10 Strategies for Painful Sex with Endometriosis

I wanted to do an episode on the back of my 9 Root Causes of Painful Sex with Endometriosis episode, as I talk about bloating, bladder pain, brain fog and fatigue a lot, but I haven’t covered painful sex much lately. 

This episode contains a range of strategies, some long-term, some more short-term and this list certainly isn’t exhaustive. Many of the changes you make to improve your endometriosis in general, such as healing the gut, are not covered here but will certainly make a difference to the pain you feel during sex.

You don’t have to try all of these and you certainly don’t have to try them all at the same time, but see which ones resonate for you.

TRIGGER WARNING: This podcast contains brief references to sexual trauma. 

Reduce chronic inflammation - Nutrition is one of the most effective ways to reduce inflammation. Foods that cause inflammation include sugar, alcohol, trans fats, processed conventional meats, processed foods and for some; gluten, dairy and caffeine, as well as other foods groups you may personally be sensitive to, even if they seem healthy (eggs, nightshades, etc.).

A four-week elimination diet is one of the best ways to identify what personally inflames your body and causes irritation. You remove certain foods for this period of time and then return them to your diet one by one and look for symptoms. This is best done with the support of a health practitioner or at least following a protocol from a patient book or course.

If a full-on elimination diet feels daunting of triggering to you, a smaller version where you just remove some of the key inflammatories like sugar, may be more doable.

Regardless of your choice, filling your diet with anti-inflammatory foods will be incredibly beneficial - aiming for 8 servings of veggies, 2 portions of fruit, healthy fats, organic clean proteins and gluten free wholegrains (as long as you’re not sensitive to them).

Balancing blood sugar is also key to lowering inflammation. Some of the basics of balancing blood sugar are keeping refined carbs and simple sugars to special occasions and ensuring you have a plate ratio of 50% low starch veggies, 25% protein and the final 25% split between healthy fats and complex carbohydrates.

Pelvic floor physiotherapy - Arguably one of the most important when it comes to healing painful sex!

Pelvic floor physiotherapy can release the tension and tightness in the muscles and ease nerve sensitivity in the area, as well as relaxing the vaginal canal. You want to look for a pelvic floor physio specifically - not just any physio - and one who is familiar with endo and pelvic pain conditions.

Don’t worry, they won’t go internal straight away if you’re uncomfortable, but if you’re willing, they’ll do an internal examination in the first session to identify what’s happening. If not, they’ll work externally to reduce your pain until you feel ready for an external examination.

If you can’t afford a physiotherapist, there are courses, free videos and paid for videos which are all incredible resources and are linked below.

The Ohnut - The Ohnut is a wearable non-toxic rubber-like ring which stacks on to the penis or whatever form of penetration you’re using and allows you to control penetration depth. The tool comes with several rings so you can customise depth to your comfort.

The tool was designed by Emily Sauer who has suffered with painful sex for years and designed the product in her kitchen! 

It has changed the sex lives of countless people with painful sex and partners enjoy it too!

Swap perfumed and toxic products for non-toxic, vagina friendly products (and get some lube!) - Did you know that the chemicals and perfumes found in everyday body products can cause reproductive health issues, fertility problems and hormonal imbalances, and have been directly linked to endometriosis? These products can also irritate the skin and inflame the sensitive vaginal area, which is made of very absorbent tissue.

Instead, try swapping to organic and non-toxic based products that are perfume free and suitable for the vagina and sensitive skin, especially focus on your period products, wipes if you use them, body wash and most definitely, lubricant! 

I’ve linked to some of my favourite products below.

Don’t rush and jump into penetration before you’re ready - If your body isn’t ready for sex and well lubricated, whether naturally or with lubricant, the friction of sex may cause tiny tears in the vaginal wall, leading to irritation, swelling and inflammation.

Equally, if you’re not ready your vagina may not be open and relaxed enough, and therefore may more easily tense up and experience pain upon penetration.

Help your brain to feel safe - This isn’t something you have to do during or before sex, but more generally on a daily basis, is to help the brain feel safe by flooding it with safety signals. When we have an upregulated nervous system, it can be hard to tell the brain to quiet those danger signals, so the aim is to calm the brain down by reassuring it with safety signals instead. We want to train the brain to move out of flight or fight and spend more time in the rest and digest mode, by repeatedly lowering cortisol.

Proven methods of lowering cortisol include connecting with your own support network, walking in nature, yoga, breathwork and meditation.

Self-massage (potentially using a yoni wand) - You can use self-massage to identify your pain points (known as triggers) in your vaginal canal and use massage to ease tension and release these tighter areas.

If you’re not comfortable with using your hands, you could use a tool called a yoni wand, which you can insert into the vagina and move in a clockwise manner to ‘map’ the pain points within your vagina, and then carefully use massage to release these. This is best done following instructions, which I’ve linked to below in the show notes.

