We’ve collected some common questions and answers to give you more information on endometriosis, painful sex and fertility. Speak to a healthcare provider if you have any unanswered questions about endometriosis and painful sex.
Endometriosis is a condition that affects 1 in 10 people1.
It occurs when tissue, similar to that which grows on the inside of the uterus (called the endometrium), grows on other parts of the body1.
Often, endometriosis grows on the inside of the abdomen, but it can also be present on the uterus or ovaries, bladder, or bowel. In some cases it can grow in other locations1.
The level of pain felt during sex does not generally tell you about the severity of the endometriosis. In a person with little or no pain, there might be a large amount of endometriosis tissue.
In a person with intense pain, there might be very little endometriosis tissue – or vice versa.
Research has shown that endometriosis tissue can stay the same, grow or regress, even with no treatments2.
No, endometriosis does not only affect women.
Being inclusive of different gender identities, endometriosis affects people who have a uterus and it can also affect people who used to have a uterus.
Endometriosis can also have an emotional impact on the family and friends of people with the condition. They might have feelings of helplessness, frustration, worry and stress.
About 60% of women describe a time when sex was painful. In about 15% of women, painful sex becomes a more consistent problem that affects quality-of-life and relationships3.
Research tells us that more than 50% of people with endometriosis experience painful sex. However, experiences can be quite different; some people say they have no pain at all while others describe sex as extremely painful4.
Sex might be painful for a lot of different reasons in people with endometriosis.
Pain with deep vaginal penetration can be caused by endometriosis directly5 or by the presence of other conditions (eg. bladder pain)6.
Superficial pain occurs at the vaginal opening and can occur in people with endometriosis; however, it is not directly caused by endometriosis. Instead it is related to other conditions7 (eg. vulvodynia, provoked vestibulodynia) that can be present in people with endometriosis.
There are many treatment and management options available that can help make sex less painful. Speaking to a doctor is a great way to discover which options might work for you. In some people, the pain may resolve completely; in other people, the pain can decrease through treatment though not completely8,9.
Yes! Painful sex is a very common symptom for people with endometriosis and it doesn’t have to hurt. Your doctor can help you determine how to treat or manage the pain you are experiencing
There are different reasons why someone might bleed during or after vaginal sex. Causes of bleeding with intercourse include abnormalities of the cervix, such as abnormal pap smears. Bleeding can also occur in some individuals with endometriosis who feel pain with sex, due to a tense pelvic floor or dryness of the vulvar/vaginal tissues (or in rare cases, endometriosis growing inside the vagina). If you are bleeding during/after intercourse, speak to a health care provider.
Most people with endometriosis are able to get pregnant but it might take a little longer10. Even women that have ovarian cysts with endometriosis have reasonable pregnancy rates when they try to conceive.
If you suspect you have endometriosis and pregnancy does not happen in a reasonable time (6-12 months) seek medical assistance as there are many treatments available to help you.
Most medical treatments for endometriosis are hormonal and they usually prevent ovulation. When you are ready to become pregnant, you will have to stop hormone treatment and give yourself a chance to conceive naturally. It might happen quickly.
If pregnancy does not happen in a reasonable time (6-12 months) seek medical assistance as there are many treatments available to help you.
When surgical treatment has been used to treat infertility due to endometriosis, there is an improvement in pregnancy rates in women who try to conceive naturally. In women treated with surgery for pelvic pain, they seem to be able to conceive at the same rate as the general population.
Women who have surgery for ovarian cysts of endometriosis will likely be able to conceive naturally, but might have a slight decrease in the number of eggs available and may need fertility treatment like in-vitro fertilization.
Painful sex does not cause infertility. However, treatment of endometriosis can reduce pain with intercourse, and thus may reduce stress and discomfort when trying to conceive.
- Yong, P. J., Williams, C., Yosef, A., Wong, F., Bedaiwy, M. A., Lisonkova, S., & Allaire, C. (2017). Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia. Sexual medicine, 5(3), e184–e195. doi:10.1016/j.esxm.2017.07.001
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Endometriosis: Overview. 2008 Feb 25 [Updated 2017 Oct 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279501/
- Glatt, A.E., Zinner, S.H. & McCormack, W. M. (1990). The prevalence of dyspareunia. Obstetrics & Gynecology, 75(3), 433-436. PMID: 2304713
- Orr, N. L., Wahl, K., Joannou, A., Hartmann, D., Valle, L., Yong, P. J., & International Society for the Study of Women’s Sexual Health. Special Interest Group on Sexual Pain. (2018). Deep dyspareunia : Review of pathophysiology and proposed future research priorities. doi:10.1016/j.sxmr.2018.12.007
- Williams, C., Hoang, L., Yosef, A., Alotaibi, F., Allaire, C., Brotto, L., . . . Yong, P. J. (2016). Nerve bundles and deep dyspareunia in endometriosis. Reproductive Sciences, 23(7), 892-901. doi:10.1177/1933719115623644
- Yosef, Ali, MBBCh, MSc, Allaire, C., MD, Williams, C., MD, Ahmed, A. G., MD, Al-Hussaini, T., MD, Abdellah, M. S., MD, . . . Yong, Paul J., MD, PhD. (2016). Multifactorial contributors to the severity of chronic pelvic pain in women. American Journal of Obstetrics and Gynecology, 215(6), 760.e1-760.e14. doi:10.1016/j.ajog.2016.07.023
- Sorensen, J., Bautista, K. E., Lamvu, G., & Feranec, J. (2018). Evaluation and Treatment of Female Sexual Pain: A Clinical Review. Cureus, 10(3), e2379. doi:10.7759/cureus.2379
- Yong, P. J., Williams, C., Bodmer-Roy, S., Ezeigwe, C., Zhu, S., Arion, K., . . . Allaire, C. (2018). Prospective cohort of deep dyspareunia in an interdisciplinary setting. The Journal of Sexual Medicine, 15(12), 1765-1775. doi:10.1016/j.jsxm.2018.10.005
- Allaire, C., Aksoy, T., Bedaiwy, M., Britnell, S., Noga, H. L., Yager, H., & Yong, P. J. (2017). An interdisciplinary approach to endometriosis-associated persistent pelvic pain. London, England: SAGE Publications. doi:10.5301/jeppd.5000284
- Mavrelos, D., & Saridogan, E. (2015). Treatment of endometriosis in women desiring fertility. Journal of obstetrics and gynaecology of India, 65(1), 11–16. doi:10.1007/s13224-014-0652-y