Let’s talk about painful sex and endometriosis

If you have read my personal blog on our homepage, you will know that one of my primary purposes in creating NeuEve was to help couples face the challenges that marriage can present over many years. As Lucy, one of our ambassadors, mentioned in one of her videos, living in a roommate situation with your husband is not what we desire when we get married. So, while researching painful sex, I came across endometriosis. Surprisingly, painful sex, scientifically known as dyspareunia, is one of the major symptoms of endometriosis. Women can experience severe pain during their menstruation due to endometriosis. Fortunately, they can take medications for this. Unfortunately, these medications may not work for relieving sexual pain. I’m sorry, but it gets even worse. The hormonal therapy drugs used to treat endometriosis can cause sexual dysfunction, leading to vaginal dryness, shrinkage, and, of course, painful sex. Here, I had another reason to introduce a natural alternative method that could support women with endometriosis experiencing painful sex.

First things first: What is endometriosis?

Endometriosis is a disease caused by the misplacement of lining tissue, which normally resides inside the uterus, growing outside of it. Common locations include the ovaries, fallopian tubes, and the lining of the pelvis. Occasionally, it may also involve the intestines and urinary tract. Is this too technical? Please let me give you an example. Think of endometriosis as the roots of a tree extending beyond the garden bed. In this case, the tissue meant for the uterus acts like these roots, growing in places it shouldn't—such as the ovaries, fallopian tubes, and the lining of the pelvis. 

Almost all of us know someone who has cysts; that person could even be ourselves. Well, it is related to this. Endometriosis may present a lesion that releases blood. When the ovary is involved, this blood can fill the ovary to form an ovarian cyst, almost like a bunch of cars trapped in an alley or the fake exit of a labyrinth.

For more information about endometriosis, you can visit the Endometriosis Foundation website.

Endometriosis – the lining tissue grows outside the uterus

But you are not a lot: Endometriosis is a collective experience

Numbers don’t lie. Endometriosis affects 10–15% of all women of reproductive age and 70% of women with chronic pelvic pain. Although many women need help, the delay in diagnosing endometriosis is very alarming. Unfortunately, this can result in unnecessary suffering and a considerably reduced quality of life.

1 in 10 women of reproductive age (15-49 years) deals with Endometriosis

176 million women today suffer from Endometriosis

Pay attention to the symptoms

At this point, we already know that due to endometriosis there is a misplacement of the tissue. During menstruation, the misplaced endometrial tissues may also swell, break down, and bleed. This not only sounds painful, it is actually very painful. That’s why the menstrual periods are worse. Do you remember the trapped cars without an exit? Well, since the bleeding from these misplaced tissues does not have an exit, the blood is trapped. We can all anticipate that nothing good could come from trapped blood. This can cause irritation, inflammation, and eventually scars and adhesions to their surrounding tissues. These endometrial scar tissue or adhesions can cause the uterus to stick in a backward position, almost like slowly gluing it in place. Sadly, the potential risk of this is the development of a retroverted uterus.

Symptoms may include:

  • Chronic pelvic pain 
  • Severe pain in the pelvis
  • Increased pain during menstrual periods, bowel movement, or sexual intercourse
  • Fertility may also be reduced.

In addition to the fact that endometriosis is often overlooked, due to the severe pain in the pelvic floor it is commonly misdiagnosed as pelvic organ prolapse, interstitial cystitis, pelvic inflammatory disease, or irritable bowel syndrome.

Interesting fact: To achieve a precise diagnosis, researchers are developing a smart tampon. Once developed, it will hopefully be able to diagnose endometriosis from menstrual fluid extracts.



We can have a very extreme “solution” for severe endometriosis: surgery. The lesions can be removed, like hysterectomy and laparoscopic surgery. However, most women with a mild case manage the condition by non-surgical options. For endometriosis pain management, your doctor may recommend or prescribe the following medication:

1) Painkillers

  • Over-the-counter painkillers (like ibuprofen, acetaminophen, naproxen)
  • Prescription-strength painkillers (like ibuprofen, naproxen)
  • If the pain is not controllable by the above medications, opioids may be prescribed (like hydrocodone with acetaminophen).

2) Hormonal therapy

  • Hormonal birth control (like pills, injection, implants, IUDs)
  • Gonadotropin-releasing hormone antagonists (like Orilissa)
  • Androgenic hormones (like danazol)
  • Aromatase inhibitors: Arimidex (chemical name: anastrozole), Aromasin (chemical name: exemestane), and Femara (chemical name: letrozole).

Painkillers may not work well for painful sex.

These medications can reduce endometriosis pain by anti-inflammation or by suppressing estrogen production. In fact, I used to take them because they may work well for pain associated with the menstrual period. But what about painful sex? Let’s be honest, sex is important, and makes us happy, we deserve to be happy! Conversely, the treatment of endometriosis with hysterectomy or hormonal therapy can cause vaginal dryness and atrophy, which may result in painful sex, loss of libido, and female sex dysfunction.