Identify and work on tensions in your relationship - Do you feel comfortable in your relationship? Do you feel pressured or guilty about sex, or have you not really been able to share how you feel during sex? Does your partner not support you around endo, or are there other tensions unrelated to endo that need to be addressed?

This is an area that can take a long time to work on and explore but can make a huge difference. If there are tensions in your relationship, this will put your brain in flight or fight mode and signal to your body that it’s not safe, potentially creating tensing and pain during sex.

Couples therapy could be an option for those who are ready, but even listening to podcasts or reading books on healthy relationships can help, or even just having a difficult conversation.

Address trauma and any discomfort around sexuality - If you’ve experienced sexual trauma, you may likely benefit from some kind of therapy that helps you to process that trauma. There are various types of therapy for trauma from EDMR to Somatic Experiencing. If you’re not ready for talking, there are a number of books, podcasts and resources available online to help you begin the process.

If you haven’t experienced trauma but you’re uncomfortable with your sexuality or sex in general for whatever reason, therapy could also be helpful, as could reading books, taking courses and workshops and listening to podcasts on sexuality. 

I’ve linked to resources for both below.

Visceral manipulation - Visceral manipulation can help free up the pelvis and organs that have become ‘frozen’ from scar tissue and adhesions. Clear Passage has lots of research behind it and is one of the most effective for pelvic pain, endometriosis, SIBO and infertility, but is expensive. Another wonderful option is Mercier Therapy, which is specifically designed for gynaecological conditions and pelvic pain, but you can also find general visceral manipulation therapists too! A good pelvic floor physiotherapist may also be able to do visceral manipulation on adhesions as well.

For more info on where to find these support resources, scroll down to the show notes.

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This episode is sponsored by my free guide ‘A Natural Pain Relief Tool Kit for Endometriosis’. This four page guide includes evidence based and effective remedies which you can use at home to reduce your pain with endo. Download your copy here.

My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here.

If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at [email protected] or visit my website.

This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more

This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk

This episode is sponsored by Semaine Health, the anti-inflammatory, plant-based pain relieving supplement. Now priced at $28.99 for subscription. Shop here.

Show Notes

Reduce chronic inflammation

Outsmart Endometriosis: The Elimination 'Undiet' for Endometriosis with Dr Jessica Drummond

Antioxidants for Endometriosis

Anti-inflammatory Living for Endometriosis

What is The Endometriosis Diet with Henrietta Norton of Wild Nutrition

Six Tips for Reducing Endometriosis Pain in The Week Before Your Period

Reduce Fatigue, Endometriosis Symptoms and Oestrogen Dominance with A Better Breakfast

Pelvic Floor Physiotherapy

Equal Treatment for Black Endometriosis Patients and Pelvic Floor Physiotherapy for Painful Sex, Interstitial Cystitis and Endometriosis with Dr. Juan Michelle Martin

Your Brain on Pain - How Your Nervous System Affects Interstitial Cystitis and Endo Pain with Dr. Nicole Cozean

Pelvic Floor Therapy for Endometriosis with Heba Shaheed of The Pelvic Expert

Yoga for Endometriosis

Yoga for Vulvodynia

Relieving Pelvic Pain yoga video

Pelvic Sanity You Tube

Ohnut

Ohnut website

How Ohnut is Easing Painful Sex with Emily Sauer

Non-toxic products

Yes Yes Yes

Into the Wylde

Foria Wellness

Womanology

Urtekram

SIMS

Headspace

Yoga for Endometriosis

Yoga for Vulvodynia

Relieving Pelvic Pain yoga video

Frequency breath work

Self-massage

Healing Endometriosis-Associated Dyspareunia and Rediscovering Pleasure with Elena of The Yoni Empire

Yoni mapping blog post

Yoni massage blog post

CURVE yoni mapping toy

Healing Endometriosis-Associated Dyspareunia and Rediscovering Pleasure with Elena of The Yoni Empire

Relationships

Communication, Relationships and Endometriosis with Melanie Cox

Relate

How We Cope with Endometriosis as a Couple - A Conversation with My Boyfriend

The Gottman Institute for relationships

The Zim-Zum of Love

Addressing trauma and getting comfortable with your sexuality

Mind charity

EDMR therapy

Trauma Recovery + The Epigenetics Of Stress + Rewiring The Survival Brain With Elizabeth Stanley, PhD

The Sex Doctor

Come as You Are: The Surprising New Science That Will Transform Your Sex Life

OMG Yes

Eat. Play.Sex. Podcast

Visceral Manipulation

Mercier Therapy for Pelvic Related Conditions with Dr. Jennifer Mercier

The Healthy Gut Podcast Ep.25: Adhesions And SIBO With Larry And Belinda Wurn

The Healthy Gut Podcast Ep.33: Visceral Mobilisation With Alyssa Tait

Visceral manipulation practitioner directory