Getting in the mood can be a complicated thing to do when you have endo. Many suffer from dyspareunia, or painful intercourse, which can disrupt a woman's chance of having a fulfilling and active sex life.
Sex and relationship therapist Carli Blau can relate. The NYC-based sexpert and endometriosis sufferer says she has turned her pain into pleasure for herself and her clientele, many of whom have endo themselves.
Living with endometriosis, “has led to my own sexual dysfunction, caused deep dyspareunia, and has been very traumatizing,” Blau, 29, tells The Blossom, revealing that she's had two endo-related surgeries to help manage the disease.
“Many times, therapists do not like to disclose aspects of their personal lives, but I am a firm believer that sometimes relating to someone can be incredibly comforting to a patient."
So what are her top sex therapy tips for endo women to get their groove on as often and as pain-free as possible? Class is in session!
Re-learn how to enjoy sex: Painful sex, "can set up a negative schema in the brain, in which patients feel like every time they will have sex, it will be painful, and in turn avoid it.” says Blau. Some of her patients have hidden in bathrooms out of fear of painful sex. "What I will do is deconstruct this notion and instead of going to the bathroom and fixating on the fact that this is going to hurt them, I encourage them to have a conversation with their partner and maybe ask them for a massage. Find something that is anxiety-reducing and engages in it before the idea of sex."
Release pelvic floor tightness: Relaxing your nether regions are just as important as relaxing the mind. “When the pelvic floor is very tight, it can make it harder for women to orgasm, and it can make sex even more painful as it causes the pelvic floor muscles to be contracted and tense," says Blau. "Imagine [yourself] after doing a full workout, and your muscles are really tight, [and then] trying to go into a strenuous activity. It will make your muscles hurt. So it is important to be present. Acknowledge what your pelvic floor muscles feel like. When you begin to identify when you are very tight versus relaxed, you can work on releasing the pelvic floor muscles as a way of relieving tension throughout the body.”
Praise your partner: “It is not uncommon to see male partners develop performance anxiety or erectile dysfunction as a result of constantly being rejected due to a woman’s pain," says Blau. "These men can feel that their partner does not want them, despite the woman not feeling that way and the reality being that sex is actually physically painful for her. Male partners must realize this is not the case and that endometriosis goes beyond their own needs and desires. These men need to be comfortable communicating how they and their partner each feel, and be open to exploring other forms of sexual pleasure."
Foreplay is your friend: Warming up before game time is a necessity, says Blau, who urges her patients to have make-out sessions or an erotic massage before getting it on. “Sex is not always penetration. It may not be able to be penetration. It is important to explore other forms of pleasure outside of intercourse. This includes oral sex and anal sex, depending on the comfort level of the patient."
Find a favorite position: In the case of Deep-Infiltrating Endometriosis (DIE), many patients can find themselves experiencing pain with certain sexual positions. “In these cases, you want to avoid deep sex positions. What is most important is ensuring that the woman is able to communicate and be in positions that can allow her to control penetration. There is a difference between having a woman be in control sexually and in control of her penetration, the latter of which is the crucial component."
Lube it up: Many endo women turn to hormonal therapy to manage their symptoms—but that can leave them feeling on the dry side. “These hormonal therapies can reduce one’s libido, reduce natural vaginal lubrication, and can even make sex more painful," says Blau. To alleviate any dryness, try "coconut oil or a proper lubricant," tips Blau. "However, it is important to use [any] natural lubricants in moderation.”
Communication is key: Speaking up isn't easy, but it's necessary to convey what's working and what isn't. “In terms of endometriosis patients, everybody is different and experiences symptoms differently. This includes sex. Therefore, it is all a matter of communicating with both yourself and your partner," says Blau. “Sex therapy is an option for treatment for those who cannot afford surgery, those who may not want it, or simply for those who want to try some type of psychotherapy before going through surgery or in conjunction with surgery.”
Editor's note: Carli Blau will be speaking at EndoFound's Patient Day in NYC on March 18th. You can register for the free event here.