Unsealed Section: How to approach pleasure when you have endometriosis, according to a sex therapist
By Bronte Gossling|
It's ?a chronic condition that sees at least one in nine Australians with uteruses forced to endure debilitating pain more often than not.
Endometriosis, clinically, is defined as a disorder whereby the tissue that normally lines the uterus grows outside of it, and it takes, on average, seven to 10 years for someone with a uterus in Australia to be diagnosed with it.
But reaching a diagnosis only does so much. While there are treatments available, ultimately, there's no cure for endometriosis, let alone one that comes without significant financial, emotional and physical cost. There are, however, strategies you can implement to live with it.
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One of the most common symptoms of endometriosis is menstrual irregularities, ?as well as pain จC agony all throughout the lower torso and below not just during menstruation, but at any time, and beyond the practical realities of having to live with chronic pain like such, there are also wider implications that seep into every facet of life, including partnered sex, self pleasure, relationships and mental health.
Here's what you need to know about endometriosis and sex, from Womanizer's sex and relationship expert Christine Rafe.
?How endometriosis can impact sex
Endometriosis manifests differently in everyone จC no two cases are alike.
As such, the impacts of endometriosis on sexual intimacy and pleasure can vary, but generally, Rafe says those who grapple with endometriosis can expect some pain during penetration.
?It's a vicious cycle, as, according to Rafe, over time, the pain can cause the tensing or tightening of the pelvic floor muscles จC our muscles, Rafe says, are inclined to "involuntarily tense or tighten if they are experiencing discomfort or pain" จC which can increase further the pelvic and penetrative pain.
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Does endometriosis cause a low sex drive??
In a word: Yes. In more words: It's complicated.?
"While endometriosis itself may not lower libido, having chronic pelvic pain and/or painful sex can be a significant contributing factor to low or lowered libido," Rafe tells 9Honey.
"It isn't likely that you are motivated to engage in activities that cause you discomfort or pain จC for example, you wouldn't look forward to placing your hand on a hot stove top if you knew it was going to be painful จC so libido can be impacted in this regard. The emotional impacts of endometriosis also contribute to lowered libido."
Endometriosis, Rafe says, is an inflammatory condition that can activate the nervous system's stress response, and influence the ability to remain present, connect with others intimacy-wise, and become aroused.
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How to increase your sex drive when you have endometriosis?
Like no two endometriosis cases being the same, there's no one-size-fits-all solution for those who may have a decreased libido as a result of their condition.
"Our libido is influenced by many factors including environmental, relational, psychological and emotional as well as physical," Rafe says.
If someone is wanting to foster a higher libido, ?Rafe encourages looking at "all of the factors" and "focus on learning more about what you need to support your libido", be it going to see a sex therapist, or, if that's too big of a step, Rafe recommends Emily Nagoski's book Come as You Are.
As for physical intimacy, Rafe suggests focusing on areas and techniques that you already know supports your arousal and brings you pleasure จC experiencing pleasure during sexual intimacy rather than pain or ambivalence, after all, ?is what can increase motivation for sex.
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"If you are engaging in sexual activities that hurt, it's not likely you'll want to have more of that sex," Rafe says.
Pleasure, for many people with endometriosis, ?may mean exploring non-penetrative sexual touch, be it using hands, mouth or toys such as an external clitoral stimulator.
Best sex position for endometriosis
?It's something once again that's dependent on the person and what specifically triggers their pain, but generally, Rafe says anything non-penetrative is usually more comfortable and pleasurable than penetrative sex.
Rafe largely encourages anyone จC with or without endometriosis จC to explore whatever feels enjoyable and pleasurable for them, with consent, in bed, and not to limit sex to the genital area.
"Consider all five senses and your whole body as available for pleasure, not just your genitals," Rafe says,
"Often in sex we are so focused on genital touch that we forget that we have sight, sound, taste and smell, and the rest of our bodies that can be sources of sexual satisfaction too."
Rafe says not to shy away from lips, nipples, the inner thigh, hands, and ear lobes during solo and partnered sex.?
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"Slow down and explore pleasure on the whole body before moving to the genitals, as the more we feel relaxed, pleasured and aroused before genital touch starts, the more we are receptive to genital pleasure," Rafe says, saying incorporating toys such as external vibrators or clitoral air-suction toys during partnered sex can being variety and increase pleasure without aggravating endometriosis pain.
But if you're looking for penetration, Rafe suggests trying positions that "allow for more shallow penetration", such as the side-spooning position.
Rafe also says that "slower movements rather than fast thrusting can minimise the chances of sudden pain."
Alternatively, positions where the person with endometriosis can control not only the speed of the penetration but also the depth ?are an option, such as the person with endometriosis being on top.
"You can use pillows or wedges to support bodies where needed to reduce pelvic tension," Rafe suggests, and she also notes that penis bumpers or strap-ons can also reduce the depth of penetration in any position.?
Can orgasms alleviate endometriosis pain?
We often hear that self-pleasure and partnered sex resulting in orgasm ?during menstruation can alleviate period pain, and Rafe says that from a hormonal perspective, the same principle can theoretically apply to those who suffer from endometriosis.
The unique presentation of endometriosis in each person, however, means that ?in practice, orgasms may not always be able to alleviate pain from endometriosis.
"Hormones released during arousal, pleasure and orgasm are the 'happy hormones' and our bodies' natural pain-killer," Rafe says, highlighting the findings of Womanizer and Lunette's Menstrubation study, which established that masturbation reduced menstrual pain symptoms due to the release of oxytocin, serotonin, endorphins and dopamine.
Yet it's not as cut and dry with endometriosis, as the increased blood flow and pelvic tension ?that occurs during arousal and orgasm can actually trigger endometriosis pain, Rafe says.
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"This will vary from person to person, and as a general piece of advice if this is the case, focus on slow deep breaths into your diaphragm and active relaxation of the pelvic floor muscles outside of, as well as during, masturbation [or partnered sex] to reduce overall pelvic tension," Rafe says.
"Seeing a pelvic floor physiotherapist is often invaluable for those who suffer from arousal, penetrative or orgasmic pain due to endometriosis."
How to approach endometriosis and sex with a partner?
"Communication is key, as your partner can't possibly know what is happening for you unless you share it with them," Rafe advises those with endometriosis.
"Endometriosis can cause significant emotional and relational stress on top of physical symptoms, and it's important to acknowledge that both of you are part of the sexual relationship."
In her practice as a sex therapist at Good Vibes Clinic in Sydney, Rafe says she focuses on any sexual concerns, including pain during sex, as a couple issue rather than an individual one.?
Contact Bronte Gossling at bgossling@nine.com.au.
"There needs to be involvement by both people to support overall sexual satisfaction and enjoyment," she says. "The more your partner can be involved in and understanding of your needs, the more likelihood of overall relational and sexual satisfaction."
As for someone who is a partner of someone with endometriosis, Rafe advises being supportive and curios where possible, and emphasises listening to, with the goal of understanding, your partner's emotional and physical needs.
"Consider the sexual impacts of endometriosis as a couple issue, and work to identify ways that you can support your partner's desire, pleasure and arousal, as well as seeking to understand what aggravates or triggers any pain symptoms," Rafe says.
"Take sensual and sexual arousal slowly. If possible, seek additional information or resources on endometriosis, attend couple's sex therapy and/or relevant appointments if you feel you need support in understanding the disease or personal impacts."
The medical information in this article is general in nature. Please always seek advice from your doctor to ensure that it addresses your specific health needs.
