormones that are released, so try oral sex if penetration hurts.
Is another option for when intercourse hurts? Remember sex doesn’t always have to mean penetration. Masturbating with your partner can be a way to take your relationship to the next level. Use toys, your hands, and whatever works for you and your partner.
Try a standing position face to face in the shower with your leg perched somewhere for access or try it from behind. You can still control the depth of penetration. It is important to remember water can wash away your natural lubrication or water-based lubricant. This can lead to condoms breaking or increased friction and pain. You could try using a silicone lubricant which is condom safe and will last longer in running water.
Endometrial scar tissue for many can cause the uterus to tilt backward toward the rectum instead of toward the belly. It can also mean the uterus and vaginal don't move the way they typically would when aroused. This means that the cervix, at the lower part of the uterus, sits at a different position. So, when you are having intercourse and the penis is bumping into the cervix it can hurt a lot. Placing a pillow under your hips in the missionary position can help elevate the pelvis and change the angle and depth of penetration which can mean less pain.
In all the penetrative sex positions you can also use aids like The Ohnut. Worn externally at the base of a penetrating partner (ex. penis or toy), The Ohnut compresses down to act as a comfy buffer during sex. Each set comes with 4 linking rings that make it simple to incrementally adjust and explore penetration depths. With the Ohnut, you and your partner can not only discover comfort but also what depths feel really good—for both of you.
There are always options if you are willing to explore them and work with your partner to find the right fit for both of you. A little imagination goes a long way but if you would like help from not only a sexologist but also someone that has experienced life with endometriosis and the impact it can have on all aspects of life you can have an online education consult with someone like Jodie West our resident sexologist. Or if you are looking for someone to work with face to face you can find a sexologist in your area, a pelvic physiotherapist and other HCP’s can be helpful too. You are not alone.