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Endometriosis: When Sex is Painful

The medical term for painful intercourse is dyspareunia (dis-puh-ROO-nee-uh), defined as persistent or recurrent genital pain that occurs just before, during or after intercourse. There can be many causes from Vaginismus, psychological issues, stress, surgeries or other medical conditions. I know from having a lick of Vaginismus, that it can be downright painful and debilitating. It can also be difficult from a self-worth standpoint. I know that I personally get a level of self confidence from satisfying my partner in bed and skipping or cutting sex short due to discomfort isn’t my idea of a good time. One of our new readers agreed to do a question and answer session by email to discuss painful sex in her relationship and how she has come to terms with it. With no further ado, please welcome @eve.

Hi Eve and welcome to the site. Can you give us some background about you and your husband?

Like I said in your forum, my husband and I have been together for 8 years and married for 5 years. He is a wonderful man and I am lucky to have him in my life. It was practically love at first sight when we were introduced by a friend. He is very handsome and our personalities are a very good fit for each other. I couldn’t imagine experiencing life without my partner.

We get along quite nicely but recently we’ve been challenged on the sexual side of our partnership. Up until this point, sex has never really been a problem. Once sex becomes a problem for a couple, it can be devastating and tear even the closest of relationships apart. Distant and torn apart is a great way to describe how we began to feel.

That sounds very challenging for both of you. Can you tell us more about the condition and the symptoms that you experienced in addition to the painful sex?

I have a condition called Endometriosis or endo for short and that makes vaginal sex to be increasingly painful. Endo is a condition where the normally occurring endometrium from inside your uterus, grows outside and causes inflammation. This can happen in the ovaries, fallopian tubes or even in your bowels. For mine, this happens in my ovaries and fallopian tubes. Not everyone experiences painful sex and some of the symptoms are painful menstrual cramps, lower back pain, intestinal pain and very painful annual pelvic exams. If you experience any of those symptoms, please do some research and go see your doctor.

There is so much shame with anything female related. I even had a doctor tell me that the pain is all in my head and refused to continue prescribing pain medication for me to take during my periods.

What can you do to fix it? Surgery? Medication?

Birth control pills/hormonal treatment including progestin is the most common. Surgery is also a very common way to remove some of the excessive tissue. Surgery isn’t an option for me due to some other health issues but I’ve been on progestin therapy since November and it seems to be helping somewhat.

How did this impact your sex life and your relationship with your husband?

Sex became increasingly more painful. It doesn’t hurt at first penetration but it hurts as my vagina stretches. Very shallow sex doesn’t hurt so we would limit ourselves to that since that was less painful for me. I tried to mask the discomfort with lots of lube so he can slide in without too much pain but it doesn’t help much.

I know that he needs sex as most of us do but the whole thing made me very resentful. I would dread it and each time he would mention it, I experienced waves of feelings about him not caring about me. While he never actually said that he didn’t care about my experience, I distanced myself from sex and made it about fulfilling a sexual obligation. As a woman, my sexual expectation based on his desire for sex was making me resentful of him and even resentful of my own sexuality. I understand of course that even in a relationship sex is never an obligation to either partner. Even with that, I care deeply about the emotional well being of my chosen partner and tried to make sex and intimacy important. Knowing that physical and sexual fulfillment was essential to his happiness, I made it essential to mine.

The painful sex wasn’t enjoyable to him either. I was rejecting 99% of his sexual advances and kept sex to the bare minimum. When I did accept, I would never be enthusiastic about it. He could see me carefully weighing the amount of time since our last encounter and my struggle about whether I owed it to him yet. I regrettably never really considered his need to feel sexually desirable and now try to stay conscious that desirability is very important to men just like it is for us. Each of our sexual encounters set off in a bad place since he didn’t feel desirable to me even when I accepted.

He started to see me not as an excited partner in his sexual experience but as a wife, fulfilling a sexual obligation. That was in fact my reality and exactly how I felt and he was able to see through my charade. He knew that I wasn’t interested because it hurt and being a great partner, he did not want to hurt me. Not hurting me also meant that his needs must go unmet. The resulting compromise only has two options and they both result in unmet needs and resentment for both partners.

At the beginning of our relationship through the first couple years of our marriage we would have sex three or four nights a week. After the endo set in, we got to the point where we would only have sex once or twice a month. That was just enough to keep the resentment at bay but not enough to give us any sort of meaningful closeness, a meticulous balance.

Can you describe the resentment that you felt?

We both experienced a great deal of resentment and only recently do I feel like we have come to cope with our new sex life. I do quite a bit of research about my condition from forum posts about women living with endo I know that most simply deal with the pain. In many cases, surgery or even pregnancy is able to correct things. For those like me where surgery isn’t an option, a life of unmet sexual needs is the most common theme. Many of them disconnect from their sex lives and the sexual side of their womanhood. This is something that I refuse to do.

