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Pain, fatigue, and other symptoms associated with endometriosis can affect quality of life, including sexual health and happiness. In fact, a study published last year found that patients with endometriosis have more than twice the sexual dysfunction as compared to women without the disease (Fairbanks, Abdo, Baracat & Podgaec, 2017).  Below is a list of common sexual health problems associated with endo and some strategies to help:

Diminished sexual desire

Some people with endometriosis report that pain and fatigue can be better or worse at certain times of the month. Keeping a diary can help identify patterns of pain associated with the cycle. Estrogen levels peak during ovulation, usually day 12-15 of the cycle, leading to higher pain levels for some with endometriosis. Knowing how your body feels during different parts of the cycle can help you make decisions about when to engage or avoid in sex to manage your pain.

Problems with sexual arousal and lubrication

Hormonal treatments for endo as well as surgeries including hysterectomies can contribute to vaginal dryness, vulvar tissue pain and irritation. Moisturizing the vulvar tissues daily with a vagina-safe moisturizer like organic coconut oil can help manage the tissue irritation. During sex, use lubrication. Try to avoid lubricants containing glycerin, parabens, flavoring, synthetic fragrances, and warming agents because these chemicals can irritate the tissues down below. In general, water based lubricants are the least irritating and safe to use with condoms. Natural oils such as coconut oil may be used, but they break down latex condoms.

Pain during or after intercourse

Pain with penetration, or “dyspareunia,” can make sex difficult or unbearable to some people with endo. The pain can be experienced in different ways: extreme tenderness, sharp, stabbing, throbbing, jabbing, an ache deep inside, or pain superficially at the opening of the vagina. This pain can start with sex and last up to days after.  Dyspareunia can be caused by several issues associated with endo, often times overlapping:  location of endometriosis lesions, inflammation, tight pelvic floor muscles, central nervous system sensitization, depression/anxiety, interstitial cystitis/bladder pain syndrome.

Pelvic floor therapy may help.

The therapists at Femina can help with some of the pain that you may be feeling. Therapy may include:

    • Dilator therapy to help with pain with penetration and to relax the pelvic floor, reducing tension and pain in the pelvic bowl
    • Exercises for pelvic muscles to lower pain, improve bowel movements, and increase the flow of blood to the area, which can improve your sexual health
    • Skincare and hygiene regimens to reduce vulvar tissue thinning, irritation, and dryness—including vaginal lubricants and moisturizers
    • Manual therapy including soft tissue, connective tissue, and myofascial massage to reduce pelvic pain, uterine pain, bladder pain, rectal pain, low back pain, hip pain, and reduce pressure throughout the abdomen
    • Self massage and myofascial release techniques to help you manage pain at home
    • Therapeutic yoga to reduce chronic pain and encourage relaxation and stress reduction
    • Neuromuscular re-education and autogenic relaxation to reduce chronic muscle over-activity, reduce pain, and improve sleep
    • Advice and guidance to find sexual positions that do not make pain worse during intercourse

If you are a person with endo experiencing a less-than happy sex life, you are not alone. Get in touch with Femina or your local pelvic floor therapist for some support and guidance back to a happy sex life!


De Graaff AA, Van Lankveld J, Smits LJ, Van Beek JJ, Dunselman GA. Dyspareunia and depressive symptoms are associated with impaired sexual functioning in women with endometriosis, whereas sexual functioning in their male partners is not affected. Hum Reprod. 2016;31(11):2577-2586

Fairbanks F, Abdo CH, Baracat EC, Podgaec S. Endometriosis doubles the risk of sexual dysfunction: a cross-sectional study in a large amount of patients. Gynecol Endocrinol. 2017;33(7):544-547

Yong PJ. Deep Dyspareunia in Endometriosis: A Proposed Framework Based on Pain Mechanisms and Genito-Pelvic Pain Penetration Disorder. Sex Med Rev. 2017;5(4):495-507

**This information is for educational purposes only and is not intended to replace the advice of your doctor.**

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  • Testimonials

    • Testimonial by Lauren B.

      Femina PT (née Fusion Wellness & Physical Therapy) has been such an answer to prayer, i'm so glad I found them! I've been struggling with vaginismus my whole life, but didn't have a name for it until about 6 or 7 months ago. Even once I did have a name for it though, I didn't know where to begin in getting help. My OB/GYN had me get a set of dilators, but I couldn't even insert the smallest one by myself. Most times I tried I just ended up frustrated and in tears. I felt really alone, like I...

      Read more Testimonial by Lauren B.

  • Testimonials

    • Testimonial by Rosanna R., age 35

      Heather has affected my life in the MOST POSITIVE way and I am forever grateful.  My husband refers to her as the "sex doctor" so you can only imagine how happy he is with my therapy outcome.  After the birth of my son I suffered from "Vaginismus", however, at the time I just thought I was broken. My "broken vagina" affected me physically but it was an emotional struggle as well. Many women in my life also suffered with pain from sex after their babies were born so I knew I wasn't alone.  They...

      Read more Testimonial by Rosanna R., age 35


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