Endometriosis and Pain With Sex: Why Your Pelvic Floor May Be Involved

Do you have endometriosis and experience pain with sex?

If you’ve been wondering why intimacy hurts, you are not alone.

As a women’s health physical therapist, one of the things I want women to understand is that endometriosis can affect the way structures inside the pelvis move.

Most women were never taught this.

And when those structures cannot move the way they are supposed to during intimacy, pain can become part of the experience.

How Endometriosis Can Affect Movement Inside the Pelvis

One of the things we know about endometriosis is that it creates lesions that can be black, tarry, and sticky.

These lesions can be found on different structures throughout the body, including:

• The bladder
• The uterus
• Ligaments
• Other areas inside the pelvis

They have even been found in other areas of the body.

The important piece when we’re talking about pain with intercourse is this:

Where those lesions are located can affect how well the organs and tissues around them move.

Your body is designed to move internally.

Your organs are not supposed to stay completely fixed in one position.

During intimacy, that movement matters.

Mayo Clinic notes that endometriosis can cause pain during or after sex and may also lead to scar tissue and adhesions that cause pelvic tissues and organs to stick together.

Learn more from Mayo Clinic about endometriosis

What Happens During Arousal

As the female body becomes aroused, the uterus lifts and pulls away from the vaginal canal.

This is not a huge movement, but it is still an important part of how the body prepares for intercourse.

If the uterus has lesions on it, or if lesions on the bladder, ligaments, or ovaries limit how those structures move, the uterus may not be able to shift as freely.

The body is trying to do what it is supposed to do.

But if that movement is restricted, dysfunction can occur.

And that dysfunction can contribute to pain.

The Pelvic Floor Connection

The pelvic floor also plays an important role during intercourse.

The pelvic floor muscles need to part and accommodate during penetration.

That allows space for a penis, finger, or other form of penetration.

If those muscles are not functioning well because of what is happening in the structures above them, they may not be able to do their job as effectively.

Instead of comfortably making room for penetration, the system may become restricted.

That can contribute to pain with intimacy.

Why This Matters

For many women, this connection has never been explained.

They know they have endometriosis.

They know sex hurts.

But no one has helped them connect those two experiences through the way their internal tissues and pelvic floor function together.

Understanding what may be happening inside your body can help the symptoms feel less mysterious.

Understanding your body creates confidence.

What to Do Next

If you have endometriosis and pain with sex, consider working with a provider who understands both women’s health and pelvic floor function.

A pelvic floor physical therapist can help evaluate how your pelvic floor is functioning and whether it may be contributing to the pain you are experiencing.

If you’re local, schedule an appointment. If you’re not, look for a pelvic floor physical therapist in your area who can help you better understand what your body needs.

Your body is not broken.

Pain with intimacy deserves attention, answers, and support.

If you’re ready to stop guessing and start understanding your body, complete Your Pelvic Floor’s Next Step Form for guidance based on your symptoms and goals.