Endometriosis definition shown in a dictionary

Sex & Endometriosis by The Endo Monologues

March is endometriosis awareness month so what better time to talk about how sex and endometriosis have a very, very complicated relationship.

What is endometriosis?

Endometriosis is a medical condition wherein cells that are similar to those of the lining of the uterus grow elsewhere in the body and can cause a plethora of issues as a result (Kennedy et. Al 2005). The best way to imagine it is like a sticky tar that has unrestricted access to the inside of your body. 1 in 10 individuals with uteruses have endometriosis and shockingly it takes between 7 to 8 years to receive a diagnosis (Arruda et al. 2003). Yupp. You read that right. "But why?" You might be asking. Endometriosis has similar symptoms to polycystic ovary syndrome, irritable bowel syndrome, interstitial cystitis and as a result is often at the bottle of the list when an individual tries to get a diagnosis (Mayo Clinic, 2021). That and the only way to receive an official diagnosis is via laparoscopic surgery. This delightful condition can cause heavy, prolonged periods, pelvic pain, bowel pain, bladder issues, bloating, infertility and pain when having sexual intercourse (dyspareunia).

Endometriosis Yellow Ribbon

What can make sex painful and/or difficult when you have endometriosis?

Endometriosis isn't a one size fits all sort of condition but there are a number of reasons as to why it can cause painful intercourse. First of all, endometriosis can cause inflammation so any pressure or movement can lead to the sensitive tissue being antagonised. Linked to this, pain can also be caused when endometriosis nodules/lesions and/or scar tissue is pressed on or tugged, once again leading to the tissue becoming aggravated (Fauconnier et al., 2002) & (Vercellini et al. 2007). Some individuals may find that when they are aroused, the increased blood flow can negatively stimulate the already sensitive nerve endings. Furthermore, pain can be caused during sex or as a consequence of an orgasm(s) due to the uterine muscles contracting and relaxing, leading to cramping, swelling or painful spasms. Quite frankly, it sucks. However it's not all doom and gloom, which leads me onto what is hopefully some useful suggestions and ideas to make having sex easier and enjoyable. 

What can I do to make sex easier and enjoyable?

1. Communicate

I know this might seem obvious but it's super important. Regardless of whether this is with a partner or yourself, be open and clear about what you and your body needs. If something is painful you need to be honest about that and remember that your pleasure is important, if the position/technique isn't working, say so, if it hurts, say so. The greatest tool you have is your voice.

Couple embracing

2. Lube, lube and more lube

Lots and lots of lube! If you think you've got enough, add more! With any gynaecological condition, if you anticipate it's going to hurt, you're likely to not produce enough natural lubrication as a result but even if you think you are lubricated enough, still use lube! My gynaecologist recommended using a combination of a water based and oil-based lube simultaneously because oil and water don't mix, meaning there's less chance of it drying up in the middle of your sexy session. I'd also recommend checking the ingredients of your lubes as often they include sugar-based ingredients which can aggravate the microbiome of your vagina (Ayehunie et al. 2018) and your vagina deserves better than that. This is why I absolutely love YES oil and water-based lubes. They're organic, work in perfect unison with one another and have personally made penetrative sex a hell of a lot easier for me.

YES Oil-based and Water-based Organic lube

3. Use a vaginal moisturiser

Similar in consistency to a water-based lubricant, vaginal moisturisers due exactly what their name suggests. Vaginal moisturisers help aid your natural lubrication which in turn can help with making penetrative sex more enjoyable. YES YES YES' vaginal moisturiser is one of my favourites due to its soothing, long lasting formula and compliments their lubricant range perfectly.

4. Sex is more than penetration

Even if you find penetrative sex painful, that's not all what sex is about. Sex is whatever the hell you want it to be and talking from experience when I finally realised that sex became so much more enjoyable.

5. Pelvic floor therapy/stretching

Just taking the time to stretch and check in with your body can make a hell of a difference towards having sex less painful. You don't necessarily need an actual therapist as there's loads of great videos out there which provide step by step instructions on how to reduce pelvic pain. 

Carefree women with arms stretched back looking up

6. Dilator therapy

Dilators are cylindrical plastic or silicone devices designed to help stretch out the vaginal (or anal) muscles. Some individuals may suffer with pain upon penetration as a result of their endometriosis or find that their vaginal muscles can involuntarily tighten which has the same outcome. Dilators can be used to train the vagina to make penetration easier as well as to gently internally massage any points of tension or pain and have been a key tool during my endometriosis journey. 

 Post written by The Endo Monologues Started as a wellbeing project to document her thoughts and feelings, The Endo Monologues is a satirical diary about L's experience of living with endometriosis, adenomyosis, vaginismus and vulvodynia from the point of view of her uterus (called Patricia). Her blog of the same name features reviews as well as information and advice on a wide range of topics such as: living with a chronic illness, gynaecological/sexual health and mental health. Follow The Endo Monologues on Instagram and check out the blog here.

 References: (1) Arruda, M., Petta, A., Abrão, M., & Benetti-Pinto, L. (2003). Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women. Human reproduction. 18(4), 756–759. Available from: https://doi.org/10.1093/humrep/deg136 . (2) Ayehunie, S., Wang, Y. Y., Landry, T., Bogojevic, S., & Cone, R. A. (2017). Hyperosmolal vaginal lubricants markedly reduce epithelial barrier properties in a three-dimensional vaginal epithelium model. Toxicology reports. 5, 134–140. Availble from: https://doi.org/10.1016/j.toxrep.2017.12.011 . (3) Fauconnier, A., Chapron, C., Dubuisson, JB, Vieira, M., Dousset, B. & Bréart, G. (2002) Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis. Fertility and Sterility. 78 (4), 719-726. Available from: https://doi.org/10.1016/S0015-0282(02)03331-9 . (4) Kennedy, S., Bergqvist, A., Chapron, C., D’Hooghe, T., Dunselman, G., Greb, R., Hummelshoj, L., Prentice, A., Saridogan, E. on behalf of the ESHRE Special Interest Group for Endometriosis and Endometrium Guideline Development Group (2005). ESHRE guideline for the diagnosis and treatment of endometriosis, Human Reproduction. 20 (10), 2698- 2704. Available from: https://doi.org/10.1093/humrep/dei135 . (5) Mayo Clinic (2021). Available from: https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656 . (6) Vercellini, P., Fedele, L., Aimi, G., Pietropaolo, G., Consonni, D. & Crosignani, P. (2007) Association between endometriosis stage, lesion type, patient characteristics and severity of pelvic pain symptoms: a multivariate analysis of over 1000 patients, Human Reproduction. 22, (1), 266–271. Available from: https://doi.org/10.1093/humrep/del339 .