The Intimacy pain with Endometriosis

Why Does Intimacy Hurt With Endometriosis?

Pain with sex, medically called dyspareunia, is incredibly common for people living with endometriosis. Yes sadly, it’s the symptom that many struggle to talk about.

It can be challenging to explain fully to partners, and difficult to raise with health professionals. One online survey revealed that only 40% of gynaecologists in the US routinely asked about a patient’s sexual health (Carter-Santamaria et al, 2020).

Most of the women I see in clinic will tell me of at least a few unhelpful and invalidating responses from doctors when they have tried to seek support. "Use more lubricant”, "try to relax” and ‘yes, painful sex is very common…’. No proper assessment, no education to help you truly understand what is driving your pain, and no treatment plan. Frustratingly women struggle for years without the right support. It’s no wonder that if the health professional is not asking, and the patient is finding it hard to bring up, the issue silently continues.

I want you to know that you are absolutely not alone in your experience. One study of 2060 women with endo revealed around 90% reported sexual pain, with 67% saying they avoid sex because of their symptoms (Privitera et al, 2023). A systematic review and meta analysis published this year revealed out of 4185 people across 19 studies, 62.5% reported sexual dysfunction (Zhang et al, 2026). Endo related pain with sex is linked to pre-sex anxiety, physical tension, avoidance of intimacy, relationship problems, and many report their compromised sex life has the largest impact on their quality of life.

Here's what I want you to know:

Intimacy pain with endometriosis is complex. And it’s not just about the endo lesions themselves. Over the years of working in clinic, I have found organising how we think about intimacy pain into 3 distinct zones can be a helpful place to start for identifying our pain and what’s driving it.

Zone 1: Pain at the vulva and vaginal entrance

This might feel like burning, stinging, tightness and a closed off feeling at the vaginal entrance. There also may be changes in sensation at the clitoris and around the vulva itself.

This type of pain may be connected to tension and protective bracing in the superficial pelvic floor muscles that wrap around the entrance, hypersensitive tissue at the vulval vestibule, and irritation of the pudendal nerve that carries messages to and from this zone.

Zone 2: Mid pelvic pain

This is pain felt further inside the vagina, including along the vaginal side walls.

Here, tension and pain in the deep pelvic floor muscles, tissue mobility and even constipation may play a role.

Zone 3: Deep pain

This is the pain that can happen with deeper penetration, and is often felt as an inflamed or bruised pain deep inside, that can be felt during penetration and can often linger after as a throb or ache. Inflammation from endo lesions in the Pouch of Douglas (the space between the vagina and rectum), scar tissue restricting tissue mobility, as well as a sensitive cervix can all potentially contribute.

You might experience pain in one zone—or all three. When we have multiple zones involved with multiple drivers, it’s obvious we need more than one kind of treatment! Which is exactly why some aspects of your pain may not have changed after surgery. Once you start understanding your specific zones, you can begin exploring what strategies might be most helpful for you to start creating change.

Follow along on Instagram for lots of sexual health with endo content, and stay tuned for our Sexual health series launch this October!

Coming this October:

Ebook: Decoding Intimacy Pain with Endometriosis

Masterclass: Intimacy pain explained – Toys, Tools and Techniques to move from pain to pleasure

Be first to know when our sexual health series launches!

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