Let’s Talk About Painful Sex With Endometriosis

If you have endometriosis, you probably already know this, but according to the most recent research, 50 to 70% of people with endometriosis report dyspareunia, or pelvic pain that occurs before, during, or after penetrative vaginal sex. Pain with sex for endometriosis patients has also been so normalized that the overall medical community hasn’t done much to treat it. It’s just expected, and has even been taboo to discuss in endometriosis patient circles.

For endo warrior Jacqueline Solivan, “Painful sex has no limits or restrictions — it honestly almost always hurts.” She describes it like the pain you feel when pushing on a bruise, and that it can be unpredictable in its timing with the rest of your cycle and endometriosis flare-ups.

Let’s dig deeper into the causes of endometriosis pain with sex, treatment options and workarounds, and how to begin the conversation about painful sex with your partner.

Does endometriosis cause painful sex or painful intercourse?

Yes, unfortunately, endometriosis pain during sex is very common. In fact, studies suggest that anywhere from 50 to 70% of people with endometriosis experience it at some point. It’s not just “a little discomfort,” either — we’re talking sharp, stabbing pain, deep aching, cramping, or burning that can linger long after sex is over.

What makes it even harder is that painful sex has been normalized for so long that many people don’t even bring it up to their doctor or partner. But here’s the truth: it’s not something you should have to just deal with. Painful intercourse endometriosis is a valid and well-documented symptom, and if it’s affecting your intimacy, you’re not alone, and you absolutely deserve relief.

Endometriosis dyspareunia: What does it mean?

Dyspareunia is the medical term for painful sex, and with endometriosis, it can feel relentless. Scar tissue, adhesions, and inflamed pelvic floor muscles often contribute to painful intercourse endometriosis.

Can someone with endometriosis have sex?

Absolutely, yes, but it’s complicated. Many people with endometriosis continue to have fulfilling sex lives, though it may require more communication, trial and error, and adjustments. Pain is not something you should be expected to push through.

What does endometriosis sex pain feel like?

Painful sex with endometriosis can feel very different from person to person, but many describe it as more than just “uncomfortable.” For some, it’s a sharp, stabbing pain deep in the pelvis during penetration, almost like something is being hit or pulled. For others, it’s a dull, aching pressure that lingers long after sex is over. The pain might show up in specific positions, or it may feel like burning, cramping, or throbbing that radiates into the lower back or thighs.

What makes it especially tough is that it isn’t just physical — the anticipation of pain can also bring anxiety or fear around intimacy, which can add another layer of distress. If sex is consistently painful, it’s worth bringing up with a provider you trust, because relief is possible, and you deserve to have intimacy that feels good, not something you brace yourself for

Why does sex hurt with endometriosis?

Because endometriosis is a condition in which tissue that’s similar to that of the uterine lining grows outside the uterus (on the colon, pelvic floor, ovaries, and bladder), that tissue can cause extra inflammation as it grows where it doesn’t belong, explains Lyndsey Harper, MD, FACOG, CEO and founder of Rosy.

Pain with sex can stem from a combination of factors related to endometriosis, including pelvic adhesions, scar tissue, fibrosis, and even nerve damage. Inflammation of the pelvic floor muscles may also lead to pelvic floor muscle dysfunction, where the muscles stay tight instead of relaxing for activities like sex and peeing. This tension can make intercourse extremely painful, especially when paired with conditions like vaginal dryness or ovarian cysts, such as endometriomas, which are common in endometriosis.

And because your body and mind are not really separate entities when it comes to sex, trying to be sexually active during an endometriosis flare might essentially “teach” your body that sex equals pain. “Your body and mind remember ‘this hurts…’ and that can increase the pain experience and become a cyclical problem,” says Dr. Harper. It can be difficult to disassociate pain and sex, so you may benefit from mental as well as physical support.

Endometriosis pain after sex? Here’s what to know

Painful sex due to endometriosis doesn’t always end once the intimacy is over. Many people notice cramping after sex with endometriosis, as the pelvic muscles tighten in response to irritation. Others experience bloating after sex with endometriosis, where inflammation leads to abdominal swelling and discomfort. Burning after sex is also common, as sensitive nerves and tissues remain aggravated, and in some cases, bleeding after sex with endometriosis can occur when lesions or inflamed tissue are disturbed.

Can sex trigger an endometriosis flare-up?

Yes, for some people. Deep penetration, certain positions, or even orgasms can trigger an endo flare, leaving you sore for hours or days afterward.

Endometriosis sex drive: How pain affects desire

When sex is linked with pain, desire often fades. Studies show that people with endometriosis are more likely to report reduced sexual desire, difficulty with arousal, and less overall satisfaction. One study found that the intensity of pelvic pain and dyspareunia directly predicted sexual dysfunction — not just physically, but psychologically too.

It’s not simply “sex hurts, so I don’t want it.” Fear of pain, anxiety about disappointing a partner, or feeling disconnected from one’s body can all erode libido over time. Research confirms this: women with endometriosis and pain score significantly worse on measures of sexual function, anxiety, and depression compared to those without pain.

Does sex help endometriosis — or make it worse?

For a few, orgasm and the muscle relaxation that comes with it may bring temporary relief. But for many, sex — especially deep penetration or during a flare — can make symptoms worse. Studies show that people with endometriosis are much more likely to experience painful sex and report lower satisfaction overall compared to those without the condition.

The truth is, there’s no one-size-fits-all answer. For some, intimacy offers release; for others, it’s a trigger. Whatever your experience, it’s real, it’s valid, and it deserves to be taken seriously.

Endometriosis pain during sex treatment: How to make sex better with endo

Improving intimacy with endo isn’t just about positions or products — it’s about connection. Talk openly with your partner about what hurts, what helps, and when you’re comfortable trying again. Build intimacy outside of penetration, and consider therapy (solo or couples) to help reframe how you approach sex.

