Painful Sex Positions for Endometriosis Patients

Endometriosis is a chronic gynecologic disorder where the endometrial tissue (the tissue that lines the uterus) begins growing outside of the uterus. Often, this causes painful and heavy periods, bloating, and can be a cause of deep dyspareunia. Deep dyspareunia is pain during sex with deep penetration. Some women have reported deep dyspareunia with specific positions, which makes sense because the penis can affect the position of the uterus from different angles.

For example, in “doggy style” or other rear-entry positions, the uterus can be pushed forward, while “missionary” or similar positions can cause the uterus to be pushed upward and backward. So, depending on where the endometriosis has grown outside the uterus, some positions may be more painful than others.

A recently published study aimed to explore the relationship between endometriosis and deep dyspareunia.

Specifically, 71 adult women undergoing laparoscopic surgery for endometriosis were surveyed on their dyspareunia pain and which sex positions were most painful for them. During their surgery, the doctors were able to record where the endometriosis was located, allowing researchers to compare painful positions to the location of endometriosis.

Positional Dyspareunia May Depend on Endometriosis Location

Researchers reported 83.1% of patients complained of deep dyspareunia, 7% with superficial dyspareunia, and 9.9% with both. Additionally, 84.7% of these patients developed dyspareunia over time since their first penetrative sexual encounter, while 15.3% had been experiencing dyspareunia for the entirety of their sex lives.

This may have led to avoidance or partial avoidance of sexual activity for 57.4% of patients. Meaning, around half of the patients surveyed have tried to avoid certain sex positions or avoid sex altogether in order to avoid feeling pain during sex.

The survey revealed that 68.3% of patients only experienced dyspareunia in certain positions, with “doggy style” being the most painful. This may be because a large number of patients had endometriosis close to the rectum. Researchers also suggested this may be because positions where the penetrated partner is on all fours may cause faster or more vigorous penetration.

Unfortunately, there is not enough research on endometriosis and dyspareunia to have effective treatment options for positional dyspareunia. However, the simplest way to cope is to try different positions. If rear-entry positions are more painful, it may be less painful to try front-entry positions. Additionally, laparoscopic surgery to remove endometrial tissue may be beneficial until the endometriosis begins to grow again.

Key Takeaways

• Due to the smaller sample size and individualized experiences of patients, no one position can be recommended for pain-free sex.

  • It is recommended to explore what works best for each person and partnership.

• More research is needed on endometriosis and positional dyspareunia in order to understand the best treatment and coping methods.

• It may be beneficial to speak with a sexual healthcare professional if painful, heavy periods and painful sex are affecting your quality of life.

Resources:

Enzelsberger, S.-H., Oppelt, P., Brandstetter, N., Fadinger, N., Ghannadan, S., & Trautner, P. S. (2026). Painful sexual positions in endometriosis patients (the PSST! study): A prospective cohort study.The Journal of Sexual Medicine,23(1).https://doi.org/10.1093/jsxmed/qdaf296