Due to our lack of sexual compatibility, my husband resorted to frequent masturbation and his resentment toward me was very obvious. He would masturbate daily and sometimes multiple times a day. Sex began to tear us apart instead of bringing us together. Sexual jokes or any comments regarding the topic would be a absolute turn off and made me feel physically ill since my mind would associate it with the pain of intercourse. I placed the blame for the pain and discomfort on him which made me pull away and push him away emotionally. After some counseling, I realized that from his perspective, he signed up for a marriage with a healthy sex life and was resentful toward me when things changed despite it being outside of my control. Resentment from both sides was eroding away at the intensely close emotional bond that we had always shared together.

You mentioned that you’ve made changes. How are things now with PIV sex?

We tried marriage counseling but the counselor made me feel guilty about what she defined as my unwillingness to have sex. No. I am not holding Yet another example of shaming regarding female problems from the professional community that is supposed to be helping us. Another topic for another blog though, I suppose.

Thanks to your amazing site and other research that I’ve done, we’ve gone to what I consider to be a more alternative sex life. We still have very slow and shallow vaginal sex once a month. I show him on his penis how deep he is allowed to go and although challenging for him at first, he has gotten better. He knows that if he goes deeper than what is comfortable, we stop so it only took a few times for that to sort itself out.

After we are both satisfied with the shallow sex, we also enjoy the closeness of laying in bed with him fully inserted. This can take a few minutes for him to ease it all the way in. I’ll usually wrap my legs around his or he lays on top of me and we accompany this with touching and other body contact. We don’t do much genital to genital movement, simply feeling him inside me and our touching bring a great deal of closeness.

These sexual changes were difficult for him at first since his natural instinct tells him to thrust deep and thrust constantly until completion. The slower and shallower sex would also prevent him from ejaculating so these sessions turned into twenty to thirty minutes of slow sensual sex, touching and intimacy instead of the previous five to ten minutes of fervent humping.

How about pegging how did that come to play?

I read about pegging in your blog but I didn’t expect that he would be interested. During our first few times playing with chastity, I shared your blog with him and explained the chastity benefits that I was seeing after the first few days. The chastity changes weren’t apparent to him but your blog helped him become aware the positive changes that he was going through. After reading through a few of those blogs he timidly agreed to give it a try.

Separately we both became daily readers of your blog and we would both send each other articles. One night he texted me the link while we were laying in bed reading and asked if pegging was something I would want to try. I laughed and said that I would try it but told him he was going to be walking funny for days. We both laughed but he brought it up again the next day and even sent me some links from an online sex toy shop.

We settled on a harness and dildo and waited for them to show up in the mail. We tried it the first night when we got it. We took things very slow. It was awkward and we almost certainly started with too aggressive of a dildo. He selected one that was brightly colored and did not look like a penis because he said that it made it feel less gay (his words). My opinion is that anything between a man and a woman can’t be gay but whatever. We selected the one that he wanted.

I eased it in and was very slow. The feelings were very strange from my end and it didn’t feel natural at all. I really didn’t like it. The hip thrust is awkward and made my ab muscles hurt. He was tense and didn’t seem to be enjoying it either. I stopped and rubbed my nails up his back. His breathing changed and his body loosened up. I felt him breathe and I felt like we got into a groove. Like I said, a smaller toy would probably help but this is the one he wanted. Sex with a guy usually ends with his orgasm but it was up to me as to when it was over. Empowering.

We cuddled after we were done and he was snuggling his body into me. It felt good, we felt closer than we’ve felt in months. Perhaps as close as we’ve ever felt before. I think he felt ashamed for liking it because he smiled when we made eye contact and seemed like an uncharacteristically shy guy that I didn’t even recognize.

I didn’t think much of pegging at the time however I found myself thinking about it for days after. The control, the feeling of his body quivering beneath mine. It wasn’t even a week before I wanted to try it again. Each time I became more comfortable with it and before long I was hooked.

What did you learn from pegging? What could you have done differently?

We should have bought a few toys and allowed him to grow in to his lofty goal for what he would be able to accommodate with his bum. Currently we still have that one toy but we are much better with it now. The first few times, we also didn’t properly prepare his bottom and that caused something of a mess on the towel that was beneath him. An inexpensive anal douche is a necessity and I didn’t read that on any sites including yours. You may want to add something about anal preparation for your readers.

Feeling like I have a very certain measurable sexual power over him is exhilarating. The level of love that I feel from him makes me feel the love right back. When the walls of resentment came down, the quality of our relationship and communication went through the roof.

The biggest thing is understanding the sexual drive that my husband has and not hate him for it. His drive exists and I need to meet him halfway if I want to be in a relationship free of sexual resentment. His sexual satisfaction isn’t my responsibility but guiding his sexual releases to be relationship-positive are. It took me some time to understand that.