Every person’s experience with dyspareunia is different, but here are some techniques that might help with painful sex.

Pelvic floor physical therapy

There’s not a magic bullet “cure” for endometriosis, but pelvic floor physical therapy can be an effective treatment, according to Marcy Crouch, PT, DPT, board-certified pelvic floor therapist and creator of The Down There Doc. “It can help with the muscle tension, weakness, or dysfunction that develops in the pelvic floor muscles due to the pain,” says Dr. Crouch. It may sound intimidating, but pelvic floor PTs are trained to do manual therapy in a trauma-informed way with explicit consent from patients. They can also help you work on stretches, exercises, and relaxation techniques for pelvic floor muscle function and reduce pain, she adds.

Home exercises and stretches

“Between pelvic floor PT sessions, a physical therapist will ask you to practice relaxation techniques such as diaphragmatic breathing and mindfulness exercises to manage pain and reduce muscle tension,” Dr. Crouch says. Your PT will also give you “homework” exercises that will be customized to you and will help you practice strengthening, lengthening, and relaxing the pelvic floor muscles at home.

Some other pain management techniques include applying heating pads to your pelvic area, says Dr. Crouch. You can also keep up with a regular gentle yoga or stretching routine to keep the muscles both strong and as relaxed as possible, she adds. A healthy diet, adequate hydration, and stress management (which could look like meditation, counseling, neither, or both) is all part of the pelvic pain picture, too.

Sex therapy or other mental health support

Pain with sex is so wrapped up in blame, shame, and embarrassment, Dr. Harper says. Dyspareunia is no one’s “fault,” and it’s important to have open conversations about it. A sex therapist, for example, can help you navigate those discussions by giving you sample scripts to articulate the pain and your comfort level with sex to a physician, a partner, or whomever needs to listen, suggests Dr. Harper. You can even bring a partner into that therapy experience.

Getting creative with lube and positions

Sex is not supposed to be painful for any party involved. For some people, adding a lube can ensure comfort with movement, especially one that provides a warming sensation, like K-Y Yours and Mine Couples Lubricant, says Shan Boodram, certified sexologist and K-Y’s sex and relationship expert.

It’s worth experimenting with your partner to find go-to positions that ease pain and discomfort. To control the depth and speed of penetration, you can try getting on top of your partner and adjusting the angles from there.

Best sex positions for endometriosis

There isn’t one magic position that works for everyone with endometriosis, but the general rule of thumb is: positions where you have more control usually hurt less. Positions like being on top or side-lying (spooning) can make it easier to control depth and angle, so penetration doesn’t feel as sharp or jarring. For some, rear-entry positions are too painful, while for others, changing the angle with pillows for support makes a huge difference.

The “best” position is the one that lets you communicate, adjust, and stop if pain flares up. Experiment gently, use plenty of lube, and don’t be afraid to pause and try again another time. Pleasure and comfort should lead the way — not pushing through pain.

How to communicate with a partner about painful sex

If you’re working with a sex therapist or counselor, something to work on is holding space for all of your feelings, including the emotional impact of painful sex — and the grief that comes with it. “It has taken a toll on me emotionally for sure, and feels like part of my womanhood has been ripped from me,” Solivan says. “I want sex to be fun, enjoyable, and consistent because I deserve that. I feel like if anything is taboo, it’s that.” The pain should not be considered as normal as it is.

Open, honest communication about dyspareunia is essential — and can be incredibly healing. “Before sex begins, couples should lay out what they want and don’t want (e.g., pain) and spend quality time gushing about why they want each other to help increase that sexual desire for one another,” Boodram advises. It’s important that both partners are committed to ensuring safety and prioritizing intimacy first. “This can help set the playing field and increase the emotional connection before the physical connection takes place,” she adds.

Understanding your partner’s perspective can also help reduce the relationship tension that can arise when pain becomes part of the bedroom dynamic. Listening to your partner — and giving them the tools to support their loved one — can make this feel less like your burden alone. Some couples even benefit from couples coming in together to therapy sessions, to talk openly about boundaries, fear, desire, and how to reconnect with your partner in ways that don’t rely on penetration or performance.

One other thing your partner can do to play an active partner’s role in your healing? Educate themselves. Reading up on endometriosis, joining a support group, and getting involved in your care plan can be powerful acts of love. “There’s nothing sexier or more comforting than knowing that you are not expected to carry both the pain and the planning of managing the pain, alone,” says Boodram.

Painful sex isn’t just in your head

Let’s be clear: painful intercourse is never something you should have to “just deal with.” Yet so many people with endometriosis find themselves tolerating the pain — sometimes for years — because they’ve been taught it’s normal. That mindset can take a serious emotional impact, especially when the pain becomes persistent pain during intercourse or starts interfering with your daily life.

If painful sex has left you feeling isolated, dismissed, or unsure where to turn, just know that your pain is real — and help is out there. Non-invasive options like the MyReceptiva test can offer more information about whether endometriosis or inflammation might be part of your experience. You don’t have to keep guessing, tolerating, or pushing through. Getting answers is possible — and you deserve them.

Want to learn more? Use code RESCRIPTED to get $85 off your MyReceptiva Testing Kit.

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Mara Santilli is a journalist reporting on health and wellness and how social and political systems influence the well-being of certain groups, including but not limited to Black and brown communities, women, and the LGBTQ+ community. Her editorial work has appeared in publications such as Shape, Marie Claire, Cosmopolitan, Women’s Health, InStyle, Glamour, and more. Outside of reading and writing, she enjoys traveling (especially to Italy), singing, dancing, musical theatre, and playing guitar and piano.