Many people with endometriosis experience painful penetration. Maybe certain positions are unpleasant, or maybe they're downright impossible. Often, endo patients start to believe that sex just isn't something they can enjoy, or that it's something to simply grin and bear.
Though painful penetration can be challenging to overcome, it's imperative to point out that sex and penetration aren't synonymous. Defining sexual activity by where a penis goes is both heteronormative and simplistic. Portland-based Certified Sex and Relationship Coach Jessie Fresh defines sex as, "Anytime you feel connected to your body and your eroticism. Sex [is] the exploration of oneness, either being at one with yourself, another, or with multiple people." This definition is broad for a reason: you have the ability to make sex exactly what you want it to be.
Before getting into bed with a partner, the experts recommend that folks with endo check in with themselves first. Explore what feels good and become an expert in your own pleasure. Clinical sexologist and Sex and Intimacy Coach Kristine D'Angelo put it simply: "If we don't know about our bodies, our partners sure don't know about our bodies!" Try experimenting with toys, speed, and angles and make notes about what you enjoy. Only after endo patients better understand what feels good can they successfully invite a partner into the situation. Open communication will help patients experience less pain and enable their partners to feel included.
D'Angelo shared that some of her clients who regularly experience painful sex just want to please their partners and rush through the process. "They get into a pattern with their partner of just getting in and out [of the bedroom]. They aren't giving their bodies that time to ramp up and to let their genitals do their thing, which is to get plump and responsive." Remember that allowing your body the time to prepare is key and that everyone needs a chance to warm up, regardless of whether they're dealing with endo. You are not obligated to make your partner happy at your own expense, but rather to approach sex with healthy curiosity and to honor how your body feels in that moment.
If you're battling endo, being able to comfortably discuss pain, preferences, and what kind of intimacy you'd like to have is imperative. "It's your responsibility to openly communicate where it hurts, how you're feeling, and most importantly, what [your partner] can do to help," Kaylyn Easton, endo sister and founder of the personal lubricant brand Chiavaye, explained.
Using lube is particularly important for people with endo if penetration is on the table. According to a study conducted by Indiana University professor and sex researcher Debby Herbenick, 65.5% of female-identified participants reported that using lube made sex "pleasureable and more comfortable." According to Easton, "The whole point [of using lube] is to reduce any type of friction or discomfort during intimacy because you don't want to psychologically train your brain that sex is painful. When your brain feels over and over that sex is painful, you'll identify sex with pain and you'll no longer want to be intimate. A lubricant during sex is a must."
Dr. Karli Goldstein, an endometriosis surgeon at Seckin Endometriosis Center, explains that even after a patient undergoes surgery to successfully remove endometriosis lesions, penetrative sex can still be painful at first. “If you're used to penetrative sex being painful," Dr Goldstein says, “it's natural and common for your body to tense up in response and the pelvic floor to tighten in anticipation of pain you had before.” Dr. Goldstein suggests working with a sex therapist or pelvic floor therapist to learn how to recalibrate and down-regulate that response and help you to be comfortable again.
Tracking your cycle and exploring how your hormones affect your body can transform what might seem like unpredictable symptoms into a patchwork quilt of your endo experience. Becoming an expert in these changes is like uncovering a map to your pleasure - you can figure out exactly when getting intimate is most enjoyable. Keep a journal to track pain so that it's easier to anticipate when to expect which symptoms. If you have a partner, try including them in this exercise by exploring this pattern of symptoms together. Not only will they better understand your needs, they'll also have an honest look at what it can be like to live with endo every day.
Endometriosis often goes hand in hand with other conditions, like pelvic floor dysfunction. Some of these conditions can be helped through physical therapy and patients can see real improvement after treatment. Speaking with a healthcare provider about what other options are possible is imperative, as is consulting a support group for people with endometriosis.
Painful sex isn't inevitable for those with endo. "One of the main things I try to stress is that sexual experiences should be pleasure-oriented rather than goal-oriented," D'Angelo said. If you've always focused on your partner's needs or prioritized achieving orgasm, take a step back and explore what sex really means to you. You owe it to yourself to get your desires met, so commit to the exploration and listen to every little thing your body has to say. Don't be afraid to take your pleasure into your own hands!