Having Sex With Endometriosis and Fibroids: What to Know

Pain with sex is common if you’re living with endometriosis, uterine fibroids, or both. These conditions can affect comfort, desire, and intimacy—but there are practical steps and medical treatments that can help. This guide explains why sex may hurt, what’s normal vs. not, ways to make sex more comfortable, and treatments supported by trusted sources.

Why sex can hurt with endometriosis or fibroids

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, often on the ovaries, fallopian tubes, bowel, or pelvic lining. These implants can become inflamed, form adhesions (scar tissue), and lead to deep pelvic pain and pain during or after intercourse (dyspareunia). Inflammation and adhesions can tug on pelvic organs during penetration, causing sharp or deep ache. Learn more from the National Institutes of Health (NIH): NICHD: Endometriosis and HHS Office on Women’s Health.

Uterine fibroids are noncancerous growths of the uterus. Depending on their size and location, they can cause pressure, a feeling of fullness, pain with deep penetration, and postcoital spotting. Submucosal fibroids (inside the uterine cavity) may increase bleeding; intramural or subserosal fibroids (within or on the outer wall) can change the shape of the uterus and alter comfort during sex. See: OWH: Uterine Fibroids and ACOG: Uterine Fibroids.

What’s normal, and when to call a clinician

Occasional discomfort—especially around your period—can happen, but ongoing, severe, or worsening pain is not something you need to push through. Seek care if you have:

• Deep pain during or after sex, especially if new or worsening
• Bleeding after sex not explained by a cervical cause
• Pelvic pain outside of sex that disrupts daily life
• Pain with bowel movements or urination, or painful periods
• Fever, foul discharge, or sudden severe pain (urgent evaluation)

Evaluation may include a pelvic exam, ultrasound, and discussion of symptoms. For guidance on painful sex and evaluation, see ACOG: Painful Sex (Dyspareunia).

Practical ways to make sex more comfortable

Plan around your body’s rhythm

• Track symptoms to learn your less-painful days. Many people feel more sensitive near menstruation with endometriosis and when fibroid-related pressure is worse.
• Warm up thoroughly. Longer foreplay and arousal boost natural lubrication and relax pelvic floor muscles.

Use lubrication and go slow

• Generous use of a high-quality lubricant (often silicone-based for longer glide) reduces friction. Reapply as needed.
• If medications lower estrogen (for example, certain endometriosis or fibroid therapies), dryness can increase. A vaginal moisturizer between encounters may help. Ask your clinician about options; avoid starting vaginal estrogen without medical guidance if you have endometriosis.

Try positions that reduce deep pressure

• Positions that let you control depth and angle—such as being on top or side-lying (spooning)—often help.
• Use pillows under hips or between knees to adjust the angle and decrease contact with tender areas.
• Favor shallow thrusting; communicate and pause if pain increases.

Relax the pelvic floor

• Pelvic floor physical therapy can improve muscle tension and coordination, a common contributor to dyspareunia. Therapists may use relaxation, biofeedback, and at-home exercises. See ACOG’s guidance on painful sex.
• Breathwork, progressive muscle relaxation, or warm baths/heat packs before intimacy may ease guarding and cramping.

Manage pain flares

• Over-the-counter pain relievers like NSAIDs (e.g., ibuprofen) taken as directed on the label may help cramping and inflammation. Avoid if you have contraindications and ask your clinician what’s safe for you.
• Have a plan: agree on a stop signal, switch to non-penetrative touch if pain starts, and check in afterwards.

Protect emotional wellbeing

• Pain can trigger anxiety or avoidance. Sex therapy or counseling (solo or with a partner) can rebuild confidence, address fear of pain, and improve communication.
• It’s okay to prioritize pleasure without penetration. Many couples broaden their sexual menu and report greater satisfaction and less pain.

Treatments that can reduce sexual pain by treating the cause

Endometriosis treatments

• Anti-inflammatories and hormonal therapy: Combined hormonal contraceptives, progestin-only methods, and other suppressive therapies can reduce pain by quieting endometrial-like tissue. See NICHD on treatment.
• GnRH modulators: These medications reduce ovarian hormone production and can significantly relieve pain. FDA-approved options include elagolix (Orilissa) and a combination of relugolix/estradiol/norethindrone acetate (Myfembree).
• Surgery: Laparoscopic removal or ablation of endometriosis and lysis of adhesions can improve pain and sexual function for some people. Discuss risks, benefits, and likelihood of recurrence with your surgeon.

Note: Some therapies can cause side effects like hot flashes, mood changes, or vaginal dryness; “add-back” therapy is often used with GnRH modulators to protect bone and reduce side effects. Your clinician can tailor a plan to your goals, including fertility.

Fibroid treatments

• Medical therapies: Hormonal contraceptives and the levonorgestrel-releasing IUD can reduce bleeding and cramps. Tranexamic acid (a non-hormonal option) helps heavy menstrual bleeding. See ACOG and OWH.
• GnRH modulators: Relugolix/estradiol/norethindrone acetate is FDA-approved for heavy menstrual bleeding due to fibroids and can decrease pressure symptoms, which may improve comfort with sex.
• Procedures: Uterine artery embolization, radiofrequency or MRI-guided focused ultrasound ablation, myomectomy (fibroid removal), and hysterectomy are options depending on symptoms, size and location of fibroids, and fertility plans. Discuss recovery time and how each option might affect sexual function.

Fertility, contraception, and family-building

Both endometriosis and fibroids can affect fertility for some people, but many conceive naturally or with assistance. If you’re trying to conceive, ask which treatments preserve fertility (e.g., myomectomy vs. hysterectomy; medical suppression vs. long-term GnRH therapy). If pregnancy is not desired, use reliable contraception: ovulation can continue with some treatments. Your clinician can help match birth control to your symptoms and goals.

Building trust and a plan with your care team

• Track pain and bleeding, noting triggers, positions, and timing. Bring this to visits—it guides diagnosis and treatment.
• Set priorities: pain relief, preserving fertility, lighter periods, or avoiding side effects. Shared decision-making improves outcomes and satisfaction.
• Ask about pelvic floor PT, sex therapy, and mental health support as part of a comprehensive plan.

The bottom line

Painful sex is common but not inevitable with endometriosis and fibroids. With the right strategies—communication, timing, lubrication, position changes—and evidence-based treatments, most people can feel better and enjoy intimacy again. If sex consistently hurts, you deserve an evaluation and a plan tailored to your body and goals.

References and trusted resources

• NIH NICHD: Endometriosis and Treatment
• HHS Office on Women’s Health: Endometriosis and Uterine Fibroids
• ACOG FAQs: Painful Sex (Dyspareunia), Uterine Fibroids, Endometriosis
• FDA approvals: Elagolix (Orilissa) for endometriosis pain; Myfembree for fibroid bleeding; Myfembree for endometriosis pain

This article is educational and not a substitute for personal medical advice. If you have severe or persistent symptoms, seek care from a qualified clinician.