Eleanor Hadley's 13 Tips To Reducing Pain & Increasing Pleasure During Sex
I was diagnosed with endometriosis a couple of years ago. Deep Infiltrating Endometriosis (whose acronym is unironically DIE) in ‘the pouch of Douglas’ to be exact. Learning that this was the cause of the intense period pain I had been experiencing since I had come off the pill was at once overwhelming and relieving.
I was relieved to finally know why I’d been spending day one of my period feeling like it was my last day on earth - nausea, fevers, chills, cramps that felt like a machete hacking from the inside, blurry vision, vomiting, and cold sweats to name a few of the symptoms I’ve come to expect each month. I’m one of the ‘lucky’ ones when it comes to endometriosis though - many with the disease suffer from endo flare-ups multiple times a month and not exclusively during their period, while others have near-constant pain.
One of the side effects that had a big impact on me in particular - especially as a Sex Educator and certified huge fan of sex - was the incidence of painful penetrative sex. When something that is quite literally designed to be pleasurable becomes painful, it can be incredibly overwhelming.
As a refresher - endometriosis is caused when the endometrium, which is the tissue that is supposed to grow inside the uterus, decides to go rogue and start growing in other regions of the pelvis. This can include the ovaries, Fallopian tubes, the bladder, rectum, vagina, cervix, and even sometimes the vulva.
Sex can become painful for those with endo when the site of the endometrial growth gets pushed or pulled, especially during penetration, causing aggravation of the tissue, spasms, and pain.
Sex shouldn’t be painful. You deserve pleasurable, pain-free sex. So I want to share some ways that you can reduce pain and increase pleasure during sex if you suffer from endo or any other condition that impacts your sex life.
Pelvic Floor Physiotherapy
As a first step, I highly recommend getting yourself some professional guidance with a Pelvic Floor Physiotherapist. These specialised physios know the pelvic region unlike anyone else and work directly with you to help you ease pain and embrace pleasure through personalised treatment plans, specific to you and your condition.
Your initial consultation will likely include an internal pelvic floor exam so your Physio can assess the strength of your pelvic floor as well as pinpoint any painful areas and offer targeted exercises for you.
I highly recommend downloading the GINA App for a range of tools and exercises, along with guidance to help you navigate painful sex. The app is designed for those with vaginismus but has plenty of helpful resources for anyone experiencing pain with sex.
Depending on your condition, your Pelvic Floor Physio may suggest using dilators or specific tools to help manually stretch and release the tension in the vaginal muscles. Dilators or vaginal trainers are a medical tool that, according to GINA, “allows the brain and the body to experience non-threatening, non-painful sensations of stretching and touch, without activating those aggressive and painful pelvic floor spasms”.
I’ve found glass cervical wands, as well as my Double Entendre really helpful too, for giving myself an internal massage. Long and curved tools like these allow you to easily reach those areas that usually cause you pain during penetrative sex, and gently release them. Just like you would get a deep tissue massage for a wry neck, vaginal massage can offer relief internally.
Track Your Cycle
As the cervix moves up and down during the month depending on when you menstruate and ovulate, you might find different times throughout your cycle when deeper penetrative sex is more comfortable, and other times when it’s more painful. Try tracking your cycle and making note of the days that you feel more sensitive. You can then look for patterns each month and plan what type of sex you might go for or steer clear of on certain days.
Breath and Stretching
A lot of pain during sex can be caused by our vaginal muscles being too tight, and pelvic stretching along with intentional breathing can help to soften the tension, relax and lengthen the vagina. Restorative yoga poses like Happy Baby, Child’s Pose, Legs Up the Wall, and Frog Pose can help to relax muscles in the pelvis, abdominals, back, and thighs which can relieve tension and promote deep breathing.
If you’re regularly experiencing painful sex with a partner, or you are seeing someone new, it’s really important to give them a heads up that due to your endo, sex can sometimes be painful for you. Discuss what you personally need in order to make sex less painful, which positions are off-limits, what helps, and how they can support you. It’s important that you speak up and don’t simply push through your own pain in order to prioritize their pleasure.
Build Up to Sex
For anyone with a vulva, it’s recommended that we experience a minimum of 20-40 minutes of arousal before penetration. This gives us plenty of time for blood to flow to our vulva, allowing our erectile tissue (yes we have it, too!) of the vulva and internal structure of the clitoris to engorge, along with our natural lubrication to take place.
When we rush sex, our vaginal canal isn’t ready and penetration can be painful for anyone, even those without conditions like endo. It’s so important to take the time to build up your state of arousal prior to any kind of penetrative sex - be that fingers, toys, or a penis.
Try Different Positions
Depending on where your endo is, you might find that some sex positions aggravate it more and some don’t at all. So, get experimenting and take note of the positions that feel good, and the certain angles that hurt so you know what to avoid and communicate this with your partner. It can also be worthwhile noting the angles and places where you feel pain or pressure and trying to find these spots when you do your internal massage. Mention them to your Pelvic Floor Physio too, as they’ll be able to share more in-depth with you what could be contributing and what to do.
Sex is always better with lube. Often, people with endo experience pain due to friction and vaginal dryness, so lube is your best friend. Oh La La Love Lube is a natural, water-based option that feels like the real thing. Have a bottle on your bedside at all times and apply generously - both for solo and partnered sex.
Often during sex with a partner, we can experience pain upon deep penetration. Perhaps penetration feels okay - up until a point. Then, because we start to anticipate pain, we can often tense up, prepared to pull ourselves away or push our partner back before they hit that one painful spot. It’s no fun and can really take you out of the moment, lessening any pleasure you may have been having.
A specially designed tool to help control the depth of penetration is Oh Nut. This is a set of silicone rings that fit around the base of a penis, strap-on, or dildo that controls how deep you are penetrated. Such a wonderful idea that prioritises pleasure for both partners, while minimising pain for you.
Explore with CBD
CBD Oil is known to help reduce inflammation, and some people have had positive results from using CBD products for their pain. When it comes to sex, you can try using a CBD pessary which you insert vaginally that localises the healing and muscle relaxing properties of CBD into the pelvic region. *Note, its best to consult a doctor if you want to explore the use of CBD.
Many people who experience painful sex as a result of endometriosis report their pain starts post initial orgasm. Suppose you also feel pain after an O. In that case, I suggest taking some time away from penetration and to other forms of sex to give your vaginal muscles some time to relax again before attempting penetration again.
Often when we keep going right after orgasm, our vaginal muscles have already tightened as a result of the orgasm - which is essentially an involuntary muscle contraction - and it goes into spasm and can feel like it’s locked up. This results in a raw, stingy, or sandpaper-like feeling. Take a break and come back for more later.
If penetrative vaginal sex is a solid ‘no’ for you - don’t forget that sex is so much more than penetration. Explore with clit play, edging, nipple orgasms, sex toys, anal, a steamy make-out sesh, or oral sex. Don’t limit your sex life as a result of painful sex instead look for the opportunities to try sex in a different way.