Women with endometriosis tend to experience pain with deep penetration and thrusting due to the location of endometriosis adhesions. There are however several things you can do to make vaginal sex more pleasurable.
First, make sure that you are ONLY dealing with endometriosis pain. Many women with endometriosis also end up developing some level of pelvic floor muscle dysfunction, which will cause more pain with penetrative sex. I have seen cases where the pelvic floor muscle dysfunction is actually causing most of the pain during penetrative sex—not the endometriosis. If you start to notice pain upon entry, this is a red flag for pelvic floor muscle dysfunction. Luckily, pelvic floor muscle dysfunction can be successfully treated with pelvic floor physical therapy. I would highly recommend you going for a pelvic floor physical therapy evaluation. Once you can rule out that the pain is only related to endometriosis, try the following suggestions to make penetrative sex more pleasurable:
First, make sure you and your partner are spending enough time on foreplay. Whenever women (even those without endometriosis) engage in penetrative sex before being fully aroused (and women need at least 20 minutes of foreplay…) sex will be painful! So make sure you are setting enough time aside for sex. A ten minute quickie is not going to be ideal for a woman with endometriosis. You and your partner both may have to adjust your schedules, but make sure you have at least a thirty minute window (ideally longer) to sexually connect.
Experiment with different positions that naturally create more shallow penetration. Generally women with endometriosis will experience less pain with vaginal sex using positions where penetration is more shallow. These may include side-to-side, modified missionary (legs together), spooning, or modified doggy-style (use pillows to support her core and pelvis). There are hundreds of sexual positions to choose from! A simple tilt of the pelvis or slight change in the angle of your penis during penetration could make all of the difference. Experiment and have fun! If you can both focus on pleasure and having fun, you will both be more likely to stumble upon something new that works for you both.
Next, consider a product like OhNut (https://ohnut.co). This product is like a “penis bumper” and is worn by the male partner to create more shallow penetration. Using OhNut may enable you to engage in sexually positions that previously were too painful. In addition, reducing the depth of penetration will not rob either of you or your partner of sexual pleasure.
Incorporate sexual positions where you can be more in control of the speed and rhythm of the thrusting. Any variation of woman on top is great for this. Hard and fast thrusting will generally increase pain for women with endometriosis. Slower and more controlled thrusting will generally feel better. Slower and more controlled thrusting is sometimes used with tantric sex and can even increase pleasure for both you and your partner.
Maintaining arousal throughout the sexual experience will also be key for increasing your pleasure. Some couples like to add a vibrator to maintain arousal for her. In addition it may be helpful to switch from penetrative sex after a few minutes (or whatever you can tolerate) to another outercourse activity. Long periods of penetration are not going to be pleasurable for anyone experiencing pelvic pain. Try two minutes of penetration (or again, whatever you can tolerate) then oral or digital stimulation for another few minutes. Make sure you are using lube and reapply when needed. I highly recommend Uber Lube as a good option for all women, but especially for those with endometriosis. Men generally report to me most liking this lube as well.
You should also track how your endometriosis pain changes over your monthly cycle. Usually women’s endometriosis pain is the worst during ovulation and during their periods. The pain may be so bad that you may have to avoid penetrative sex completely at these times. However, this does not mean you have to stop connecting sexually. With your partner you will want to broaden your sexual menu so that there is always something to choose from. Outercourse (basically everything outside of penetrative sex) can be just as pleasurable and fun. Tracking the pain will also help you two to realize when the least painful times of the month are, which will be the more optimal times to engage in penetrative sex. Again, the degree of modification will depend upon the severity and location of the endometriosis adhesions.
While it can feel frustrating for you and your partner to have to contend with endometriosis, I often find that my couples who face certain obstacles with sex end up having some of the most varied, healthy and happy sex lives. Sometimes couples can put too much focus on penetrative sex and neglect all of the other fun and equally pleasurable sexual activities. Couples that are forced to get a little creative usually end up discovering a whole new range of sexual activities they enjoy.