Endometriosis and Painful Sex: Why It Hurts and What Helps

Yes, endometriosis can make sex painful. The pain is often deep inside the pelvis, and it can continue for hours or even days after sex.

Pain during sex has a medical name: dyspareunia. You are not alone with it. In one study of 334 people with endometriosis, about 3 in 4 had pain during sex. This guide explains why it happens, what you can try at home, and when to get help.

Why endometriosis makes sex hurt

With endometriosis, tissue like the womb lining grows outside the womb, often on the ovaries, fallopian tubes and other parts of the pelvis. Three things can add to the pain during sex:

• Deep endometriosis. Patches can grow deep into tissue in the pelvis, including the bowel, bladder or ureter. Deep pain during or after sex is one of the symptoms that should make a doctor think of endometriosis.
• Scar tissue (adhesions). Endometriosis can leave bands of scar tissue that join organs together. Adhesions are linked to pain during sex.
• Tight pelvic floor muscles. Deep endometriosis is linked to pelvic floor muscles that stay tense. Tense muscles can make even shallow penetration hurt. Fear of pain can make the muscles tighten more.

Deep pain and pain at the entrance

There are two main types of painful sex, and many people have both:

• Deep pain is felt inside the pelvis during deep penetration. It can feel like cramping or stabbing.
• Superficial (entry) pain is felt at or near the opening of the vagina.

In the study of 334 people, 43% had both deep and entry pain. More than half of them felt the deep pain first. People with both types also had worse quality of life. Tell your doctor which type you have, because knowing the type helps them choose treatment.

Pain can also be linked to certain positions, come at orgasm, or start after sex. If the pain is mainly at the vaginal opening around your period, our page on vaginal pain during your period can help.

What can help during sex

Treatment for the endometriosis itself is important. These steps can also make sex easier while you look for the right treatment.

Positions that give you control

Pain is often linked to specific positions, and many people find positions that do not hurt. Try positions where you control how deep and how fast penetration goes:

• You on top. You set the depth, angle and speed.
• Side by side (spooning). Penetration is often less deep in this position.
• Shallow penetration. Agree with your partner to keep penetration shallow, and stop if deep pain starts.

Make a note of which positions hurt and which do not. A pattern helps you and your doctor.

Pacing and planning

• Pick your time. Choose a time when neither of you is tired or anxious. A symptom log can show if some days in your cycle are worse for you.
• Prepare your body. Before sex, empty your bladder, take a warm bath, or take an over-the-counter painkiller.
• Go slowly. Take time to relax and get aroused. When you cannot relax, arousal is difficult and pain may result.
• Stop when you need to. Agree on a word or signal before you start, so stopping feels easy.

Use lubricant

Lubricant reduces friction, which can help with entry pain. Water-based lubricants are a good choice if your skin is sensitive. Silicone-based lubricants last longer. Do not use petroleum jelly, baby oil or mineral oil with latex condoms, because they can make the condom break.

Other ways to be close

Intimacy does not have to include penetration. If penetration hurts, you can focus on oral sex, mutual touching or massage. Many people with endometriosis find other ways to enjoy sex this way.

Pelvic floor physiotherapy

A pelvic floor physiotherapist helps you relax the muscles around the vagina, bladder and bowel. When sex is painful, your doctor may involve a physical therapist in your care.

In a small trial in people with deep endometriosis and entry pain, five sessions of pelvic floor physio helped entry pain and pelvic pain, and helped the muscles relax. Most people were happy with the treatment. It did not clearly change bladder, bowel or overall sexual function. Ask your GP or gynaecologist for a referral to a physiotherapist who treats pelvic pain.

Talking with your partner

Painful sex can affect how you feel about yourself and your relationship. Many people feel guilt or shame, or worry that they let their partner down. Support from a partner makes a big difference.

Tell your partner where and when you feel pain, and what feels good. It is easier to talk outside the bedroom. You can try phrases like these:

• "I want to be close tonight, but I'm in a flare. Can we do things without penetration?"
• "Some angles give me a sharp pain. Can we try a few positions, and I will tell you what feels okay?"
• "If I need to stop, it is the endometriosis, not you. Let's agree on a word for 'slow down' and one for 'stop'."

When to see a doctor

See an ob-gyn or other health professional if sex is often painful or the pain is severe. Many people find it hard to raise, and doctors do not always ask about sexual pain. It is a valid medical symptom, and you can bring it up yourself.

Also see a GP if:

• you have pelvic pain that comes and goes or does not go away
• deep pain during or after sex comes with painful periods or pain when you poo or pee, as these together can point to endometriosis
• you had treatment, but sex still hurts or the pain gets worse

If you already have endometriosis and sex keeps hurting, ask about a referral to an endometriosis specialist. A specialist ultrasound or MRI scan can help find deep endometriosis before surgery is planned.

Get urgent help

Call 999 or go to A&E if you have pelvic pain and any of these:

• the pain is severe, getting worse, or hurts when you move or touch the area
• you feel faint, dizzy or lightheaded, or you pass out
• you have heavy bleeding from your vagina

Get help from NHS 111 if you have pelvic pain with a very high temperature, unusual discharge or bleeding from your vagina, or you are pregnant or may be pregnant. Outside the UK, use your local emergency number or urgent care service.

What to track

A short record makes the conversation with your doctor easier. After sex, note:

• where the pain was (entrance or deep inside)
• how bad it was (0 to 10) and how long it lasted
• the position, if it matters
• your cycle day
• what helped, such as lubricant, painkillers or a different position

Our guide to a pain diary for your doctor shows how to set this up. The Endolog tracker app lets you log pain, cycle and other symptoms in one place and turn them into a report for your appointment. For other signs of the condition, see our endometriosis symptoms guide or read how to get diagnosed with endometriosis. The free printable period and symptom tracker has a row for pain during or after sex.

Related guides

• Pain Diary for Your Doctor: What to Track and How to Share
• 20 Symptoms of Endometriosis and What the Pain Feels Like
• How to Get Diagnosed with Endometriosis
• Vaginal Pain During Your Period