Painful Sex & Endometriosis: 13 Ways to Reduce Pain and Increase Pleasure
“Eleanor, I’m finding sex can be painful sometimes due to my endometriosis. Is this normal? It’s not every time but it’s making me less likely to initiate.”
Girl, I feel you! I was diagnosed with endometriosis a couple of years ago — Deep Infiltrating Endometriosis (whose acronym is unironically DIE) in the Pouch of Douglas, to be exact. Learning that this was the cause of the intense period pain I experienced after coming off the pill was both overwhelming and deeply relieving.
For years, day one of my period felt like the last day on earth — nausea, fevers, chills, cramps that felt like a machete hacking from the inside, blurry vision, vomiting, cold sweats. And yet, somehow, I’m considered one of the “lucky” ones. Many people with endometriosis experience flare-ups multiple times a month or live with near-constant pain.
One of the side effects that hit me hardest — especially as a sex educator and certified huge fan of sex — was painful penetrative sex. When something designed to feel pleasurable becomes painful, it can be distressing, disconnecting, and heartbreaking.
As a quick refresher: endometriosis occurs when tissue similar to the uterine lining grows outside the uterus — on the ovaries, fallopian tubes, bladder, rectum, cervix, vagina, or even the vulva. Sex can be painful when penetration pushes or pulls on these areas, triggering inflammation, spasms, or sharp pain.
Sex should not hurt. You deserve pain-reduced, pleasure-forward sex.
So here are 13 ways to reduce pain and increase pleasure during sex if you live with endometriosis or experience painful sex for any reason.
Pelvic Floor Physiotherapy
One of the most impactful first steps is working with a pelvic floor physiotherapist. These specialised physios assess pelvic muscle tension, pain points, and coordination, then create a personalised plan to support pain-free sex.
Expect that your initial consultation may include an internal pelvic exam to assess muscle tension and identify specific trigger areas. You can find a growing list of Recommended Providers here
Use the GINA App
I highly recommend the GINA app, which offers tools, exercises, and education for navigating painful sex. While it’s designed with vaginismus in mind, many of its resources are incredibly helpful for endometriosis-related pain too.
I interviewed the founder of GINA on my podcast - listen to the ep about Vaginismus & Painful Sex here
Vaginal Massage
Your pelvic floor physio may suggest dilators or internal tools to gently stretch and release tight vaginal muscles. According to GINA, dilators help the body experience non-threatening sensations without triggering protective muscle spasms.
I’ve personally found tools like glass cervical wands helpful for internal massage, allowing me to gently access and release areas that cause pain during penetration — similar to internal trigger-point therapy. My all-time favourite internal wand is the Cervix Serpent (Use code ELEANOR for 10% off).
Track Your Cycle
Cervical height and sensitivity change throughout the menstrual cycle. You may find deeper penetration more comfortable at certain times of the month and more painful at others. Tracking your cycle can help you plan what kind of sex feels best on different days. I love the Stardust App for their witchy vibes and hilarious daily notifications.
Breath & Stretching
Pelvic tension plays a huge role in painful sex. Intentional breathing combined with restorative stretching can soften tight pelvic muscles and encourage relaxation.
Try poses like Happy Baby, Child’s Pose, Legs Up the Wall, Frog Pose, or deep diaphragmatic breathing before sex.
Communicate Clearly
If sex is painful due to endometriosis, your partner needs to know. Discuss boundaries, positions to avoid, signals to pause, and what support looks like for you. You do not need to endure pain for someone else’s pleasure.
Build Up to Sex
People with vulvas typically need 20–40 minutes of arousal before penetration. This allows blood flow, lubrication, and clitoral engorgement — all of which reduce pain.
Rushed penetration is one of the biggest contributors to painful sex, even without endo.
Experiment With Positions
Some sex positions will aggravate endometriosis more than others. Experiment with angles and positions that allow you greater control over depth and movement, and avoid those that consistently cause pain. You might like to use a nice firm pillow or a sex wedge for propping up the hips.
Use Lube (Generously)
Lube is non-negotiable. Vaginal dryness and friction are common contributors to pain. Use a quality, water-based lubricant and apply liberally for both solo and partnered sex. Check out my faves here
Control Depth
If pain occurs during deep penetration, tools designed to limit depth can be game-changing. Products like the OhNut, a penetration-limiting ring allows for pleasurable sex without triggering pain — protecting both your comfort and desire.
Explore CBD (With Medical Guidance)
Some people find relief using CBD pessaries or topical products to support muscle relaxation and reduce inflammation. If you can’t get a hold of CBD, you might find a hemp-infused lube like Kuub is useful. Always consult a healthcare provider before exploring CBD internally.
Take Breaks
If pain appears after orgasm, take breaks between penetration. Orgasms involve involuntary muscle contractions, and continuing penetration immediately afterward can trigger spasms and raw, stingy pain.
Alternative Pleasure
Penetration is not the definition of sex. Explore clitoral stimulation, oral sex, edging, nipple play, toys, anal play, or sensual connection. A fulfilling sex life does not require penetration.
Ask Eleanor
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