Sex with endometriosis got better when I started having it on my terms
What happens when you decide to take ownership of your pleasure despite a chronic condition that makes sex hurt? Olivia Walters asks
Once when I was having doggy-style sex with my then long-term partner, I remember fixing my gaze on the wall in front of me hoping that if I counted the seconds in my head it would be over sooner. I wiped my glassy eyes and decided not to say anything; better to pretend it felt good than to admit something was wrong with me.
But the thing is, I didn’t know what was wrong.
In past relationships and intimate encounters, I never thought of the phrase “painful sex” or the medical term “dyspareunia” (pronounced dis-puh-roo-nia) during foreplay or intercourse. I could only make associations based on the way certain positions, depths, and speeds made my insides ache, as if lava was bubbling inside the deepest part of my cervix.
All I remember about sex before my endometriosis diagnosis in 2022 is being trapped within walls of pain that I could feel but no one could see.
“Sex should never be painful!”
My diagnosis was a clue to unsolved, escalating pelvic pain that, at the time, had me teetering on the brink of a mental breakdown.
When a gynecologist agreed to go forth with laparoscopic surgery (a minimally invasive procedure that looks inside your stomach or pelvis) and found endometriosis spread across my insides, this discovery contradicted accusations from (male) partners who seemed intent on rationalising my disinterest in sex:
“You must be cheating”,
“Our sex life better improve, or else this is over”,
“You’re acting totally bipolar with this hot and cold game you’re playing”.
I wish I could say that after they cut the endometriosis out of me, everything clicked, and sex suddenly got wildly better. Spoiler alert: it did not.
It took me leaving a relationship, months of pelvic floor physical therapy, several more specialist visits, and a slew of disappointing situationships to figure out what felt good and safe in the bedroom.
According to obstetrician and gynecologist Dr Cordelia Nwankwo, one of the biggest things that improves sex with endometriosis is open communication with your partner.
“Sometimes trying different positions can change the angle of penetration and decrease the amount of pain,” Nwankwo says. “For example, being on top gives you a bit more control and allows you to adjust to a pace, depth, and angle that is more comfortable.”
She also recommends taking over-the-counter pain medication before sex and using plenty of lubrication.
More: Why is it so hard to get diagnosed with endometriosis?
The first thing I did to put the power back in my hands was to remove dating apps from my phone and stop having casual sex. My support group and I agreed that situationships no longer served my best interests.
And this brings me to the main reason I recently told a friend I could go the rest of my adult life and never sleep with a man again. I shudder writing the word –you know the one – the “P word”.
Penetration. The thought of the act sickens me, no doubt because it reminds me of pain. This also extends to non-sexual situations, such as pap smears and using tampons.
Penetrative sex can be terribly boring and unsatisfying for a woman, not to put the onus all on men either. Penetration with a man or woman, in my history, feels like violent pornography one person agreed to act out while the other (me) wonders what the point really is, what we’re trying to prove.
Every hookup or fling had the sullen weight of regret and after repeat offenses, I’m tired of the same script. On the eve of my one-year anniversary of celibacy, I sensed the unfamiliar opening of a new chapter.
How to have painless intimacy with endometriosis
Post-diagnosis, I knew I had to approach sex and intimacy differently, which took experimenting on my end to keep pain as far away from the bedroom as possible.
According to physical therapists, this is something everyone with endometriosis should strive towards.
“When dealing with pelvic floor dysfunction and endometriosis, we like to remind patients that sex should never be painful!” share physical therapists Alison Valdepenas and Sarah Amos.The two work as a pair and specialise in treating pelvic floor conditions.
“What you’re “supposed” to do in your reproductive years as a woman makes me want to declare lifelong abstinence”
“Simple tips we would suggest is to work on addressing symptoms outside of sexual intimacy.”
One thing porn and movies don’t show is pre-sex rituals, the things each of us do as individuals, or maybe with partners, to make intimacy more enjoyable. The prep-step is uniquely personal to each person, but lately, mine involves deep breathing, self-massage, and vibrators.
If you do have penetrative sex, Valedpenas and Amos emphasise the importance of preparing your body before intercourse with sexual arousal. They suggest stretching and relaxation methods to reduce stress and muscle tension, foreplay, and of course, lube.
Personally, if I am in the mood for internal stimulation, I’ve found it possible to use penetration accessories that create a bumper, such as the Ohnut, and feel pleasure.
This with a pillow under your bum and all of the suggestions mentioned above minimise entry pain and deep aches people with endometriosis feel from fingering, dildos, or penises.
More: Why is no one talking about adenomyosis?
Regardless of whether you already have a diagnosis or suspect you have endometriosis, painful sex is not a symptom to ignore or feel shy to speak up about.
If you find it difficult to advocate for yourself at provider appointments, try bringing someone you trust to advocate on your behalf or seek out another opinion to get your symptoms medically validated.
When change is lonely
Years of unidentified pain, the diagnosis process, explaining the condition to others, and then managing the pain day in and day out all make endometriosis an isolating experience.
Along with “the P word”, I’m not fond of people referring to other people’s horniness as part of their “sexual prime”. It’s isolating enough dealing with the invisibility of endometriosis; added perspectives from the peanut gallery about what you’re “supposed” to do in your reproductive years as a woman makes me frustrated to the point of wanting to declare lifelong abstinence.
But I’m a realist. I’m not immune to loneliness and I sometimes crave human touch. It’s feasible to believe I’ll meet a partner who won’t care that I don’t like having penetrative sex and will open up doors of intimacy I have yet to experience.
In the meantime, I’m capable of pleasing myself. It’s easier, anyway. Over-explaining and saying again and again, “No, I will not shave for you” gets old, and makes loneliness, or should I say solitude, more appealing.
I’m excited to get to know this new version of myself.