March 22, 2023/Women's Health

What Are the Best Positions To Reduce Endometriosis Pain During Sex?

The most comfortable sex positions minimize deep penetration

fixed pillows on a messy bed with towel

If you have endometriosis, pain may prevent you from having or enjoying sex, especially if you engage in penetrative sex with your partner. But there are lots of different sex positions that can reduce pain and help you reclaim your sex life.

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“Painful sex is a common symptom of endometriosis,” says gynecologic surgeon Miguel Luna, MD. “The main thing is to experiment to find comfortable sex positions or other ways to find pleasure. It’s essential for partners to understand how painful sex can be and create a comfortable, pressure-free environment.”

When experimenting, make sure you and your partner are on the same page. Communicate your feelings before, during and after sex. Openness can help reduce stress if you need to stop or shift your approach.

And remember, don’t force yourself or allow a partner to force you to have sex if you’re in pain or don’t feel like it.

Preparing for sex when you have endometriosis

You may think sex should be spontaneous. But if you have a chronic condition, a little preparation can enhance the sexual experience for you and your partner.

One suggestion is to track how you feel across your cycle. If you have predictable times in your cycle when you have less pain, plan sex accordingly.

And have the right supplies on hand, like:

  • Lubricant: Endometriosis can cause vaginal dryness by interfering with your sexual arousal pathways. A water-based or silicone lubricant can reduce friction and increase comfort.
  • Penile bumper: This soft donut-shaped ring fits around the base of your partner’s penis and prevents deep penetration.
  • Pillows: A regular pillow or specially designed cushion or wedge can help you find a more comfortable position.
  • Towel: Some people with endometriosis bleed after sex, so plan for this by putting a towel down.

Finding the best sex positions to reduce pelvic pain

Finding what feels best for you may take time. In general, strategies for reducing pain during sex help by:

  • Decreasing the depth of penetration.
  • Changing the angle of penetration, so the penile head hits the front of your vagina, not the back.

Dr. Luna recommends these sex positions to reduce endometriosis pain during sex:

1. Get on top

Being on top puts you in control of the depth of penetration and speed of sex. This position also has a wide range of variations to adjust the angle of your body, such as:

  • Face-to-face.
  • Backward.
  • Lotus, where your partner sits cross-legged with you on top.
  • Sideways.

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2. Missionary position with elevated pelvis

Many people find the missionary position (on your back with your partner on top) painful due to the penile angle. Dr. Luna suggests modifying this position. Have your partner stand at the end of the bed. Lie on your back, scooch down to the edge of the bed and elevate your hips using a pillow or wedge.

3. Sideways sex

During sideways sex, you and your partner lie on your sides, either face-to-face or spooning. This relaxed position lets you control the thrusting and depth of penetration.

4. Modified doggy style

Doggy style (you on all fours with your partner behind you) typically involves deep penetration and is often too painful for people with endometriosis. Dr. Luna suggests modifying the position by arching your back to alter the angle of entry.

You can also lie on your stomach with your partner on top for full-body contact. A pillow under your stomach or hips in this position can provide support and help you find a comfortable angle.

5. Nonpenetrative sex

If penetration is too painful, you and your partner can find pleasure without intercourse. Oral sex and mutual masturbation are great options. You’ll also find many types of vibrators and sex toys that don’t require vaginal penetration.

What causes endometriosis pain during sex?

Endometriosis is an inflammatory disease where tissue similar to your uterine lining (endometrium) grows outside your uterus. This tissue sheds each month, causing painful inflammation and scarring.

Not all people feel endometriosis pain the same way. “Endometriosis that develops behind the vagina, cervix and uterus can be especially painful during sex,” states Dr. Luna. “The upper portion of the vagina is an area of sexual pleasure during penetration. And if you’re in the missionary sex position, this area is generally where the head of the penis hits.”

Is endometriosis treatable?

There isn’t a cure for endometriosis, but you can manage your symptoms by working with your healthcare provider.

The most common treatment options include medications and surgery. Medications, such as hormone therapies and pain medications, can help control symptoms. For some people, surgery can provide longer-term pain relief. Other treatment options include:

  • Alternative therapies, such as acupuncture and yoga.
  • Pain psychology.
  • Pelvic floor physical therapy.

“We treat the underlying cause of pain so you can find more enjoyment in life — and sex,” says Dr. Luna.

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