How To Make Sex Hurt Less With Endometriosis and Fibroids: What to Know

Pain with sex (dyspareunia) is common in people living with endometriosis and uterine fibroids. It is real, it is treatable, and you deserve compassionate, evidence-based care. This guide explains why sex can hurt, what you can try now, and the medical options that can help—grounded in guidance from trusted sources like the NIH, FDA, and ACOG.

Why Endometriosis and Fibroids Can Make Sex Painful

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, often around the ovaries, pelvis, and uterosacral ligaments. These implants can trigger inflammation, scarring, and nodules that make deep penetration painful, especially in positions that press the cervix or posterior pelvis. Many people also develop pelvic floor muscle guarding in response to chronic pain, which can cause burning or tightness at the vaginal opening and pain with initial penetration. Learn more from the National Institutes of Health (NIH): NIH on Endometriosis.

Uterine fibroids are benign muscle tumors of the uterus. Depending on size and location, they can cause pressure, a feeling of fullness, and deep pain with penetration—particularly if the uterus is tilted, enlarged, or a fibroid sits near the cervix or posterior wall. Heavy periods and anemia can also lower pain thresholds and energy. See NIH information on fibroids: NIH on Uterine Fibroids.

Clinicians often distinguish between superficial dyspareunia (pain at the opening—burning, stinging) and deep dyspareunia (pain with deeper penetration). Endometriosis and fibroids more commonly cause deep pain, but pelvic floor irritation, vaginal dryness, and hormonal changes can add superficial pain as well. ACOG’s overview of painful sex is a useful primer: ACOG: Painful Sex (Dyspareunia).

When Pain Is an Emergency

Seek urgent care if you have sudden severe pelvic pain, fever, fainting, vomiting, a rigid abdomen, heavy bleeding soaking through pads hourly, pain during pregnancy, or signs of infection. These can signal complications that require immediate attention.

What You Can Try Today

1) Choose positions and pacing that reduce pressure

• Favor positions that limit deep penetration and give you control of depth and angle: side-lying spooning, being on top, or using pillows under the hips or abdomen for support.
• Use slow, shallow thrusts, and pause when you feel pressure at the cervix or deep in the pelvis.
• Try intimacy during times of the cycle when symptoms are milder (often mid-cycle for some people), but individual patterns vary—track yours.

2) Optimize lubrication and avoid irritants

• Use a generous amount of high-quality lubricant. Silicone-based lubricants last longer; water-based options are compatible with most toys and condoms.
• Avoid products with fragrance, warming agents, or glycerin if you’re sensitive. If using latex condoms, skip oil-based products that can degrade latex.

3) Calm the pelvic floor

• Before intimacy, try diaphragmatic breathing, a warm bath, or a heating pad to relax pelvic muscles.
• Gentle external perineal massage or progressive dilators (with guidance) can reduce guarding and improve tolerance of penetration over time.

4) Over-the-counter pain strategies

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen 30–60 minutes before sex can reduce inflammatory pain for some people. Avoid if you have ulcers, kidney disease, bleeding risks, or medication interactions—ask your clinician first.
• Topical 4% lidocaine gel applied to the entrance 10–15 minutes before penetration can reduce superficial burning; discuss with your clinician to ensure it’s appropriate.

5) Communicate and redefine intimacy

• Agree on a stop signal. Talk about what feels good and what doesn’t—shallow angles, hands, oral sex, and toys are valid intimacy options.
• If pain triggers anxiety, consider sex therapy or cognitive behavioral therapy alongside medical treatment.

Pelvic Floor Physical Therapy: A Key Piece

Pelvic floor physical therapists can assess muscle tightness, trigger points, and coordination. Treatments may include manual therapy, biofeedback, relaxation training, dilator protocols, and home exercises. ACOG recognizes pelvic floor therapy as a component of care for dyspareunia. Ask your clinician for a referral, especially if you notice burning at the entrance, difficulty tolerating tampons, or pain on initial penetration.

Medical Treatments That Target the Underlying Condition

The right plan depends on your goals (pain relief, fertility, bleeding control) and your health history. Options include:

Hormonal therapies for endometriosis pain

• Combined estrogen–progestin methods (pill, patch, ring) or progestin-only methods (pill, injection, IUD) can suppress ovulation and reduce endometriosis-related pain.
• GnRH antagonists reduce estrogen to quiet endometriosis activity. The FDA has approved oral elagolix for moderate to severe endometriosis pain (FDA news release) and a relugolix combination for endometriosis-associated pain (FDA approval). These may help deep dyspareunia by reducing inflammatory lesions.

Therapies for fibroid-related symptoms

• Hormonal options such as combined or progestin-only contraception and the levonorgestrel IUD can reduce bleeding and cramping, which may indirectly improve comfort with sex.
• GnRH antagonist combination therapy (e.g., relugolix–estradiol–norethindrone acetate; elagolix–estradiol–norethindrone acetate) is FDA-approved to reduce heavy menstrual bleeding due to fibroids, which can shrink the uterus and reduce pressure symptoms for some (FDA on elagolix combo; FDA on relugolix combo).

Procedures and surgery

• Endometriosis excision or ablation via laparoscopy can remove lesions and adhesions, often improving deep dyspareunia for appropriately selected patients. Discuss risks, benefits, and recurrence rates.
• Myomectomy removes fibroids while preserving the uterus; uterine artery embolization (UAE) shrinks fibroids by cutting off their blood supply. Both can relieve pressure-related pain and improve quality of life. Suitability depends on fertility goals and fibroid characteristics.
• Hysterectomy is definitive for uterine sources of pain and bleeding but is usually reserved for those who have completed childbearing and for whom other treatments have failed.

Decisions should be individualized with a gynecologist experienced in endometriosis and fibroids. NIH and ACOG offer overviews of these options: NIH: Endometriosis Treatment and ACOG: Uterine Fibroids.

Build a Plan With Your Clinician

Bring a symptom diary noting where the pain is (entrance vs deep), cycle timing, positions that worsen or relieve it, and any associated bleeding, urinary, or bowel symptoms. Ask about:

• Pelvic exam and assessment for pelvic floor muscle tenderness
• Imaging if fibroids are suspected or known (transvaginal ultrasound; MRI for complex cases)
• Trial of hormonal therapy or GnRH antagonist if appropriate
• Referral to pelvic floor physical therapy and, if needed, sex therapy
• When surgery is indicated and how it might affect pain and fertility

Bottom Line

Painful sex with endometriosis or fibroids is common but not inevitable. Practical changes—better lubrication, gentler positions, pelvic floor relaxation—can make a difference right away. Medical therapies that target inflammation, hormones, and fibroid size, along with pelvic floor physical therapy and, when needed, surgery, can further reduce pain and restore intimacy. Partner with a clinician you trust to tailor a plan that meets your goals.

Trusted Sources

• NIH: Endometriosis overview – https://www.nichd.nih.gov/health/topics/endometriosis
• NIH: Uterine fibroids overview – https://www.nichd.nih.gov/health/topics/uterine
• ACOG: Painful Sex (Dyspareunia) – https://www.acog.org/womens-health/faqs/painful-sex
• ACOG: Uterine Fibroids – https://www.acog.org/womens-health/faqs/uterine-fibroids
• FDA: Elagolix for endometriosis pain – FDA press announcement
• FDA: Relugolix combination for endometriosis pain – FDA approval
• FDA: Oral therapies for fibroid heavy menstrual bleeding – FDA on elagolix combo and FDA on relugolix combo

This article is for educational purposes and is not a substitute for personalized medical advice. Always consult your healthcare professional for diagnosis and treatment.