Endometriosis, PCOS, PMDD, Adenomyosis — she’s complicated.
One minute you’re feeling sexy and spontaneous, the next… you’re curled up in a ball, dodging intimacy like it’s your ex’s texts. Hormonal and reproductive health conditions can shake up your love life — physically, emotionally, and mentally. If you’re dealing with any of the above, you're not alone.
In this post, we’re deep diving into how endometriosis affects intimacy, but many of these challenges (and tips!) apply to folks with PCOS, PMDD and Adenomyosis too. Because pain, fatigue, hormonal chaos and emotional overwhelm don’t exactly scream “let’s get it on”.
How Does Endometriosis Affect Intimacy?
Let’s rip off the band-aid. Endo isn’t just about painful periods. It’s about pelvic pain that can hit during or after sex (yep, that’s called dyspareunia) — and for up to 50% of people with endometriosis, it’s a reality¹⁺². We're talking pain that can feel deep, sharp, cramping, or like someone lit a bonfire in your uterus.
Why? Endometriosis causes endometrial-like tissue to grow where it shouldn’t. This can lead to inflammation, scarring, and adhesions, especially in areas like the cul-de-sac behind the uterus. When penetration hits that zone, ouch.
And here’s the thing: it’s not just physical. Endo can impact your confidence, your mental health, and your emotional connection with your partner³. It can feel like a third wheel in the bedroom. And not the fun kind.
Can Sex Make Endometriosis Pain Worse?
Short answer? Yes⁴. For many in the Hey Sister! community, sex doesn’t just hurt — it can set off a chain reaction of increased inflammation and lingering pain that lasts hours or even days.
But that doesn’t mean sex is off the table. It just means we need to rewrite the script. Think of it like finding a new rhythm, not giving up the dance.
8 Ways to Reclaim Intimacy with Endo
Let’s be real. Sex might look a little different when endometriosis is involved—but it doesn’t have to disappear.
1. Communication is sexy.
The hottest thing in bed? Honesty. Let your partner know what hurts, what helps, and what you need to feel safe and turned on. Vulnerability creates connection, and less tension means less pain.
2. Find your Goldilocks position.
Some positions (like you on top or spooning) give you the power to control depth and pressure. Translation: more pleasure, less pain.
3. Lube it up – but choose wisely.
Did you know most lubes can totally wreck your vaginal microbiome?
Yep. That silky-smooth glide can come at a cost. Many mainstream lubes are packed with ingredients like glycerin, petrochemicals, parabens, and even sugar (seriously?)—and they can throw off your pH, irritate your tissues, and kill off the good bacteria that keep your vaginal ecosystem happy. Cue yeast infections, BV, and the whole "why is my vagina mad at me?" vibe.
And condoms? They’re not always innocent either.
Some condoms come coated in spermicides or flavoured lubes that are just as disruptive. Add in latex sensitivities and you’ve got a recipe for irritation—not intimacy.
So what helps?
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Look for a water-based, pH-balanced, fragrance-free lube with gentle, microbiome-safe ingredients.
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Choose non-latex condoms if you’re sensitive, and skip anything with extra coatings unless you really know what’s in them.
Treat your vagina with the same care you’d give your face, because honestly, it is just as sensitive.
4. Don’t skip foreplay.
Longer foreplay = more arousal = more blood flow and lubrication = a happier pelvic floor.
5. Time it right.
Try being intimate when your pain is at its lowest, mid-cycle for many. If your body’s giving you a green light, go for it.
6. Book a date with your pelvic floor physio.
Yep, they’re a thing, and they’re brilliant. They can help with muscle tension, alignment, and breathing techniques that reduce pain during sex.
7. Try mindfulness or gentle yoga.
Stress and tension can amp up pain. Calming your nervous system can make sex more enjoyable.
8. Don’t be afraid to redefine ‘sex’.
Who says intimacy = penetration? Massage, mutual pleasure, oral sex, or cuddling can all build closeness and feel amazing.
P.S. You don’t have to tick just one diagnosis box.
Many of our community are living with more than one of these conditions. Endo and adenomyosis often go hand in hand. PCOS can bring pain, mood swings and hormonal dips that also affect your sex life. PMDD? She’ll ghost your libido for half the month and bring it back with a vengeance. So if your experience doesn’t fit into one tidy category – that’s valid.
Don’t Go It Alone: When to Get Professional Help
If sex feels scary or painful more often than not, it’s time to call in backup. A gynaecologist can help with medical options, a pelvic physio can help with muscle tension, and a sex therapist can guide you through emotional blocks and communication challenges. Endo is real—but so is support.
The Heart of It All? You Deserve Joy.
We see you. Navigating sex and relationships with endometriosis isn’t always easy. It takes patience, courage, and a sense of humour when things get weird (because let’s be honest, they will). But you deserve joy. You deserve intimacy that makes you feel safe, seen, and satisfied. And you deserve to own your pleasure—on your terms.
Keep experimenting. Keep talking. Keep asking for what you need. The best kind of intimacy starts with you.
References
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Ferrero, S., Abbamonte, L.H., Giordano, M., Ragni, N., & Remorgida, V. (2005). "Deep dyspareunia and sex life in women with endometriosis." Fertility and Sterility, 83(3), 573–579. https://doi.org/10.1016/j.fertnstert.2004.08.031¹
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Vercellini, P., Fedele, L., Aimi, G., Pietropaolo, G., Consonni, D., & Crosignani, P.G. (2006). "Association between endometriosis stage, lesion type, patient characteristics and severity of pelvic pain symptoms: a multivariate analysis of over 1000 women." Human Reproduction, 22(1), 266–271. https://doi.org/10.1093/humrep/del339²
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Pluchino, N., Wenger, J.M., Petignat, P., Tal, R., Bolmont, M., Taylor, H.S., & Genazzani, A.R. (2016). "Sexual function in endometriosis patients and their partners: Effect of the disease and consequences of treatment." Human Reproduction Update, 22(6), 762–774. https://doi.org/10.1093/humupd/dmw031³
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Mayo Clinic Press. "Endometriosis and a healthy sex life: Is it possible?" Retrieved 2023 from https://mcpress.mayoclinic.org/women-health/endometriosis-and-healthy-sex-life/⁴
