Sex and Endometriosis: A Post-Op Guide

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If you are suffering from, or have recently been diagnosed with Endometriosis, an autoimmune disease causing endothelial cells to appear outside of the uterus resulting pain and fertility issues –sex can seem challenging to say the least. There are countless articles that discuss fertility after an endo diagnosis but little, explicit literature has been written on sex after endometriosis.

I think it’s important to note that most of the time women who suffer from endometriosis are having successful, fulfilling sex; but after major operations or flare-ups, knowing how to approach sex with endo is vital.

Let me start by telling you about my personal experience with endometriosis:

In late December 2014, I was rushed into the emergency room after experiencing excruciating pain in my lower left quadrant of my abdomen. After an ultrasound, I was admitted into the hospital after the tech found my right ovary had grown to a whopping 9 cm in diameter (roughly the size of a softball) making it larger than my uterus. Additional cysts were found in my uterus and I was scheduled for emergency surgery the same night.

After everything was said a done, my surgeon removed my enormous right ovary and all existing cysts within my uterus. Parts of my right and left Fallopian tubes were removed as well. Needless to say, after a never-ending, post-endo period and minimum two week “pelvic rest” order from my obstetrician, I was in bad shape. Hormonally, I was a wreck (still am) and sex still seemed alien at this point.


Do not think that enjoyable sex goes out the window just because endometriosis rears its ugly head at you. Instead, think of it as a time to re-visit your sexuality and explore the new parameters of satisfaction.

Even after my mandatory two-week “pelvic-rest” period, sex was a challenge. Just feeling like having sex was a challenge. I am currently in a committed relationship and managing sex after an endometriosis diagnosis/emergency operation was not easy. Physical restraints were an obvious factor, but I think my real struggle has been managing my hormones and consequent mood swings. I feel like a pre-menopausal teenager: riddled with acne, intensely emotional and sweaty as hell from regular hot flashes. Now, I am faced with reincorporating painless sex back into my life.

Understand that all sex before my official endo diagnosis was technically sex with endo. Endometriosis is an autoimmune disease that affects anywhere from 10-15% of women. Likely, there are more women affected but under-diagnosed due to expensive and invasive procedures it takes to verify a diagnosis. After a woman’s first menses, endometriosis builds upon itself year after year. Endometriosis takes up to an average of seven years before a woman is correctly diagnosed.

If you experience regular pain after intercourse, visit your OB-GYN. Cervical pain or cramping after sex and light spotting (regularly) is telltale sign of endometriosis, along side excruciating pain during menses that can interfere with your ability to perform daily tasks. Severe menstrual or post-sex pain is not normal. Women suffer from endometriosis, sometimes without knowing it because of their impressive pain thresholds. Understand that you do not have to live life in constant pain. Make an appointment with your OB-GYN stat.

How to Sex on Endo:

  • Communication & boundaries

Before you saddle up, be sure to verbally communicate with your partner about what you are able to physically achieve, without hurting yourself. Try to look at as a new chapter of sexual exploration within your relationship(s), post-op. If you prefer being on top, you might have to cut back because it can trigger cervical pain. Doggy style is another position great for the female orgasm, but after surgery it became too much to handle… if you get my drift. You can still have mind blowing sex, but first you have to break away from the usual. Go buy a book on sex, google new sex positions. Make out before/during/after sex for once.

  • Medicate

Pre-sexy time, take some IB Profen to reduce inflammation, post-sexy time. I prefer to use cannabis for pain-management/treatment of endometriosis. Cannabis capsules, raw organic cannabis oil or a small dose of an edible takes the edge off. If you’re going to do the sex and suffer from endo, be an adult about it. Self care first!

  • There will be blood

Forever bleeding. Please remember to make sure you are getting plenty of iron post-surgery, due to blood loss. Sex will be bloody and say goodbye to those white or adorable, pastel-colored underwear. My advice: invest in dark panties only and don’t worry, your crimson crotch is normal. Your body is trying to regulate itself and it is normal to take up to six months before a woman fully adjusts (that is straight out of my doctors mouth). Depending on how intensive the bleeding is post-romp, contact your OB-GYN is bleeding is heavy and persists over three hours.

  • Foreplay & lube are (always) your best friends

Vaginal dryness. Not something I thought I was would experience in my twenties. Learning to sex up my body post-op is still a work in process. I highly advise plenty of foreplay before vaginal sex (DUH). Lube never hurts either. Oral (cunnilingus) is a solid, painless way to achieve orgasm without pain. Vaginally intercourse can prove to be particularly difficult due to a tender cervix/retrograde menstruation. Make sure to take it slow and communicate regularly. Try sixty-nine, the position that never stops giving. Ride his or her face.

  • Hetero? You Might Need A Condom

The European Journal of Obstetrics & Gynecology and Reproductive Biology released a study and found seminal plasma increased the growth of endometriosis in women, sometimes by three-fold. Yes ladies, you heard me right. Semen induced flare-ups can be a real thing. If you are in a heteronormative relationship and do not use condoms for protection, you might reconsider if dealing with a particularly bad flare-up . Scientists have suggested that semen can trigger endometriosis by causing an inflammatory response, post-romp. Understand that this study was small and more research must be done, but if you are experiencing a flare-up try using a condom to lessen painful after affects.

  • Positions

Again, honor yourself and do not push pelvic boundaries. Positions to avoid or ease into are woman on top such as ‘reverse cowgirl’ or variations of ‘doggy style’. My explanation: jabbing your lady parts vertically does not feel as satisfying post-operation. Depending on your cervical anatomy, most positions from the back tend to leave a woman’s cervix more vulnerable than traditional missionary positions. Constant verbal communication is a must. Sex with endo does not equate to a boring sex life. Accept the challenge and consciously spicy up your sex life post-endo with plenty of love and intimacy, while honoring your body.

  • State of mind is everything

Do not think that enjoyable sex goes out the window just because endometriosis rears its ugly head at you. Instead, think of it as a time to re-visit your sexuality and explore the new parameters of satisfaction. You are forced to listen to your body and understand what it needs from you or a sexual partner.

Understand, this is my personal experience. Despite all of the pain, I gained a sensitivity that has allowed me to critique and better my sex life, post-endo diagnosis. It was not easy at first. Both myself and my partner heavily relied on heavy communication during sex to make sure I was comfortable throughout the process.

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Feature image: Giulia Ciappa via Wikipedia