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Pain during intercourse: The impact endometrisois has

Updated: Jul 5, 2023



Pain during intercourse can have a negative impact on our physical and emotional well-being.


When living with endometriosis, pain during sex can often lead to frustration and can impact relationships.


In this blog post, we’ll discuss the connection between endometriosis and pain during intercourse, its causes, and along with some ways to help manage the physical and emotional burden.


What we’ll cover:

  • Understanding endometriosis and its impact

  • Causes of pain during intercourse in endometriosis

  • Management strategies for pain during intercourse in endometriosis

Understanding endometriosis and its impact:


Endometriosis is a chronic condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterus.


These abnormal growths, called endometrial implants, can be found on organs such as the ovaries, fallopian tubes, and even in the pelvic cavity.


One of the common symptoms of endometriosis is pain, and this includes pain during intercourse, medically known as dyspareunia.


Causes of pain during intercourse in endometriosis:


The exact mechanisms causing pain during intercourse in endometriosis are not fully understood. However, several factors contribute to this discomfort:


Adhesions and scar tissue:


Endometrial implants can lead to the formation of adhesions, which are abnormal bands of fibrous tissue.


These adhesions can cause organs to stick together, resulting in pain during sexual activity.


Imagine you have a beautiful garden with a variety of plants, each representing different organs in your body. However, some unwanted weeds start to grow between the plants.


These weeds represent endometrial implants, which are abnormal tissue growths.


As these weeds grow, they intertwine with the roots of your plants and form a tangled mess.


Over time, they become thicker and stronger, creating a network of fibrous tissue, similar to the formation of adhesions.


Now, imagine trying to move or separate the plants in your garden.


Due to the entangled weeds, the roots of neighboring plants become stuck together, preventing them from moving freely.


This restriction of movement can be compared to the organs sticking together due to adhesions.


When you try to engage in sexual activity, just like trying to move the plants in the garden, the stuck-together organs cause discomfort and pain.


The adhesions act as barriers, limiting the organs' ability to glide smoothly against each other.



Deep infiltrating endometriosis (DIE):


Deep infiltrating endometriosis occurs when the endometrial implants invade deeply into the surrounding tissues, including the walls of the vagina or the muscles of the pelvis.


This can lead to pain during deep penetration.


Imagine you're exploring a vast cave system, filled with intricate tunnels and chambers.


As you venture deeper, you discover that some sections of the cave are inhabited by aggressive, invasive plants.


These plants represent deep infiltrating endometriosis (DIE), where the endometrial implants invade deeply into surrounding tissues.


As you navigate through the cave, you come across areas where the plants have grown into the walls, embedding their roots into the sturdy rock.


They have even managed to infiltrate the walls of the caves, including the walls of the main chamber or the passages that lead to other parts of the cave system.


Now, picture trying to pass through these invaded sections of the cave.


The plants have created thick, tangled webs of roots, making it extremely difficult to move through or explore further.


As you encounter these invasive plants, you experience pain and resistance, especially when trying to maneuver through narrow passages or engage in deep exploration.


In this analogy, the cave represents the pelvic region, and the invasive plants symbolize deep infiltrating endometriosis.


The walls of the cave, such as the walls of the vagina or the muscles of the pelvis, are invaded by these plants, causing pain and discomfort during deep penetration.


By visualizing the complex cave system and the invasive plants intertwining with the cave walls, we can better understand how deep infiltrating endometriosis can penetrate surrounding tissues and result in pain during deep penetration.


Pelvic floor dysfunction:


Endometriosis can contribute to pelvic floor muscle dysfunction, leading to muscle spasms, tension, and pain during intercourse.


Imagine you're a tightrope walker preparing for a high-wire performance.


Your body represents the pelvic region, and the pelvic floor muscles are crucial for maintaining your balance and stability on the rope.


However, before you even begin your act, you notice that the supporting cables of the tightrope are tangled and knotted.


These cables represent the impact of endometriosis on the pelvic floor muscles, leading to dysfunction.


As you step onto the tightrope and start walking, you feel your pelvic floor muscles becoming tense and experiencing spasms.


It's as if the tangled cables are pulling and tugging, causing disruptions in your performance.


The muscle tension and spasms make it challenging to maintain your balance and navigate smoothly across the rope.


Now, let's introduce a secondary challenge.


As you progress along the tightrope, there are sudden jolts and vibrations that further exacerbate the tension and spasms in your pelvic floor muscles.


