Close-up of an African couple holding hands while sitting together on a beach at sunset
Goodboy Picture Company/E+/Getty Images

Endometriosis & Your Sex Life

Doctors explain what might help.

Unless you have the disease yourself, you probably have only heard of one symptom of endometriosis: Painful period cramps. While that’s definitely a hallmark symptom, endometriosis can interfere with your body’s ability to function in myriad other ways. This disease, which affects roughly 190 million people worldwide, has historically gotten scant attention from medical researchers. People with endometriosis often have their pain dismissed or hear the same untrue myths about endo over and over again. And while plenty of celebrities have been public about their battle with the disease, there still isn’t much discussion of one common symptom: painful sex. So what are the best sex positions when you have endometriosis? Is that even a thing?

Endometriosis can interfere not only with your general quality of life, but with your ability to be intimate with you partner. And yet just because some sex acts might be more difficult for endo sufferers, there are some sex positions that can help relieve endo pain that might otherwise crop up when you’re trying to be intimate.

What is endometriosis?

“Endometriosis is when you have cells that are similar— not identical, but similar to — the lining of the uterus, and they’re found external to, or outside, the uterus,” explains Dr. Iris Kerin Orbuch, a gynecologist and surgeon who specializes in endometriosis treatment. These cells have been found on almost every organ, so it’s not wonder that endo can wreck havoc on the body.

The list of symptoms that can accompany an endo diagnosis is long and unpleasant. “I work in primary care, so I see patients who complain about symptoms that may not obviously be endo if you aren't familiar with its presentation. There's a misconception that it is just a painful period. But, patients will often complain about things like pain with bowel movements, bloating, and fatigue,” Jenneh Rishe, a registered nurse and founder of the Endometriosis Coalition, tells Romper via email.

Part of the suffering from endometriosis comes from the fact that there’s so often a delay in diagnosis. “We need to look at the whole body — with endo, there’s a 10-year diagnostic delay from symptom onset to diagnosis. By the time someone gets to me, it’s not only the endo, I need to undo all these other things that have accrued over the course of this inflammatory disease that has taken its toll on the body,” Dr. Kerin Orbuch explains.

How can endometriosis affect your sex life?

SDI Productions/E+/Getty Images

That list of endo symptoms itself isn’t exactly arousing, but in addition to making you feel ill and not like yourself, endo can also cause sex itself to be painful. Rishe experienced this firsthand: “As my endo symptoms progressed, sex became more and more painful. I developed what's known as pelvic floor dysfunction from my pelvic muscles being so tense from years of pain.”

To make matters more complicated, not all sexual pain in endo sufferers has the same cause, so Kerin Orbuch always asks her patients whether the pain is upon entry or with deeper penetration. “If it’s on entry, it’s typically tight muscles. If it’s deeper penetration, it’s usually endo implants,” she explains. Of course, some people have pain with both. Figuring out where your pain stems from is crucial in determining a course of treatment as well as which sex positions will work best for you.

Are there sex positions to relieve endo pain?

If your primary pain is with deeper penetration, there are certain sex positions for endometriosis sufferers that can help avoid that pain. They include:

  • Having sex on your side
  • Woman on top (allows you more control over the depth)
  • Spooning, with your partner behind you

If penetration in general is painful, you might want to skip it all together, whether it be with a penis or a vibrator. There are, of course, non-penetrative ways to have sex, including oral sex, mutual masturbation, and fondling. And yet for some people with endo, having an orgasm, or getting turned on, can itself cause pain.

One thing not to do? Dismiss your own pain, or take patronizing advice from people who just don’t get it. Dr. Kerin Orbuch has seen scores of patients who’ve been told to just “drink a glass of wine before you have sex.” “If I had a penny ever time I heard that — it’s so invalidating,” she tells Romper.

What are the treatment options for endometriosis?

There is some much-needed good news for endo sufferers: There are possibilities for pain relief, though there’s not yet a simple magic bullet. Endo sufferers are frequently put on birth control, which can help some patients with symptom management. Many people find some relief through acupuncture, CBD, physical therapy, and steroid injections, Rishe says. What truly ended her own suffering was laparoscopic excision of endometriosis, a surgery that cuts out endo at its root wherever its found in the body. “I found a specialist who was able to perform an excision surgery to remove the endo from my diaphragm and at that surgery, endo was found in many other places including my abdominal side walls, bowels, and uterosacral ligaments. After months of recovery, healing, and physical therapy, I have been pain free since that surgery in 2016,” she tells Romper.

Pelvic floor physical therapy also might be necessary, particularly if you’re having entry pain, which stems from chronically tight muscles and which surgery won’t necessarily correct. “If someone has painful sex, one of the first place I would go is to a trained pelvic floor physical therapist. You don’t ever want to do Kegels, which tighten the muscles. You want to do the opposite,” Kerin Orbuch explains.

Depending on how your endometriosis manifests, figuring out both the right treatment and the best sex positions for endometriosis sufferers can, in conjunction with other treatments, help you start enjoying sex and enjoying life.

Sources Interviewed:

Dr. Iris Kerin Orbuch, OB-GYN, Director of the Advanced Gynecologic Laparoscopy Center in Los Angeles.

Jenneh Rishe, RN, BSN, founder of The Endometriosis Coalition