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If you work with women, you have probably met patients coping with endometriosis, one of the most common female health issues. According to the American College of Obstetricians and Gynecologists, endometriosis occurs in about 10% of women of reproductive age. Because of the pain and discomfort involved, endometriosis can interfere with all aspects of a woman’s life. Today, we’ll talk a bit about how endometriosis affects a woman sexually.

Endometriosis – Some Basics

Endometriosis involves the endometrium – the lining of the uterus. Women with endometriosis have this tissue outside of the uterus as well. It might be found on the ovaries, Fallopian tubes, or peritoneum. It can also develop on the bladder, ureters, and rectum.

Even though the tissue is outside the uterus, it still responds to changes in estrogen, especially around the time of a woman’s menstrual period. This can cause the affected areas to become inflamed, swell, bleed. The tissue can grow to eventually cover the ovaries or block the Fallopian tubes. Some women develop cysts, scar tissue, and adhesions.

The most common symptom of endometriosis is pain in the pelvis, abdomen, and lower back. Pain may become worse during menstrual periods, bowel movements or urination. Sex can also be painful.

Depending on the severity, endometriosis may be treated with medications, hormonal therapy, or surgery. Some women with endometriosis become infertile.

Endometriosis and Sex

There are many ways endometriosis can interfere with sex. Most stem from pain and emotional/psychological issues.

  • Pain. A woman with endometriosis may experience severe pain during intercourse. This pain may be caused by pressure on the pelvis, penetration, or thrusting during intercourse. Anticipating pain can make the situation worse. Knowing that sex could be painful can make a woman tense. Because she can’t relax and enjoy herself, the pain intensifies. Women may find relief by trying different sexual positions or finding other ways to be intimate with their partner, such as kissing, cuddling, and caressing. Women may also time sex around their menstrual periods. It might be more comfortable to have sex when the growths are less likely to be inflamed.
  • Emotional/psychological issues. Endometriosis can affect a woman emotionally and psychologically, too. In turn, such issues can cause problems in the bedroom and in a relationship. Constant pain can be exhausting and fatigue can make a woman lose interest in sex. She might feel anxious about how endometriosis is affecting her day-to-day life. For example, if she has had to miss work because of the pain, she might feel stressed about her job and income. Not surprisingly, depression is common in women with endometriosis. They may feel that the pain will never go away and worry that life will never get back to normal. A woman may also worry about how her endometriosis is affecting her relationship. She may feel insecure about sexually pleasing her partner or guilty about the changes in their sex life. Many couples aren’t comfortable discussing sex, leading them to drift apart. In these cases, counseling is often suggested. A mental health professional can help a woman cope with depression and anxiety. With therapy, couples can learn how to communicate with each other and repair their relationship, if necessary. A sex therapist may be able to suggest changes to the couple’s sexual routine to make intimacy more comfortable and enjoyable.

If you have a patient or client struggling with endometriosis, talk with her about how she’s managing it. What treatments has she tried? Are they effective? Is her sex life or relationship suffering? If so, would it help for her to see a sexual healthcare provider? Might she benefit from a support group?

It’s not easy coping with a chronic condition like endometriosis. Being aware of the physical, emotional, and sexual implications of endometriosis can help clinicians understand the challenges of their female patients affected by it.

Print this article or view it as a PDF file here: Professional Audience Announcement – Endometriosis


The American College of Obstetricians and Gynecologists


(October 2012)

Davis, Julie

“Why Sex Hurts With Endometriosis”

(Last updated: May 21, 2010)

The Journal of Sexual Medicine

Montanari, Giulia, MD, et al.

“Women with Deep Infiltrating Endometriosis: Sexual Satisfaction, Desire, Orgasm, and Pelvic Problem Interference with Sex”

(Full-text. First published online: April 3, 2013)

“Endometriosis Fact Sheet”

(Last updated: July 16, 2012)