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7 Tips To Make Sex Less Painful If You Have Endometriosis.

7 Tips To Make Sex Less Painful If You Have Endometriosis.
There’s no sugar-coating it: endometriosis sucks. I have lived with it most of my life. It sucks if you have it and it sucks if your partner has it. If you live with endometriosis you will understand when I say that endometriosis is a painful and often debilitating condition and affects pretty much every part of your life, from periods, mental health, fertility, work or study, relationships and sex.
 
What is endometriosis?
“The lining of the uterus is called Endometrium. This is the tissue that grows inside the uterus each month and bleeds away with a period. When tissue like this is found in other areas around the pelvis, not just inside the uterus, it is called Endometriosis.
The areas of endometriosis are called lesions.
Endometriosis lesions form a spotty covering on the sidewalls of the pelvis, or on the surface of the pelvic organs. More severe endometriosis grows into the pelvic organs themselves or forms round ‘cysts’ called ‘Chocolate Cysts in the ovaries. Most endometriosis lesions can’t be seen on an ultrasound scan.
Endometriosis is a pain you can see at a laparoscopy, but often it is only one part of pelvic pain. Many girls and women with endometriosis have a mix of different symptoms, not just period pain.” (Pelvic Pain Foundation of Australia)
The latest figures say that one in 9 women have endometriosis. Some of these women live with severe pain, others have minimal symptoms but everyone’s experience with endometriosis is difficult. Many wait 9 years or more for an accurate diagnosis.
 
Symptoms of endometriosis include but not limited to;
heavy bleeding
painful periods
backache
cramping
lower abdominal aching
pain during and after a bowel motion
nausea and/or vomiting
painful intercourse
Cramps are not unusual when it comes to having your period, however pain that stops you from living everyday life is not normal.

A study published in 2017 found that two-thirds of women with endometriosis experience some form of sexual dysfunction, which includes painful sex, known as dyspareunia. There have actually been quite a few studies about sexual function and satisfaction in women with endometriosis, before and after laparoscopic surgery. More recently there have been a couple of studies (still to be published) about sexual satisfaction of partners. All these are an important studies in order to work towards the quality of life of all those impacted by endometriosis. Hopefully, there will be similar studies conducted soon that include same-sex couples and trans and gender nonconforming people.
 
Being a sexologist who came to be a sexologist because of my own personal experience with endometriosis. I was one that experienced pain with sex as a result of my endometriosis (although it is important to note that not everyone with endometriosis experiences pain during sex). I would describe pain with sex to have ranged from a dull ache to sharp, stabbing pain, they are common descriptors of the pain. I have had clients describe the pains as feeling like a hot poker was stabbing them through there vagina and into their pelvis and abdomen. Others have used the term knife stabbing followed by sharp nails scraping from the inside out. Penetrative sex or thrusting during intercourse can stretch, pull or push against the misplaced endometrial tissue and scar tissue in the pelvis. The severity of the pain may vary depending on a number of factors: how deep the penetration is, when sex is happening and where the implants are located. There can also be a psychological part that may also play a role in pain. When dealing with endometriosis and repeated periods of pain, the body can start to equate sexual stimulation with pain. When we are in pain we automatically go into postures and behaviors to protect us, our body braces for pain which equals tension including tension in the pelvis. As a consequence, this protective action or fear reaction can negatively impact libido, cause reduced vaginal lubrication, pelvic floor tension, one or all of these can make sex more painful and continue to feed into the pain cycle. 
 
Sex is suppose to be pleasurable and enjoyable, chronic pain or episodes of severe pain will take away from that for all those involved. Pain that we as vulva owners experience and also because our partners do not want to be the reason we hurt.
 
Here are some tips to boost intimacy while avoiding pain;
  1. Communicate with your partner.
This is my top sex tip for everyone. Endometriosis means it is an even more important part of finding your pleasure. As difficult as it may be to speak up but no one wants you to suffer in silence. Talk your partner about your condition in general and as hard as it is to talk about sex get specific about how it affects your sex life. Talk about what hurts but also talk to them about what feels good, about what brings you pleasure. If you share this with them then they will have a better understanding of changes in your libido levels. Having this sort of understanding can mean that they are less likely to interpret a lack of desire to have sex as a sign that you’re not attracted to them anymore. The more they understand the more supportive and helpful they can be and the more that you can explore other ways to be intimate and how you both experience pleasure.
  1. Position, Position

The missionary may be extremely painful, this has to do with how your uterus is positioned in this position. For some women, being on top allows them to have more control over the depth of penetration and can reduce pain. If you and your partner like the connection you have in the missionary position you can try using pillows or a wedge to adjust the position of your hips. The other tip would be no feet on shoulders, keep them down to control the depth of penetration. The other way you can control the depth of penetration is by using a product like the Ohnut. The Ohnut is like a cushion and allows you to adjust the number of rings to control the depth of penetration. Try different positions and see what works for you.

  1. Time it right.
Your symptoms likely change through your menstrual cycle and the symptoms associated with your sex life are not different. Keep track of your cycle and how it affects your pain levels, an important part of managing your endometriosis and finding what works for you. You can figure out if there are certain times of the month that tend to be better windows for sex, that then allows you to make plans and schedule time for sex that works for you, some women find that sex just after their period is less painful. Find what works for you and for your partner.
  1. Use lube. 
Endometriosis or not vaginal dryness is a common cause of painful sex. Using a quality lubricant makes sure you have enough vaginal lubrication during sexual intercourse for it to be pleasurable.
  1. Try new things
If vaginal penetration is too painful, regardless of the position, speed or time of the month try other things. There is much, much more to sex than penetration, you can both experience pleasure without penetration. Try kissing naked, try mutual masturbation, try giving and receiving oral sex, try using sex toys to stimulate the clitoris and or the penis, try stimulating other erogenous zones. Take the emphasis of the end goal as well, try to slow down and focus on the pleasurable sensations in the moment, focus on your breathing (another important tool for managing tension and pain), relaxed and connected in the moment.
  1. Erotica and sexy images. 
There has been research (2016) conducted that has shown that just thinking about pleasurable genital sensations can light up the brain as if it were responding to actual physical stimulation. Now, this does not mean I am telling you to go and watch porn if it is not your thing then it is not your thing. Maybe reading or listening to erotic stories and letting your imagination wander is something you are more comfortable than that works too. Your brain is an important part of pleasure and arousal, it is an important but often overlooked sexual organ and is a tool you can use to shift any association you may have between genitals and sex with pain toward experiencing pleasurable sensations in the genitals.
  1. Consider talking to a health professional.
Your team of health practitioners is important in your care, in talking about medical treatment options but also for talking about sexual issues. Useful additions to this team include a pelvic physiotherapist and a sexologist who has knowledge of endometriosis. They can help you find ways to reduce your pain, improve your quality of life, inside and outside the bedroom and give you tools to improve communication with your partner(s).