By Molly Kavanagh
Endometriosis sucks. It’s a chronic illness where the tissue that lines a person’s uterus, called the endometrium, doesn’t shed completely during a person’s menstrual cycle. Instead of exiting the body via the vagina as it’s supposed to, it sheds and grows and attaches itself to the surrounding pelvic organs, including your ovaries, bladder, and bowel. It’s believed that one in ten people with a uterus suffer from endometriosis, but this number is probably a lot higher considering that it’s a condition that is very difficult to diagnose, and one that is often overlooked by healthcare professionals and researchers. There is no cure, and the only treatment is an expensive and invasive laparoscopic surgery that only provides temporary relief.
Endometriosis is different for everybody. Some people with endometriosis can go their entire lives without even knowing they have it because their symptoms are so mild, while other people writhe in pain on their bathroom floor every month groaning like a wounded animal while yearning for death. Some are in pain every single day, not just during their menstrual cycle. Endometriosis can also mean infertility or difficulties conceiving, while for others it doesn’t (the fact that endometriosis can also be hereditary is a testament to its inconsistent nature).
For me, endometriosis means a lot of things. It means extreme bloating during my period, which in turn constantly pinches a nerve in my right leg and makes it really difficult to walk. It also means hot flashes, lots of vomiting, and extremely heavy bleeding that occasionally causes me to faint. It means a horrible, sharp pain that shoots down my lower back and chronic fatigue during the days leading up to my period, and during the five to seven days of my period. One time, during a particularly stressful period of college, I had an endometriosis flare-up that lasted twenty-eight days. Can you imagine? Bleeding out of your vagina for twenty-eight days straight? Because I can. And then there are the rare occasions where I go three or four months without bleeding at all, meaning every time my period is late I have to assure a cycling cast of worried sexual partners that it’s fine, I promise I’m not pregnant (trust me, I checked), this is just something that happens sometimes.
The most challenging symptom of endometriosis that I experience is pain during intercourse. Sex is very difficult for me, and I tend to steer away from one-night stands because I find it tedious and uncomfortable to give random strangers a complete rundown of my pelvic health history while we’re trying to do the deed. But having endometriosis doesn’t have to be a death sentence where your sex life is concerned – there are a lot of things you can do to make sex less painful for you, whether you have endometriosis or struggle with pain during sex for any other myriad of reasons.
Use lube, and lots of it: The first time my boyfriend and I used lube, it was an absolute game-changer. For people with endometriosis, it’s normal for the vagina to feel abnormally tight or for natural lubrication through foreplay to be more difficult. I also found it incredibly hard to relax when having sex because I was nervous and would be anticipating the pain and bracing myself for it, so that anxiety and hesitancy played a huge role in vaginal tightness. While lube doesn’t eliminate the pain entirely, particularly if that pain is caused primarily by the male partner thrusting too deeply, it nonetheless makes the experience a lot more comfortable and it’s often an important first step towards finding a method of having sex that works for you. Once you’ve figured out the penetration part, the rest comes relatively easily. If you don’t have any lube, or you don’t find it’s working for you, something that I’ve done in the past is take a hot shower and perform some deep breathing exercises before sex in order to help myself physically relax.
Experiment with different positions: As a person with endometriosis, the missionary position is my absolute worst enemy. It hurts. So. Much. The reason missionary is universally hated by the endometriosis community is because of how your uterus is tilted during it – which is to say, it’s not titled at all. You should try to avoid lying flat on your back – try placing a couple of pillows under your hips and propping your legs on your partner’s shoulders so your uterus is at more of a downward angle. This works really well if you’re not a fan of going on top, which is another great way to have sex if doing so is typically painful for you. When you’re on top, you can control how deep or how shallow the penetration is, meaning you can find the exact point at which penetration becomes painful for you and plan accordingly. Similarly, other positions that I’ve been told are good for those who experience painful sex are face to face, spooning, and doggy style.
Communicate with your partner: Having a conversation about vaginal health with a potential sexual partner doesn’t sound pleasant, and yeah, it’s admittedly a little awkward, but you’re never going to have a mutually enjoyable experience if you don’t openly communicate what your needs are. In my experience, every man I’ve had sex with has been surprisingly understanding and even excited to experiment with the different positions – and if any man doesn’t respond with patience and kindness, then I know they’re not the type of person I want to have sex with or date anyway, so it’s basically a win-win either way.
Teach your partner where the clitoris is: A lot of people with endometriosis can not reach orgasm through vaginal penetration alone, but that’s not an issue exclusive to us. In a book written by Elisabeth Lloyd, The Case of the Female Orgasm: Bias in Science of Evolution, published by Harvard University Press in 2006, it’s revealed that approximately half of all women sometimes have orgasms during vaginal sex, while twenty-percent rarely have orgasms during vaginal sex, while five-percent of women never have orgasms during vaginal sex. So, this piece of advice goes out to everybody with a vagina, not just endometriosis sufferers: teach your partner where the clitoris is. Engage in oral sex, experiment with sex toys, extend your use of foreplay – do whatever is most pleasurable, and assert your sexual needs! Sex isn’t meant to only benefit men – if that was true, then why would the clitoris have 8,000 nerve endings while the penis only has 4,000, in addition to being the only human organ that has no purpose other than to provide sexual pleasure?
Engage in mutual masturbation: Although it might sound a little weird to those who haven’t tried it, masturbating with your partner is a very intimate activity that is mutually satisfying for you both. It just means laying down in bed and masturbating beside each other, and since both you and your partner know your own bodies better than anybody else does, it often works quite well. It also circumvents the possibility of any tension or frustration arising if your partner finds that they can’t make you orgasm themselves, while also making it so the two of you can still bond and be intimate with each other.
Experiencing pain during sex isn’t merely an inconvenience, and desiring a healthy and active sex life isn’t ‘shallow’ or superficial. It would be reductive and an outright lie to say that sexual activity and intimacy aren’t or shouldn’t be an important factor in a relationship between two consenting adults who want to fulfill their sexual needs. Sexual difficulties can put an enormous amount of strain on an otherwise healthy relationship, and being unable to engage in the casual, spontaneous hookup culture of college can be alienating and embarrassing. And when you feel as if you can’t be intimate with the person you love in a way that satisfies you both, it’s normal to feel ashamed or insecure, or even a little guilty, or as if you’re ‘broken’ (even though none of us should have to feel this way). An open dialogue on how common it is to experience pain during sex is an important first step towards eliminating the stigma towards those of us who sometimes need to plan for sexual activity in advance. Trying to have sex with endometriosis is hard. It’s frustrating, it’s exhausting, and it can be a lot of work. But having a healthy sex life while simultaneously experiencing pain during sex is by no means impossible – you just need to get a little creative.