Painful intercourse

by Ellen Johnson and Lone Hummelshoj

Pain during or after sexual intercourse is a common symptom for women with endometriosis.

Unfortunately, all too often it causes couples immense emotional pain and turmoil. Some of this can be avoided with an understanding of the problem, better communication, and a little experimentation.

Up to 50% of women with endometriosis complain of painful intercourse

The pain of painful intercourse has been described as sharp, stabbing, jabbing or a deep ache for the woman. It ranges in intensity from mild to excruciating. It may be felt during intercourse, for up to 24–48 hours after intercourse, or both.

Some women experience pain with any form of intercourse, but others experience it only with deep penetration.

Some women feel pain only at certain times of the month, such as around the time of the period, while others feel it throughout the month.

That’s the challenge with women with endometriosis:
our disease is not predictable!

Painful intercourse (dyspareunia)

Painful intercourse is usually caused by stretching and pulling of endometrial implants and nodules located behind the vagina and lower uterus. Sometimes, it is caused by vaginal dryness as a result of hormonal treatment or a hysterectomy in which the ovaries have been removed.

Dealing with pain during intercourse

Dealing with painful intercourse can be a difficult and emotional task. It needs open and honest communication between you and your partner. It also needs both of you to be patient and understanding towards each other. In particular, you need to develop an awareness of each other’s predicament and feelings. Without these efforts, dealing with the problem can quickly degenerate into an emotional battlefield.

Communicate – it is difficult but essential

As a woman with endometriosis you need to explain to your partner the nature of your pain, and how it affects you, physically and emotionally.

You also need to talk about such things as:

• your need to love and be loved
• your fear of intercourse
• your fear of intimacy that may lead to intercourse
• your guilt about not being able to have intercourse
• your guilt about letting your partner down
• your fear of losing the relationship to someone else, and
• your fear that your unwillingness to have intercourse will be interpreted as a sign of rejection.

At the same time your partner needs to talk about such things as his/her need to love and be loved, frustrations at not being able to have intercourse with you, fear of hurting you, frustration at your emotional withdrawal during times of intimacy, and fear of being rejected.

Once you have discussed and resolved some of these issues, you will have the foundations for moving on and finding ways of resolving the problem.

Sex therapists may also be able to help you with this.

Experiment – and check out the time of the month…

With a little experimenting, you may be able to find ways or times when you can have intercourse. If appropriate, try experimenting with different positions.

Some women are able to enjoy intercourse if it is shallow, or if slow and gentle penetration is used. You may like to try experimenting with foreplay and artificial lubricants. Some women are able have pleasurable intercourse if there is plenty of foreplay to stimulate the natural lubricants in the vagina or if a lubricant such as KY Jelly is used.

Similarly, it may be appropriate to try experimenting with the timing of intercourse. Some women find that intercourse is pleasurable at certain times of the month, such as in the week after ovulating or in the two week period after having a period. If you can identify the times when intercourse is pain-free, make that time of the month a special time to enjoy intimacy together.

Keep talking…

If you experience pain during intercourse, it is important to tell your partner immediately, so he can stop. Trying to conceal the pain will usually result in you unconsciously withdrawing from him, which may be perceived as rejection. Even though it isn’t.

In the long term, it may lead to hesitation on your part regarding any intercourse, which will place unnecessary stress on the relationship. It is better to be open and honest at the time, so you and your partner can learn which situations create pain. That way you can learn which situations to avoid, so you can both have pleasurable and satisfying intimacy together.

Find alternatives

Even with the most patient and sensitive experimentation, some women will not be able to experience pain-free intercourse because of their endometriosis. If this is the case, you need to experiment to find other ways of sharing intimacy and lovemaking — after all, intercourse is not the only way of being intimate!

Lying in bed together, kissing, hugging, holding, stroking, massaging, and mutually masturbating can be as just pleasurable as intercourse if you want it to be.

See also

→ Lone Hummelshoj’s talk on “Sex and endometriosis …perhaps not in the morning”
→ Marta Meana’s talk on “Painful intercourse …taking sex seriously“

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