These jolts mimic the movements and pressure associated with sexual intercourse.


With the tangled cables and the ongoing jolts, your experience becomes uncomfortable and painful.


The pelvic floor muscle dysfunction caused by endometriosis intensifies the sensations, making it difficult to engage in intercourse without discomfort.


Psychological factors:


The chronic pain and emotional burden associated with endometriosis can contribute to anxiety, fear, and psychological distress during sexual activity, exacerbating the pain experienced.


Imagine you're an avid hiker who loves exploring new trails and immersing yourself in nature.


Your mind and emotions represent the beautiful landscapes and serene atmosphere that typically accompany your hikes.


However, one day, you set out on a hike in an unfamiliar territory, which represents the experience of living with endometriosis.


As you start walking, you notice that the path becomes progressively more challenging and rugged.


The terrain represents the chronic pain and emotional burden associated with endometriosis.


With each step, you encounter steep climbs and treacherous obstacles, symbolizing the difficulties and hurdles you face on a daily basis due to endometriosis.


The chronic pain weighs on your mind, just like the rugged terrain weighs on your body.


Now, as you continue along the trail, your once-joyful hiking experience becomes marred by anxiety and fear.


The anticipation of encountering more pain and struggling with each step heightens your distress, mirroring the psychological impact of endometriosis on your mental well-being.


As you approach a particularly challenging section of the trail, representing sexual activity, your anxiety and fear intensify. The emotional burden associated with endometriosis exacerbates these negative emotions, creating a cycle where psychological distress magnifies the pain you experience during intimacy.


Just as the rugged terrain and psychological factors combine to make your hiking experience more difficult and distressing, the chronic pain and emotional burden associated with endometriosis contribute to anxiety, fear, and psychological distress during sexual activity, ultimately worsening the pain felt.


People’s experiences of pain during sex with endometriosis



Management strategies for pain during intercourse in endometriosis:


If you are experiencing pain during intercourse due to endometriosis, it's essential to consult with your healthcare provider for a comprehensive evaluation and tailored management plan.


Here are some strategies that may be helpful:


Communicate with your partner: Open and honest communication is crucial when addressing pain during sex. Approach the conversation with your partner in a safe and supportive environment. Explain the impact of endometriosis on your sexual well-being, emphasizing that it is not a reflection of your desire or attraction to them. Encourage them to ask questions and express their concerns as well.


Seek couples therapy or counseling: If the pain during sex is causing strain in your relationship, consider seeking couples therapy or counseling. A professional can provide a neutral space for both you and your partner to discuss your feelings, learn coping strategies, and strengthen your emotional connection.


Explore alternative intimate activities: Sexual intimacy is not limited to intercourse. Discuss and experiment with alternative activities that focus on pleasure and closeness, such as sensual massage, cuddling, or exploring non-penetrative forms of sexual expression. Finding ways to connect intimately without triggering pain can help maintain a fulfilling and satisfying relationship.


Pain management techniques: Applying heat packs or taking over-the-counter pain relievers before intercourse can help alleviate discomfort. Additionally, relaxation techniques, such as deep breathing or mindfulness, may help reduce anxiety and muscle tension.


Lubricants and moisturizers: Using water-based lubricants or vaginal moisturizers can enhance comfort during sexual activity by reducing friction and dryness.


Pelvic floor physical therapy: Working with a pelvic floor physical therapist can be beneficial in addressing muscle tension, improving flexibility, and reducing pain during intercourse. They can provide guidance on exercises, relaxation techniques, and other modalities tailored to your specific needs.


Hormonal treatments: Hormonal therapies, such as birth control pills, hormonal IUDs, or GnRH agonists, may be prescribed to manage endometriosis-related pain. These treatments aim to suppress the growth of endometrial tissue and alleviate symptoms.


Surgical intervention: In cases where conservative approaches do not provide relief, surgical intervention may be considered. Laparoscopic surgery can remove endometrial implants and adhesions or address deep infiltrating endometriosis, potentially reducing pain during intercourse.


The takeaway


Pain during intercourse can significantly impact the quality of your life but it does not have to be the end of your sexual life and pleasure.


Seeking help and finding what works for you will allow you to live a more fulfilling life. At ELANZA we believe in a multidisciplinary approach to managing endometriosis.


Learn more about how a care navigator and a personalized ELANZA endometriosis management plan can help you regain control of your life and manage pain.




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