If you have endometriosis, you have probably already encountered how frustrating and isolating it can feel when pain interrupts intimacy. Sex becomes something to endure, and the anxiety around it can make even the idea of being sexual feel overwhelming.
Pain during sex is common in people with endometriosis, but it is not something you should just tolerate. Pain tells your body that something is wrong and when you ignore that signal, your nervous system learns that sex is something to be feared, and perhaps even avoided. Over time, this can create a cycle where even the thought of sex triggers anxiety, making penetration more painful due to muscle tension and reduced arousal.
The pain is your body’s way of saying; I don’t feel safe doing this. And if sex doesn’t feel safe, pleasure isn’t going to happen.
The psychological side of pain and sex
Anxiety is a very common response to pain. Anxiety about pain can make it difficult to relax, which in turn makes pain worse. You might start avoiding sex – or any kind of touch – completely, worrying that it will lead to discomfort or disappointment, and this can create real distance in our relationships.
And that’s where pressure comes in – the ultimate desire killer. The pressure to “perform,” to be a “good partner,” to meet expectations (yours or someone else’s). But sex isn’t a duty, and your pleasure matters just as much as anyone else’s. If penetrative sex is painful, it doesn’t mean your sex life is over. It just means it’s time to expand what sex means to you.
Expanding the sexual menu
Sex does not equal penetration. I’m going to say that again, just to make sure you don’t miss it! Sex does not equal penetration. We live in a world that centres a very heteronormative, penetrative idea of what sex is. But I truly believe sex to be a subjective term; I define for myself what counts as sex, and I invite you to do the same.
Sex is a broad range of intimate, physical and emotional expressions of eroticism and sexuality, and in fact, some of the most pleasurable and intimate experiences don’t involve penetration at all. When you broaden your definition of sex, you open up a world of connection and pleasure that works with your body rather than against it.
Here are some ways to explore pleasure without penetration:
- Outercourse: Oral sex, mutual masturbation, grinding, and other forms of external stimulation can be just as fulfilling as penetration.
- Sensory play: Focus on different sensations – massage, temperature play, or exploring different textures to create a full-body experience.
- Erotic massage: Not just relaxing, but also a way to foster intimacy and tune into what feels good for you.
- Sexual communication: Talking about desires, boundaries, and preferences can be incredibly arousing and deepen intimacy.
- Using toys: Regardless of whether you can tolerate some penetration or not, there are toys available to you to help you explore pleasure of all kinds.
- Building arousal gradually: Allowing time for full arousal can make a huge difference, and it maximises the chance for our muscles (and mind) to fully relax.
All of these strategies can help you to maximise relaxation and minimise pain, which is going to go a long way to increasing the odds of you accessing pleasure.
Managing anxiety around sex
If anxiety around sex has built up due to pain, it’s important to acknowledge that and work with it rather than against it. Some ways to manage this include:
- Mindfulness and breathing techniques: Learning to calm your nervous system before and during intimacy can help reduce tension.
- Pacing yourself: Give yourself permission to stop if something doesn’t feel right. You are allowed to slow down, adjust, or change course entirely.
- Communication: If you have a partner, talk about your fears and needs openly. The more informed and supportive they are, the safer and more connected you’ll feel.
- Therapeutic support: Working with a sex therapist who understands pain conditions can be transformative. They can help you untangle the psychological impact of pain and build a sexual relationship that works for you.
Reclaiming pleasure on your terms
Living with endometriosis means that sex might not look the way it once did – or the way mainstream media tells you it should look. But by shifting the focus from ‘pushing through’ to tuning in, you can have a pleasure-filled and fulfilling sex life.
By honouring your body, expanding your idea of what sex can be, and managing anxiety with self-compassion, you can create a sex life that feels both pleasurable and safe.
Your body deserves care, your pleasure is valid, and sex should feel good for you, too!
LAURA LEE
Laura is a psychologist & sexologist who works at the intersection of all things sex, relationships and mental health. Laura provides individual and relationship therapy and coaching to help people to explore, enjoy and embrace their sexuality.
IG: @lauraleesexology
