Painful Sex? Endometriosis Could Be the Cause—Here’s What to Do

In Honor of Endometriosis Awareness Month

Painful sex, or dyspareunia, is often dismissed or normalized, leaving many people suffering in silence. One of the most overlooked yet leading causes of painful sex is endometriosis, a whole-body inflammatory disease that can impact multiple organs beyond the reproductive system.

For too long, discussions around sex—especially for women—have emphasized pain rather than pleasure. Many of us were conditioned to expect that our first sexual experience would be painful, rarely hearing that sex should be enjoyable and fulfilling. These messages stay with us, shaping our expectations and even how we hold tension in our bodies during sex.

But painful sex—especially with endometriosis—is not just about “relaxing more” or “trying a different position.” The pain is real, often debilitating, and rooted in complex biological, neurological, and psychosocial factors.

To reduce pain and reclaim pleasure, we need a deeper understanding of what’s happening in the body when endometriosis is present.

What is Endometriosis? A Whole-Body Inflammatory Disease

Endometriosis is not just a reproductive disorder—it is a systemic inflammatory disease that can impact any organ in the body, including the uterus, ovaries, bladder, rectum, intestines, and even the lungs or diaphragm in severe cases.

Endometriosis occurs when tissue similar to (but not the same as) the uterine lining grows outside the uterus. Unlike normal endometrial tissue that sheds during menstruation, this displaced tissue has no way to leave the body, leading to:

• Chronic inflammation that sensitizes the nervous system to pain.
• Scar tissue and adhesions that fuse organs together, restricting movement and blood flow.
• Deep pelvic pain and hypersensitivity to any physical manipulation, including sex.

When endometriosis affects the bladder, rectum, and pelvic floor, pain during or after sex is common. This is not just from penetration but also from the tension, inflammation, and nerve activation that occurs due to restricted blood flow and muscle contraction.

Why Does Endometriosis Cause Pain During Sex?

The pain associated with sex and endometriosis is not psychological—it is deeply physiological. Here’s what happens in the body when you experience painful sex with endometriosis:

1. Inflammatory Tissue & Adhesions Create Physical Restrictions
   • Endometriosis lesions and scar tissue can bind the uterus to the rectum, bladder, or ovaries, creating pulling sensations and sharp pain during movement.
   • Deep penetration can irritate inflamed tissues, causing severe cramping and post-sex pain.
2. Reduced Blood Flow & Muscle Tension
   • Adhesions and scar tissue can restrict blood circulation to pelvic muscles and nerves, making them tense and hypersensitive.
   • Poor circulation contributes to nerve pain, muscle tightness, and burning sensations during sex.
3. Nervous System Hyperactivation & Chronic Pain Loop
   • Chronic inflammation keeps the nervous system on high alert, making the body more sensitive to pain.
   • Even light touch can trigger an intensified pain response due to the nervous system’s heightened sensitivity.
4. Pelvic Floor Dysfunction (Muscle Guarding & Tightness)
   • Many people with endometriosis unknowingly clench their pelvic muscles in anticipation of pain, leading to further tightness.
   • This results in a cycle of muscle spasms and pain that can make penetration, arousal, and even non-sexual touch uncomfortable.
5. Post-Sex Inflammation & Delayed Pain
   • Pain doesn’t always stop after sex—many people with endometriosis experience delayed pain hours or even days later.
   • This can manifest as deep cramping, bloating, nausea, or sharp shooting pains that make it difficult to move or function normally.

Beyond “Just Relax”: A Holistic Approach to Healing Painful Sex

Because endometriosis affects multiple systems, reducing painful sex requires a whole-body approach that includes medical, physical, and psychological healing.

1. Medical Treatments & Professional Support

🔹 Proper Diagnosis & Specialist Care – Many people go years without a proper diagnosis. A gynecologist specializing in endometriosis or an excision surgeon can provide the best assessment.

🔹 Surgical Excision – Unlike ablation (which only burns the surface), excision surgery removes endometriosis lesions at the root, reducing inflammation and pain.

🔹 Hormonal Therapies & Pain Management – Birth control, progestins, or GnRH agonists may help some people, but they do not cure endometriosis. Finding the right balance of medications, anti-inflammatory treatments, and lifestyle adjustments is key.

2. Pelvic Floor Therapy & Movement-Based Healing

🔹 Pelvic Floor Physical Therapy – Many people with endometriosis develop chronic pelvic tension. A trained pelvic floor therapist can help with muscle relaxation, trigger point therapy, and desensitization techniques to reduce pain.

🔹 Breathwork & Pelvic Mobility – Learning how to move the pelvis with ease can help release tension and improve circulation during sex.

🔹 Dilator Therapy & Touch Desensitization – If penetration is painful, working with dilators or guided touch therapy can help retrain the nervous system to feel safe.

3. Mind-Body Techniques to Support Healing

🔹 Reframing Sex Education & Communication – Many of us were not taught how to communicate about pain, pleasure, or boundaries. Understanding how your body works and what it needs is essential.

🔹 Sex Therapy & Emotional Healing – Sexual trauma, medical gaslighting, and negative beliefs about pain and pleasure can amplify distress and muscle guarding. A therapist specializing in sex and pain can help navigate these experiences.

🔹 Mindfulness & Somatic Therapy – Techniques like yoga, nervous system regulation, and guided touch therapy can help rewire pain pathways and restore a sense of safety in the body.

Final Thoughts: Pain is Not Normal—And You Deserve More

Sex should not be painful. If it is, your body sends a message that something needs attention. Whether due to endometriosis, pelvic floor dysfunction, hormonal imbalances, or past trauma, you deserve proper care, compassionate support, and a plan that honors your body’s unique needs.

Healing from painful sex is not just about “pushing through” or “relaxing.” It’s about:
✔️ Understanding what’s happening in your body
✔️ Finding a team of professionals who believe you
✔️ Exploring movement, breath, and therapeutic techniques to restore comfort
✔️ Changing the way we talk about sex—so that pleasure, not pain, becomes the expectation

Your body deserves compassion, respect, and care. And most of all, you deserve pleasure without pain.

If you or someone you know is struggling with painful sex due to endometriosis or another condition, you are not alone. There are treatments, therapies, and a path to relief. Seek the help you need—and never let anyone tell you that pain is “just part of being a woman.”

Your pain is real. Your pleasure matters. Healing is possible.