Painful sex, termed dyspareunia, is an often overlooked and taboo subject when it comes to women’s health. Though the causes are numerous, endometriosis is one such medical condition that is often seen in women with dyspareunia. Worldwide, endometriosis affects 170 million women, up to 10% of women of reproductive age.1 Endometriosis occurs when endometrial tissue from the uterus grows outside the uterine cavity. Endometrial tissue has been found in the intestines, vagina, the ureters, and even the bladder.1 As a consequence of this infiltration, inflammation occurs, and results in soft tissue restrictions. Traction and mechanical pressure on these inflamed tissues can cause painful sex.2,3

Several theories exist as to why endometriosis occurs in the first place

The most notable theory is the retrograde menstruation theory. First described in 1925, this theory claims that endometrial tissue proliferates in the pelvic cavity due to the backwards flow of endometrial cells through the fallopian tubes.1 Still other theories propose an immune dysfunction, genetic predisposition, or environmental/lifestyle factors (such as alcohol and caffeine consumption) as causative for endometriosis.1 In all actually, the exact cause is likely multi-factorial.

Besides dyspareunia, endometriosis symptoms include:

Dysmenorrhea (painful periods), constipation, painful urination, and chronic pelvic pain.1 Sadly, the diagnosis of endometriosis is often overlooked; some patients go many years before properly being diagnosed. Often, the pain experienced during sex has further negative consequences on a woman’s psychological health. Loneliness, depression, social isolation, and deterioration of intimate relationships are often observed.1 In a study by Ferrero et. al., women with dyspareunia from endometriosis reported less satisfying orgasm and felt less fulfilled after sex than other groups.1 Over time, women experience a fear of pain during sex, and this fear manifests itself in a decreased sexual desire, decreased lubrication of vaginal tissues, and painful spasms of the pelvic floor muscles.3

Just like the exact cause of dyspareunia is multi-factorial, so is the treatment

Medication therapy, surgical excision, and pelvic floor therapy are typical treatments. Pelvic floor therapy performed by specialty-trained women’s health therapists, involves a tailored approach to help reduce dyspareunia. Treatment options include patient education, manual techniques for reducing inflammation, dry needling, core strengthening, stretching of hip and back muscles, and education on use of medical devices such as vaginal dilators.3 In addition, a multidisciplinary approach with a woman’s GP, gynecologist, and sexual health counselor helps improve treatment outcomes.

There is help available

If you feel like your sexual health is affected by endometriosis, there is help available. It is estimated that only one third of women with dyspareunia due to endometriosis actually talk to their doctors about the issues they are having.1 So the first step is to reach out to your medical provider and discuss your symptoms. That provider could be your general practitioner, gynecologist, psychiatrist, or your physical therapist. The next steps would be individualized based upon your symptoms and goals. Please don’t suffer any longer. Remember, love doesn’t have to hurt.


Corte LD, Filippo C, Gabrielli O, et. al. The Burden of Endometriosis on Women’s Lifespan: A Narrative Overview on Quality of Life and Psychosocial Wellbeing. International Journal of Environmental Research and Public Health. 2020;6.
Mabrouk M, Del Forno S, Spezzano A, et. al. Painful Love: Superficial Dyspareunia and Three Dimensional Transperineal Ultrasound Evaluation of Pelvic Floor Muscle in Women with Endometriosis. Journal of Sex and Marital Therapy. 2019;46:2: 187-196.
Lukic A, Properzio M, De Carlo S, et. al. Quality of sex life in endometriosis patients with deep dyspareunia before and after laparoscopic treatment. Archives if Gynecology & Obstetrics. 2016;293:583-590.