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endometriosis and painful sex

The Common Links Between Endometriosis and Painful Sex

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 endometriosis and painful sex are giving you a less-than-happy sex life, you are not alone. Get in touch with Femina PT 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.**

What Our Patients Have to Say


Testimonial by M.N., age 28

A personal journey and testimonial from one of my patients:

I was diagnosed with vaginismus 4 years ago. I never heard of such medical condition until after I got married. At first my husband and I didn't know what to do, we didn't know what the issues were or how to overcome it. Being born and raised in Armenia and being Christian I wasn't that open about talking to sex with others and so it wasn't easy to seek help. But eventually I went to an Ob-Gyn and luckily she knew about the medical condition (not many doctors know). She referred me to a physical therapist and I couldn't believe it and thought it's something I can handle myself. I ordered a kit from vaginismus.com and started practicing with dilators. There was some small progress but wasn't much helpful.

Read more: Testimonial by M.N., age 28

Testimonial by Y.L. (mom of 2)

After having my second baby via C-section I searched for months to try to find help for my lower back pain and separated abdominal muscles. I finally came across Heather Jeffcoat via a mommy blog. I reached out to her via email and set my first appointment. My first appointment went amazing … she listened to what my symptoms, check my separation and explained to me in detail what the next steps would be. Not only did my abdominal separation go from 3 to about 1 -1/2 but my back has pain has significantly reduced. I’m personally recommending all my mommy friends to Heather!

Y.L. (mom of 2)

Testimonial by J.H.

My last appointment with Heather was over 6 years ago but I still think of her every day. I don’t take for granted that I can easily get out of bed, care for my two active and busy young boys, run, play tennis, clean my house, or sit at a desk for several hours at a time. None of these tasks were easy for me before meeting Heather. Eight years ago my car was struck from behind by a tractor trailer that was estimated to have been speeding. I spent 3 years working with different PTs and Drs trying to heal and move on with my life. When I became pregnant and the hormone relaxin that “relaxes” all the joints of the body and the additional weight gain erased all my progress and I was suddenly in a lot of pain again. My OB sent me to Heather for one last try.

Read more: Testimonial by J.H.

Testimonial by Fritzette H.

I went to Heather after the birth of my third child. It was lucky, really, that I was referred to her, because my doctor had referred me to a surgeon for a possible hysterectomy or pelvic wall rebuild. Thankfully, I went to Heather before undergoing either surgery, she was able to fix the problem. She has studied extensively in women's health--even written a book about it--and was able to diagnose my problem, suggest a course of treatment (6 weeks), and then follow through with said treatment. By the end, as she said, I was as good as gold. Boy, was it worth it! Though uncomfortable to talk about, much less write about, it is worth getting the word out there. If you have painful intercourse, especially after birth or other trauma, the treatment may be as simple as Physical Therapy (with Heather, of course). I highly recommend her.

-- Fritzette H., 3/24/16 via Yelp!

Testimonial by Mary L.

I started seeing Heather to treat my Interstitial Cystitis in November 2016. At this time, I was extremely miserable, in constant pain, and felt as though no one was listening or understood what was going on with my body. I have just finished my last appointment and I can honestly say that my life has completely changed for the better because of Heather and her team of PTs! I live almost completely pain free, and when I do have flare ups, I am able to treat them at home on my own. I am so grateful that this office was recommended to me a honestly cannot recommend them enough!

Read more: Testimonial by Mary L.

Testimonial by Jamie M.

I have been going to see Heather for a while now, and I can't tell you enough how much she has improved my quality of life. Heather specializes in issues like pelvic floor, but I see her for other orthopedic issues.

I have a lot of chronic joint pain and dysfunction issues (back, hips, neck) that require that have ongoing physical therapy maintenance. The effects of my problem joints/areas overlap and interconnect with each other in complex ways, so helping me requires really having a complete understanding of the entire skeletal and muscular system. Pain does not always appear where the problem actually is, the human body is a twisty, many-layered puzzle. I have an exercise program I do at home and I am very functional, but there are just something things I need a PT to help me out with.

Read more: Testimonial by Jamie M.

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