By Emma McGowan

If you’ve found your way to this article, chances are you’ve already gotten an endometriosis diagnosis. That’s great! Because while it’s certainly not great to have endo, getting a diagnosis is the first step toward taking back control of your body and your sex life. 

If, on the off chance, you haven’t gotten a diagnosis yet — or you’re just curious to learn more — let’s do a quick refresher. Endometriosis occurs when tissue similar to a person’s endometrium (or the lining of the uterus) grows in places that it shouldn’t. We’re talking inside the abdominal wall but outside the uterus; on the outside and sometimes even the inside of the vaginal canal; on the fallopian tubes; even on the bowels or bladder! 

Unfortunately, just like the endometrium inside the uterus, this outside tissue breaks down and bleeds every month. But unlike the endometrium, which exits through the cervix and vagina as part of the menstrual cycle, tissue caused by endometriosis has nowhere to go. That can lead to build-ups of blood inside the abdominal wall, causing inflammation, pain, and sometimes really major medical problems. For some people, it even grows new blood vessels and nerves in response in estrogen, leaving them in pain all of the time.  

Oh, and it also can fuse together internal organs, like the rectum and outer parts of the vaginal canal. Not great.

Think about it: You’re clenching and pushing and pulling and bumping and bouncing. All of those movements contribute to pleasure but, in the case of people living with endometriosis, they can also cause pain.

Despite being fairly common (some estimates say that more than 11% of people with uteruses have endometriosis), endo is difficult to diagnose and still relatively unknown outside of the communities it affects. As a result, many people don’t get their diagnosis until they’re in their 30s or 40s, after years of pain and searching for help. 

Which brings us back to our initial “Congratulations!” You made it! You got that diagnosis! (Or, at the very least, you’re pretty sure this is what’s going on and you’re ready to tell your doctor it’s time to do some tests.) But what do you do now? 

That’s where we come in.

While you’re working with your doctor to figure out the best medical path forward, you’re probably still living with mega pain, discomfort, and disruption to your daily life. And for many of you, that pain and disruption includes your sex lives.

Can I Have Pain-Free Sex With Endometriosis?

Because endometriosis can cause everything from abdominal tenderness to bloating to bladder problems to deep pelvic pain, it’s super common for people with endo to experience pain during sex. Think about it: You’re clenching and pushing and pulling and bumping and bouncing. All of those movements contribute to pleasure but, in the case of people living with endometriosis, they can also cause pain.

The human mind instinctually moves away from things that hurt our bodies. So if sex is painful, your brain is going to be like, “WHY WOULD YOU DO THAT THING??”

“Endometriosis is complicated,” Dr. Ashley Rawlins, PT, DPT, a pelvic health specialist working with the pelvic and whole body physical therapy group Origin, tells The Pelvic People. “It’s really this multi-systems result of what’s going on in your body. When it comes to pain during sex, that can include the pelvic area muscle system.”

Dr. Rawlins says that it’s common for people with endometriosis to have tension and restriction in their pelvic area muscles, including the abs, glutes, and thighs. When those muscles try to relax and then tighten again during intercourse, they hurt! 

As a comparison, imagine you love running so much that you’re going to try to run with a charlie horse in your leg. That gripped muscle won’t want to do what you’re asking it to do and it will protest with pain. Now imagine that happening inside your abdomen. Yeesh! 

In addition to the physical aspects of pain during intercourse, Dr. Rawlins says that people with endometriosis often have a lot of fear about sex. That makes total sense. The human mind instinctually moves away from things that hurt our bodies. So if sex is painful, your brain is going to be like, “WHY WOULD YOU DO THAT THING??” And, as an added not-bonus, your body will likely brace in anticipation of that pain, further tightening your muscles — and making sex hurt even more.

That’s grim. And it’s enough to make anyone want to opt out of penetrative sex forever. But, luckily, Dr. Rawlins says that there are ways to address both the physical and psychological effects of pain during sex caused by endometriosis. 

“Treating sexual dysfunction when you have endometriosis is often a multidisciplinary approach,” Dr. Rawlins says. “We work on teaching the nervous system to calm any chronic pain that has developed. We also practice stretching the pelvic muscles, both to help them lengthen during sex and also to teach the body that the result of stretching or sex doesn’t have to be pain. And sometimes we also pull in other practitioners, like a psychologist, to help people.”

And while each person’s pain and experience is unique to them, there are some general tips that can help reduce (or even eliminate) pain during sex. Here are Dr. Rawlin’s expert tips on the best penetrative sex positions for people with endometriosis. 

The Best Sex Positions For People With Endometriosis

1. Spooning On Your Side

Because many people with endometriosis experience “don’t-even-put-clothes-on-me sensitivity” in the abdominal area, Dr Rawlins says positions that minimize touch on the front of the body are ideal. That’s why the first position she recommends is spooning, with the penetrating partner behind the person who has endometriosis. This keeps that tender spot from getting jostled.

2. Draped Over The Sofa

Next, take that action out of the bedroom and into the living room! The person with endometriosis can drape their body over the back of the sofa, while the penetrating partner enters them from behind. Dr. Rawlins says this is great for people who are dealing with deeper pain caused by restricted pelvic muscles, because you have nearly full-body support. That means you don’t have to support your body weight, allowing those muscles to relax. It’s also a great way to enjoy “doggy style” sex without having to work all of those muscles on your hands and knees.

A note of caution for this position: from behind can also be one of the woooorst positions for some people with pain deeper inside the body during penetration. If this is you, we recommend the receptive partner stand up a little straighter so the penetrating partner isn't going in at a 90 degree angle. Still not working? No worries! There are lots of other positions to try :)

3. Supported By Pillows

No matter what your favorite position is — on top, backwards, from behind, upside down — Dr. Rawlins suggests getting some supportive pillows in there. Pillows allow you to relax and take some of that tension off of your already overtaxed pelvic muscles.

“If your muscles are restricted, you can support your hips with pillows in whatever position,” Dr. Rawlins says. “On your side, you can put pillows under your knees. With missionary, pillows under your hips on both sides, so your knees don’t splay out. For doggy style, pillows under the upper body.”

4. On Top

For people experiencing vulvar or inner thigh pain or deep pelvic pain, Dr. Rawlins suggests getting on top. This position allows you to control depth of penetration. If you’re dealing with dyspaurenia, you can also support the buttocks with pillows or even get creative with a sex sling, so that you don’t have to strain to hold your body upright.

5. With Ohnut

And, finally, Dr. Rawlins says that “Ohnut is always a go-to in these situations.” Ohnut is a donut-shaped device that’s kind of like a bumper for your partner’s penis, whether it’s biological or prosthetic. It’s a series of interlocking polymer blend rings that lets you and your partner customize just how deep you want to go. Because people with endometriosis often suffer from that deep pelvic pain, Ohnut is a great solution for pain-free penetrative sex.

Sex is rarely uncomplicated, even if you’re not suffering from an under-diagnosed and not-well understood disease. But when you’re living with endometriosis, sexual complications become a whole other world of hurt — but that doesn’t mean your sex life is over now that you have that diagnosis. Start those treatments, invest in some dense pillows, grab your Ohnut, and remember: You can do this. 

Illustrations by @saradesignsstuff