Pain During Sex? It Could Be Endometriosis

Medically Reviewed By William C. Lloyd III, MD, FACS
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Caucasian couple in bed with woman looking concerned over lack of libido, emotional issues or painful sex

There are many reasons, both physical and psychological, why sexual intercourse can be painful. One cause that may be overlooked is endometriosis, a condition in which benign uterine tissue (endometrium, the cellular tissue that lines the inner uterus) grows outside the uterus where it can adhere to other organs or cause scar tissue. It is often not diagnosed for years because the symptoms can be confused with menstrual pains.

Pain during sex, called dyspareunia, should not be ignored. If endometriosis is causing it, there are treatments that can reduce or eliminate the problem.

How Endometriosis Can Cause Painful Sex

Women with endometriosis are about nine times as likely to experience painful intercourse as those without it. If you feel pain during deep penetration rather than initial entry, it may be due to endometriosis. The discomfort often comes from endometrial tissue, called implants, forming behind the vagina and the lower part of the uterus, where sexual activity can pull and stretch that tissue.

Women have described the pain as sharp or a deep ache, and it may be mild or severe. You may feel it during intercourse, or any time within a day or two of sexual activity. Intercourse is most likely to be painful around your period, when the endometrial implants swell. Endometriosis can also affect fertility, so if you are hoping to get pregnant, it’s important to discuss your symptoms with your Ob/Gyn.

What You Can Do About Painful Sex Caused by Endometriosis

Your doctor has effective treatments for most cases of endometriosis. Hormone therapy works for 90% of women with the condition, which suppresses your menstrual cycle so that the endometrial tissue doesn’t swell or bleed. If hormone therapy doesn’t provide relief or you are trying to get pregnant, your doctor may advise minimally invasive surgery to remove endometrial tissue.

Rarely, more extensive surgery or a partial or total hysterectomy or removal of the ovaries is needed to address endometriosis. Be sure you understand the risks and benefits of these procedures, as you will not be able to become pregnant and if your ovaries are removed, you will go into menopause.

There are also techniques you can try yourself to reduce the discomfort. Relaxation can help; try taking a bath or meditating before sex. You can try an over-the-counter pain medicine, and make sure to empty your bladder before engaging in sex. Set aside plenty of time for foreplay and try lubricants.

You may be able to find pleasure in intercourse if it is shallow or if the movements are slow and gentle, or learn that a certain position is better for you. You may also find that timing is important; intercourse may feel good at certain times during your menstrual cycle and not others.

If you have burning afterwards, try applying an ice pack, wrapped in thin material like a pillowcase or T-shirt, to your vulva. You can also consider alternatives to intercourse, like massage, oral sex, or masturbation.

Don't Stay Silent About Pain During Sex

Communication with your partner is key to finding ways to help with painful sex, whether caused by endometriosis or other factors. Talk to your partner about what works for you and what doesn’t. Make sure he or she knows to stop if you say you’re feeling pain.

If sexual intercourse is painful on a regular or recurring basis, don’t wait to see your doctor. Your Ob/Gyn can determine if your symptoms are the result of endometriosis and help you find effective treatment and relief.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Oct 14
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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