This is very important, so I will repeat it one more time: endometriosis can grow in different places around the uterus, fallopian tubes, and/or the back of the vagina. This is why women may experience sexual pain differently.

If the endometriosis is behind the vagina in the lower uterus, sex can be super painful, this is known as deep dyspareunia. 

Sometimes endometriosis can grow between the vagina and rectum, causing scars or adhesion of the two tissues. Penetration can pull and stretch the adhered scar tissues, causing pain. 

If the endometriosis is in other places, such as on the ovaries, you may not have painful sex (or maybe you feel less pain). But if endometriosis occurs in multiple pelvic organs and the uterus, sex may be more painful.

Endometriosis may cause painful sex

Some women opt for hysterectomy or hormone therapy to treat their endometriosis. One of the problems with these treatments is the reduction of the level of estrogen, which often leads to vaginal dryness, making sex painful or uncomfortable. 

Endometriosis treatments may not work for relieving painful sex

We already know that when a woman has endometriosis, she may experience painful sex due to inflamed endometriosis tissue. For this issue, an anti-inflammatory painkiller may work. However, commonly painful sex may be because of the stretching of old scars or tissue adhesions which caused by previous endometriosis tissue damages. Anti-inflammatory, as it names states, is for inflammation.  Painkillers may not work on reducing pain caused by pulling old scars or tissue adhesions that have no inflammation.

Treating endometriosis with hormone therapy or hysterectomy may cause vaginal dryness, shrinking, or painful sex. Estrogen is often recommended to reverse vaginal dryness and atrophy, but this can increase the severity of endometriosis. Therefore, estrogen shouldn’t be used to relieve painful sex in women with endometriosis.

Drugs may not ease painful sex in women with endometriosis.

Natural support for women with endometriosis and painful sex

In a world full of chemicals, it’s a real pleasure and privilege to go back to the nature. And ehen estrogen cannot be used, you may try natural alternatives.

NeuEve could be seen as a natural alternative. It works by nourishing the vaginal tissue. And it is also made with natural anti-inflammatory agents for pain relief.

To date, more than 100,000 women with severe vaginal atrophy, including many women with endometriosis, have improved their painful sex by using NeuEve cream and suppositories.

NeuEve Silk suppositories

For women with vaginal atrophy, deep pain in the pelvic floor, and pain associated with penetration, adding dilation exercise can speed up the healing process. The reason is that dilation stretches the atrophied tissue and reabsorption of the scar tissue. It promotes the regeneration of the vaginal lining of skin.

Many of our customers reported excellent results using NeuEve together with a vaginal dilator. We recommend the VuVa Smooth Set of Five Dilators, and the VuVa Neodymium Magnetic Set. These are higher in price, but you’re really getting what you pay for. They are worth it!

These dilators are not our products. They are sold by VuvaTech. For convenience of our customers, we list the product links below: 

Buy Non-Magnetic Pelvic Dilators

Buy Magnetic Pelvic Dilator

Tips about using dilators:

1) Avoid overstretching. It is understandable that one may wish to move up the sizes quickly to get a more rapid recovery. However, this can be counterproductive. The recovery of vaginal atrophy is a slow process. Moving up the dilator sizes too quickly or skipping sizes can cause overstretching, which in turn can tear the atrophied tissue to cause injuries. Please do not skip the sizes and try the largest dilator first. Please be patient and do the exercise with a stepwise increment to avoid possible injuries due to overstretching. Please give one size dilator at least 3-4 weeks to allow the tissue to catch up with the growth before moving up to the next size.

2) Preventing UTI. Physically, dilation exercise is like sexual intercourse. The penetration movement can mobilize bacteria normally on the skin into the bladder to cause UTI. You will need to pee immediately after each exercise to prevent UTI. Urination can flush out any bacteria that entered the bladder during the dilation exercise. Therefore, drinking a lot of water before exercise helps build up the urinating flushing pressure and prevent UTI. If you are dealing with UTIs, you may find support on NeuEve Corsaria, our daily supplement for urinary tract health. 

Disclaimer: This article is for information purposes only. It is about natural products, nutrients, and/or methods for managing vaginal discomfort (not a true infection or disease). It is not medical advice for the treatment of any diseases.

1 comment

  • Amy Watson

    Can endometriosis continue to grow after having had a hysterectomy if they left one of my ovaries? I had severe endo when I was younger and had multiple surgeries to remove it before finally getting the hysterectomy. I have terrible pain with intercourse and atrophy for sure. I’m almost done with my first month of NewEve and I think it’s helping. I’m excited to keep trying but was just curious if this could be part of my problem.

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Dr. Renjie Chang
About the Author

Dr. Renjie Chang's medical and pharmaceutical experience:
- OB-GYN in the Peking Union Hospital in China
- a faculty member of OB-GYN at University of Oklahoma Health Sciences Center
- drug developer at the Abbott Laboratories in Chicago
- Founder of Lavax Inc, where she developed an innovative vaginal microbicide for preventing sexually transmitted disease with grants from NIH and Gates Foundation
- Founder of NeuEve, an all-natural women's health company