Let's gonna talk about sex, baby. Let's talk about endo and me. Let's talk about all the good things, all the bad things that may be... Let's talk about sex (and endometriosis...)
Musical interlude over, this has got to be hands down one of the most, if not the most requested topic I've ever had. Whilst I've seemingly avoided doing a blog post about it, it's because I wanted to make sure I that when I did it was as comprehensive and informative as I could make it. So, before you read any further please take note that these are just suggestions based on my experience and what I've found works for me. I'm not a doctor and do not claim to be and I highly recommend discussing any sexual or any other health issues with a medical professional.
For the sake of clarity, I will try and break down this post into a question and answer format, so you can hop, jump and skip through it however you like.
Why can sex be painful when you have endometriosis? There is a huge range of reasons as to why sex can be painful, some linked to others and some seeming completely random. With penetrative sex, pressure and movement can lead to endometrial tissue or inflammation being pressed on and/or tugged or scar tissue becoming aggravated. Arousal also means that there is increased blood flow to our reproductive organs which can negatively stimulate our nerve endings which once again can result in pain. Finally, sex/orgasms can lead to cramping, swelling and/or spasms due to your muscles contracting and relaxing. Ultimately, endometriosis can make our bodies incredibly sore and tender and having sex can make this pain worse, which sucks.
Why do I feel in pain or bleed after having sex? Similar to all the reasons above! Any bleeding could be caused by uterine spasms or micro tears. Cramping and pain could be your nervous system reacting to stimulation/pressure and increased blood flow can exasperate inflammation and the swelling of tissue. Which, once again, sucks.
Is it normal to have pain with penetration? This really depends on your personal situation. As someone who suffers with vaginismus, pain with penetration is a normal thing for me but that's not to say that it will always be that way. Once I spoke to my gynaecologist about this, she was able to recommend a course of action to help me.
Is it normal to experience a burning sensation afterwards? No. But there are many logical reasons as to why you might be experiencing this. I experience a burning sensation due to my vulvodynia (vulva pain) which can be triggered by sexual stimulation or aggravating ingredients in lubricants such as glycerin. If you're experiencing burning after sex, talk to you doctor about it!
Does having endometriosis mean I'm going to develop another gynaecological condition such as vaginismus? Not necessarily. I know individuals who just have vaginismus and others who just have endometriosis and others, like myself, who have a whole plethora of situations going on. Whilst you might develop another gynaecological condition, it doesn't automatically mean you will and actually many gynaecological conditions have symptoms that overlap.
Why has endometriosis affected my libido and sexual self-esteem? Our reproductive organs are a huge part of our self identity and I think it connects back to that innate connection to procreate. As a woman, knowing that my reproductive organs aren't necessarily functioning the way they should be has made me feel guilty and almost ashamed because your sexuality is a huge part of who you are and when it doesn't work the way it's supposed to, of course that's going to have an impact on you! That being said, I think it's really important to understand that those feelings are okay and normal and they won't last forever. I still have days where I feel guilty or angry that my body doesn't respond or behave the way I want to but I've learnt that sex doesn't always have to mean penetration and that I can be intimate with someone without being sexual. The best thing you can do is be honest with yourself and communicate your sexual needs when relevant.
Is it normal to not feel sexy after a diagnosis and/or a laparoscopy? Once again this is linked to the previous question but yes it is entirely normal! You're battered and bruised both physically and mentally and you need to be kind to yourself! When you feel human again, take it slow and take time for yourself to do things that make you feel good, the rest will come naturally.
How do I communicate how endometriosis can affect my sex life and/or libido? Be honest! It's the best thing that you can do because if you don't talk about it or pretend everything is fine you're going to end up hurting yourself. Honesty really is the best policy because everybody should be having enjoyable sex. If you're met with any sort of negative or selfish reaction then I think you need to decide to yourself whether it's worth it or not (it's not, be selfish about your pleasure and what's right for you! You deserve the best.)
What sex position is best to help reduce my pain? Once again this is a very individual choice but personally I recommend and avoid any positions that shorten the vaginal canal or involve deeper penetration such as doggy. This might involve trial and error but remember that you can say stop or ask to switch positions!
So what can I do to make sex easier and more pleasurable?
Lube, lube and more lube: Seriously. Even if you think you're aroused enough, you can never have too much lubrication. More lube means less friction and therefore less pressure equalling more pleasure! I highly recommend a combination of a water based and oil based lubes (such as Yes Organics) as it reduces the likelihood of the lube drying up and reduces the friction further. I also recommend using organic lubes without any sugar based ingredients (here's looking at you glycerin) as they can irritate your vagina and nobody wants that.
CBD: CBD has so many great properties and it's really great to help making sex better and more comfortable. CBD lubes and suppositories are a brilliant way to reduce muscle tension and heighten sensitivity. CBD lubes vary in strength and formula but there are a variety available such as by Medi Vita, Go Love and Dr. Ed. Also, whilst not a lube per se, I really like Foria's awaken CBD spray to help relax my vaginal muscles. I will always use a CBD lube or suppository in combination with either a standard water or oil based such as those mentioned above.
Dilators: These cylindrical devices which look like very plain sex toys are a way of gently stretching the vaginal or anal muscles to make penetrative sex easier. I first started dilator therapy due to my vaginismus but they've also been incredibly helpful in reducing my endometriosis pain. Dilators start small in size, are usually made of plastic or silicone and you work your way up; you can use them for internal massage as well as in combination with vibrators to help increase blood flow. I started with these made by MYAID before switching over to these by Soul Source.
Pelvic Floor Therapy: Whilst I haven't specifically had pelvic floor therapy, I know many individuals who swear by it and I have found doing pelvic floor exercises have helped relax the tension in my hips and in my pelvis. There's loads of resources available via Google or YouTube!
Sex doesn't always mean penetration! I think people often forget that there's so much more to having sex that penetration and there's nothing wrong with exploring that! Sex can mean masturbation, using toys, anything you like! Once I realised that and removed that expectation, sex became so much more enjoyable and less painful.
Communication: Please, please, please, talk about it! The only person you're hurting is yourself if you don't communicate how you're feeling. It's okay to say you need to stop or you need to change position or that it hurts. Your greatest tool is your voice, use it!
Endometriosis Foundation of America (2021) Endometriosis Symptoms: Painful Sex (Dyspareunia) [Online] Available from: https://www.endofound.org/painful-sex-dyspareunia [Accessed 23 January 2021].
Engle, G. (2019) The Painful Truth About Sex and Endometriosis. [Online] Available from: https://swell.damewellness.co/painful-sex-and-endometriosis/ [Accessed 23 January 2021].
Godin, C. (2019) Take Your Pleasure Back! What You Need To Know About Endometriosis & Sex. [Online] Available from: https://www.intimina.com/blog/endometriosis-sex/ [Accessed 23 January 2021].
Informed Health (2017) My Partner Has Endometriosis – What Does That Mean For Me? [Online] Available from: https://www.informedhealth.org/my-partner-has-endometriosis-what-does-that-mean-for-me.html [Accessed 23 January 2021].
Senkin, T. (2020) Endometriosis and Painful Sex (Dyspareunia) [Online] Available from: https://www.drseckin.com/painful-sex-and-endometriosis [Accessed 23 January 2021].