Endometriosis, Pain & Sex

woman in pain
L. The Endo Monologues
Written by
L. The Endo Monologues L. The Endo Monologues

More often than not, the words endometriosis, pain and sex go together in what is a very unfortunate relationship. That’s not to say that having endometriosis automatically means you’ll have pain when having sex, but research does show that individuals with endometriosis are nine times more likely to develop dyspareunia (painful sex) in comparison to individuals who do not have endometriosis (Ballard et al. 2008). Furthermore, Shum et. Al (2018) state that deep dyspareunia (pain that occurs inside the vagina and/or lower pelvis) ‘occurs in half of individuals with endometriosis.’

Yet, the first time I heard these statistics I can’t say I was surprised but in an odd way I was reassured that I’m not the only one who has to deal with this awful side of having endometriosis. And yet, that doesn’t make it any easier.

So, why can having endometriosis make having sex difficult and/or painful?

Fauconnier et al. (2002) state that dyspareunia can occur during penetrative sex when tension and/or pressure is applied on the endometriosis lesions that have grown on the uterosacral and cardinal ligaments (located…) and in a study by Vercellini et al. (2007), their findings showed that there was a strong relationship between painful sex and lesi ons/nodules on the Pouch of Douglas which cause pain when pressure is applied. Furthermore, pain can also be caused when the connective tissue that surrounds the uterus has become immobile and then is tugged and pulled during sex (Vercellini et al. 2009).

However, the good news is that there are a number of things you can do to make sex less painful and hopefully, enjoyable.

1. Communication:

Nobody knows your body and its limits as well as you do. By communicating about any pain (or pleasure for that matter) it’s important to be honest. If it hurts or if you want to stop, say so and likewise, if something seems to be working for you, say so!

2. There’s more to sex than penetration:

Just because there’s pain with one sexual activity, it doesn’t mean there’s pain with another; penetration isn’t all what sex is about. There’s masturbation, mutual masturbation, using toys, oral sex… I mean, I can go on, but I hope you get the idea. And hey, exploring that can be a lot of fun!

3. Remember to use lubricant:

There’s a whole variety of reasons to use lube! It might be that any feelings of anxiety or the expectation of pain means a lower level of natural lubrication occurs. Low natural lubrication can also be a result of hormonal birth control, connected to your menstrual cycle, hormones or age (NHS, 2021) and even if you don’t think you need lubricant, it’s only going to make the experience better. For me, using lube is an instrumental part of making sex less painful.

I’d also recommend using a combination of both a water based and oil-based lube as they work together to reduce friction (my gynae refers to it as the ‘slip n’ slide effect). Lubes that are organic and don’t contain glycerin based or petroleum-based ingredients are great as they reduce the risk of upsetting the delicate flora of our reproductive organs (Schreiber et al. 2006), (Ayehunie et al. 2018).

4. Dilator therapy:

Dilators are often recommended to individuals who experience pain with penetration and are used to gently stretch and train the vagina and anal muscles. By doing this, they increase the blood flow to the area and help to alleviate said pain. They’re also great at stimulating gentle internal massage and allowing you to focus on specific areas where you might experience pain. They’re cylindrical in shape and come in a variety of sizes so you can work your way up according to your needs.

5. Pelvic floor physiotherapy/exercise:

As a result of endometriosis, individuals may suffer with pelvic floor dysfunction/pain as a result of lesions, scar tissue and/or a weakening of the pelvic floor muscles which can make sex painful. However, as highlighted by (NAME) pelvic floor therapy can be a useful tool in treating connective tissue and muscle dysfunction as well as restoring mobility to the pelvic floor and internal organs which can result in the reduction of endometriosis pain and painful intercourse. And in a study by Wurn et al. (2012), the results showed that there was a significant improvement in sexual pain as well as increased lubrication and arousal.

Furthermore, in a study by Awad et al. (2017), they found that there was a significant decrease in pelvic pain when individuals were following a regular exercise program (on average 3 times per week) which therefore could lead to less pain during sex.

6. CBD (cannabidiol):

CBD is the non-psychoactive compound found in the family of cannabis plants and it mirrors the chemicals in our body which keeps our internal functions running. It influences and activates the receptors of this system and as a result can reduce inflammation, pain, bloating, etc. (National Center for Biotechnology Information, 2021).

CBD comes in a variety of different forms and as mentioned above, is great for using for pain relief. Using a CBD lubricant can help increase blood flow and increase sensitivity. If you use CBD suppositories it can help reduce pain related to endometriosis.

To learn more about what CBD product is right for you check out our Relief Toolkit.

L. The Endo Monologues
Written by
L. The Endo Monologues L. The Endo Monologues

L. is a reproductive health advocate and health blogger who writes The Endo Monologues, a satirical diary about her experience of living with endometriosis, adenomyosis, vaginismus and vulvodynia from the point of view of her uterus (called Patricia). Her blog of the same name features reviews as well as information and advice on a wide range of topics such as: living with a chronic illness, gynaecological/sexual health and mental health. Follow The Endo Monologues on Instagram and check out the blog here.

This article is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek medical advice from your physician or health provider for your specific needs.

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