Here's the real deal...
Nearly 3 out of 4 vagina-bearing people have pain during sex at some point in their lives. For some, the pain is only temporary (and can be related to where you are in your cycle!) but for others, it is a long-term issue. Endometriosis is a common cause and affects 1 in every 10 people with a uterus. That’s a lot of people!
I’VE HEARD OF THAT! BUT WHAT EXACTLY IS ENDOMETRIOSIS?
Endometriosis is a condition in which the inside lining of the uterus (aka endometrium) grows outside of the uterus and attaches onto other organs like the ovaries, bladder, and bowels. This external lining can’t be shed with a period so it creates lesions(1) or nodules, causing chronic pelvic pain, among other super fun symptoms. Endometriosis lesions could be superficial or deep. It’s important to ask your doctor where your lesions are located and at what level to understand the effects.
WHY DOES ENDOMETRIOSIS MAKE SEX SO DIFFICULT?
Penetration can hurt those with endometriosis depending on where the lesions live and how deep. Areas like behind the vagina or on the lower uterus can be sensitive. Positions in which a “foreign object” penetrates straight up towards the cervix can aggravate these areas, like being on top. Penetration or friction including digital stimulation or skin to skin movement around an open lesion should be avoided for the most part, says Pelvic DPT Casie Danenhauer. Our intact skin serves as a barrier between our insides, our environment, and any bacteria that may be present in the area. Lesions are breakdowns in skin integrity, small tears where the skin is not able to do its job, so yes, the infection risk is higher than with intact skin. Bleeding may occur if a lesion is made wider or larger with stretching or friction. It is always helpful for the patient and any partners to know where the lesions are, how severe they are, and if there are any changes to the skin integrity that might put both partners at risk.
Taking a deeper dive into the pelvis (#wegotpuns), all organs, muscles, blood vessels, and nerves are protected by something called fascia.(2) Fascia is living tissue that surrounds and connects every bone, muscle, organ, and nerve ending in the body. Fascia is meant to slide and glide as you move. Injury and/or surgery can cause fascia to dry and shrink.
If you’ve had surgery from endometriosis, scar tissue (aka adhesions)(3) can develop on the fascia like cobwebs, which worsens symptoms. If the muscles and fascia don’t have fresh oxygen and nutrients, they’re hyper-sensitized which sends pain signals to the brain… this means that movement is key.
WHAT ARE SOME WAYS TO MAKE SEX MORE ENJOYABLE WITH ENDO?
Lube. It. Up
If you experience vaginal dryness from endo treatments like hormones, hysterectomy, or other medications… then lube is your best friend. Scan the ingredients for your intimates like you would food, it gets absorbed into your body after all.
Cannabis infused lubes can also be helpful as the cannabinoids found in cannabis, THC and CBD(4), have proven to lower chronic pain levels because they interact with the two main cannabinoid receptors (CB1 and CB2) of the endocannabinoid(5) system in the body, which is concentrated in the brain, nervous system, and reproductive organs.
Loosen it up
Our vaginal muscles can get real tight (and contrary to the whole “tight pussy” thing, it’s not a good thing!). To loosen muscles and fascia as a “warmup,” consider the following Myofascial release technique used in Pelvic Floor Therapy,(6) which is like a massage for your vagina. The idea is to understand your trigger points and stretch with the discomfort, but never push through pain (it’s important to know the difference).
Use your pointer finger or a pelvic wand and move it slowly around the inside of your pelvis in a clockwise motion. You can invite your partner to “coach” this exercise using their finger and allow them to study every angle up close. When you find a tight spot, hold light to medium pressure for 20 seconds and you’ll feel it loosen.
Remember (both of you!) to breathe, stay present, and communicate what you’re feeling, especially if it becomes painful. For added pleasure, use the thumb or toy to rub your clitoris simultaneously. You can relax by placing a pillow underneath your hips, lightly grazing your body and your partners’, putting on soft music, and lighting candles. Or how about trying this in the bath?
Foreplay and positions matter
Self-stimulation and/or some tongue action is a surefire move to get your juices flowing and your pain melting.
Some positions that avoid deep penetration include spooning or lying on your stomach with a pillow under your hips. If you love being on top, try lying flat instead of sitting up.
Remember: penetration isn’t the only way and orgasm isn’t required. So long as you enjoy your vagina for a moment!
By: Gretchen Decker, Endo Expert
(1) Henderson, Wendy. “12 Common Places Where Endometriosis Lesions Can Be Found.” Endometriosis News, Endometriosis News, 26 Oct. 2017, endometriosisnews.com/2017/10/26/common-places-endometriosis-lesions-can-found/.
(2) Deimler, Aubree. “The Role of Fascia with Endo & Chronic Pain.” Peace With Endo, 6 Oct. 2017, peacewithendo.com/2017/10/role-fascia-endo-chronic-pain.html.
(3) Hummelshoj, Lone. “Adhesions « Endometriosis.org.” Endometriosis.org, 2018, endometriosis.org/endometriosis/adhesions/.
(4) Echo, E. “What Is CBD?.” ECHO Connection, 26 May 2017, echoconnection.org/what-is-cbd/.
(5) Echo, E. “An Overview of the Endocannabinoid System.” ECHO Connection, 17 Jan. 2017, echoconnection.org/the-endocannabinoid-system/.
(6) Wakefield, Leslie. “Physical Therapy for Endometriosis Adhesions and Symptoms.” Hormones Matter, 14 July 2014, www.hormonesmatter.com/physical-therapy-endometriosis-adhesions-symptoms/.