A Gynaecologist And Sex Therapist On The Best Sex Positions When You Have Endometriosis

One in ten Australian women have endometriosis and for many of them, sex can be agony.

A close friend of mine spent years of her life believing that painful penetrative sex was a fact of life.

Likely an extension of the fear mongering around 'lost' virginity and 'popping' hymens, she for a very long time believed that when a penis enters a vagina, it's simply supposed to hurt.

This was until a bout of reproductive health issues led her to seek medical help, and of course, consult Dr Google. Like tens of thousands of Australians, she has endometriosis.

Having endometriosis can make having sex incredibly painful. Image: Getty

Her endometriosis diagnosis gave her the knowledge that while sex is certainly not supposed to hurt her, there was an explanation for her pain. And with that, a way to fix it.

The today marks #MarchIntoYellow, a day to bring awareness to those living with endo and raise funds for Endometriosis Australia.

Painful sex is the reality for many women with endo, but experts advise that there is plenty that can be done to make sex pain-free and pleasurable.

What is endometriosis?

"Endometriosis is where hormonally responsive tissue similar to the cells lining the uterus grow outside the uterus," Dr Janine Manwaring told 10 daily.

"These cells act in a similar way to the menstrual cycle, but bleeding and inflammation is occurring outside the uterus, which can cause pain, inflammation, scarring, ovarian cysts and can lead to problems with persistent pain and decreased fertility."

According to Endometriosis Australia, there is a delay in diagnosis of between seven and 10 years, meaning that many living with the condition will go years before seeking medical assistance and receiving a diagnosis.

Why does it hurt to have sex?

Dr Janine Manwaring is a Melbourne-based gynaecologist who works closely with the Jean Hailes Foundation to provide medical advice and expertise, particularly in regards to endometriosis.

Through her work, she has met a number of women and people with a female reproductive system who have flagged that penetrative sex can cause them great pain.

Dr Manwaring explains that there are a number of factors that could be causing this.

"People with endometriosis can experience pain with sex for a few different reasons, not all which are directly from the endometriosis deposits. The pelvic areas affected by endometriosis can be tender and therefore painful with direct pressure from deep vaginal penetration. Sometimes the uterus itself can be similarly tender," she told 10 daily.

"Pelvic muscles, nerves and skin can become more sensitive to pressure which can increase the sensation of pain, which may be also from touch or pressure around the vagina or vulva. All of these symptoms can be influenced by the anxiety about potential pain."

How does anxiety impact sex?

When the brain associates sex with pain, a woman's body can have a physical response.

"Many women feel that they need to endure painful sex for the sake of their (usually male) partner’s sexual pleasure," said Dr Manwaring.

"It is important to explain to both individuals and their partners that persisting with sexual activity that is painful is likely to increase muscle tension and anxiety and decrease vaginal lubrication."



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It's a vicious cycle that Dr Manwaring explained can make the brain believe that sex will never be pleasurable.

"This will reinforce to the brain that sex is a dangerous and painful activity, which will almost definitely further decrease a woman’s sexual desire and response," she said.

"Any activity that breaks this cycle of sex associated with pain will be beneficial."

Should I try using sex toys and lube?

Masturbation and sex toys can be a helpful way for you to understand how your own own body experiences pain and pleasure. Knowing what works for you and your own condition will make it easier to experience pleasure when having sex with yourself and with others.

"In keeping with sexual expectations and experience being so diverse, people can explore their sexuality and sexual comfort in numerous ways," explained Dr Manwaring.

"This can be solo, with a toy, with a partner, with additional appropriate lubrication (water-based with condoms; products that are not irritating to the vaginal skin -- no fragrances/colours/flavours/glow-in-the-dark/chemicals... these can cause terrible dermatitis), learning pelvic relaxation exercises, experimenting with different positions and the list goes on.

The most important thing to reinforce is that sex should be a pleasurable, safe and desired experience and to encourage exploration about how this can occur.

Are certain sex positions better than others?

Using a sex toy can be helpful in deciphering what positions feel best for you. It's almost important to have an open dialogue with your sexual partner, keeping them in the loop with how you're feeling and letting them know when you feel you need to change it up.

If penetrative sex just isn't working for you, there are a realm of other ways to feel sexual pleasure.



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"If a woman associates any vaginal penetration with pain, I reinforce that she needs to stop trying to 'push through it' but rather to have sexual intimacy without any vaginal involvement," said Dr Manwaring.

She suggested that not only is it important to have these alternatives, finding pleasure this way can also decrease anxiety around sex, leading progressively back to penetration when the time is right.

How do I broach these topics and concerns with my sexual partner?

In theory, it should be easy to speak with our sexual partners about our health issues and the things we'd like to do and try in order to make sex more enjoyable. But in reality, these chats can be awkward as all hell.

According to Pamela Supple, Sex and Relationship Therapist from Sex Therapy Australia, you have to focus on yourself first.

You've got to try within yourself to find the space to be comfortable and able to speak about it.

"With endometriosis, there are a lot of positions that are painful. And we have to take time with that. Being able to speak up about this is really up to the individual person," said Supple.

Once you've built up the courage to cut through any potential awkwardness, the sex therapist recommends that all tricky conversations must take place before sex is well underway.



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She said that finding a time when you're close and comfortable is the best time to mention what you've experienced and what you'd like to try, like when you're cuddled up on the couch.

"Hopefully you will have an understanding and caring partner that will be able to maneuver this with you and to work through it with you. And work out what sex life is going to work for the two of you," she said.

Today is March Into Yellow, a day which raises the profile and awareness of endometriosis. To find out more, visit Endometriosis Australia

Featured image: Getty

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