How did you handle his masturbation?

I know you preach using cages and chastity devices on this site but that wasn’t a direction that I wanted to go. It seems kinky and not mainstream enough for me to take it seriously. I acknowledged that masturbation is a problem in our relationship that was creating resentment. It was making him dismissive, disrespectful and the closeness and intimacy that we felt was all but gone.

His resentment was manifesting in different ways, teasing me and making me feel a constant level of guilt about his clear sexual dissatisfaction. Some of this was my perception since I felt a great deal of guilt about my disinterest in sex with the man that I held so dear. All of this in stark contrast to a marriage that I otherwise felt wonderful about. It is so confusing how one thing becomes so important when it is missing.

I used your recommendation about orgasm control and created rules for him to orgasm. An orgasm was not permitted without my approval and this took the place of the need for a cage. My husband loves and respects me enough to make a verbal commitment about his self pleasure. We’ve had a mistake or two but I hoped that reducing his orgasm frequency help him open up to me emotionally and reduce his resentment.

We started scheduling some kinky playtime together. It wouldn’t be much but setting three to five minutes a night of just touching him and making him feel important did wonders. The touching was an absolute reward and it would be skipped altogether if he asked for sex or masturbation. This kept my “triggers” to a minimum so I could get back on pace with him sexually.

Reducing his orgasm frequency while making sure that his physical intimacy needs were met did wonders. Once he reached three and four days without an orgasm I saw a distinct change in him. I went from feeling like a burden to feeling like a princess. I felt like I was important to him and he treated me like he did when we were first dating. The magic I read about on this blog and others seemingly appeared overnight.

Now when he is allowed a sexual release, we now accompany it by an orgasm laying beside me in bed or kneeling on the floor in front of me. If I am busy or otherwise occupied, I will still make time. It isn’t hard to lay face down with my bum showing and legs spread slightly to allow him to empty himself out. This doesn’t need to be some big sexual undertaking. If it takes him more than a couple minutes, we stop for the night and try again in a few days when he needs it more or has less on his mind. It shouldn’t take more then three or four minutes for him to empty himself out.

How does your husband feel about all of this?

My husband can become frustrated due to the teasing and the new found infrequency of his orgasms. The frustration is nothing compared to trying to coax me into fulfilling his needs by compromising my own comfort and sanity. Neither of us knew any better but we are both so much happier now.

Overall he absolutely loves the closeness and connection that frequent sex (pegging) allows for us. He loves the innuendo and playful sexual banter that I’ve felt comfortable and emotionally close enough to bring back into our relationship.

Prior to our changes, it would make me feel so angry when he would make sexual jokes because I felt like it was a reflection on my own inadequacy. I felt like each joke was a poke at me rather than just lighthearted fun that was intended. At the same time, he was using the joking as a coping mechanism to try and remind me that he wasn’t getting his needs met. Pegging took some getting used to but he now craves it and thoroughly enjoys our time together regardless of who is penetrating who.

We’ve both acknowledged that painful sex is something that we both bear together. Neither of us should feel guilty and a loving relationship is so much more than monotonous and repetitive sex that many couples endure. My husband is ultimately happy that we found a way to cope with the challenge together and share our love physically, something that we both need in order to feel validated.

Where are you now? How frequently do you do PIV sex vs other things that you’ve described?

We rarely do PIV (painful in vagina) sex anymore. Probably once every month or two but when we do, it does feel better since I’ve lost most of my negative association between sex and my husband. Sex does hurt less now that I have fewer negative thoughts associated with it.

We tease and play regularly (daily) and enjoy pegging a couple times per week as our primary form of sexual connection. Pegging for us has taken things back to the level of sexual satisfaction early in our relationship. Most importantly, this is a sexual secret that I feel like I share exclusively with my husband. Oh and let me tell you, it can be a workout! My thighs and abs have never been in better shape. My husband really just needs to feel physically connected with me and this works incredible. Absolutely no pain for either of us and I get a wonderful emotional connection that was lacking from our PIV sex.

We do limit these masturbation sessions to just four or five minutes to prevent them from turning into a marathon session. If he doesn’t get off by the time my interest begins to wane, I’ll instruct him to save it for the next time when he has a more focused head or feels more inspired. Most of our sexual time is in-person but I’ve grown interested in Emma’s suggestion of only allowing him to masturbate to images and videos of me. He has a folder on his computer with some intimate photos of me along with some videos of us intimate together. We call the folder his spank bank and he is permitted to enjoy it by himself from time to time.

In addition to that we also perform oral sex on each other from time to time. Not too frequently but possibly a couple of times per month. I do enjoy oral sex but it isn’t an everyday craving for me. I also don’t really enjoy orgasming by oral sex but I do like to start things off that way.

If you can’t tell from this piece, we have never felt closer emotionally or sexually than we do right now. All of our health is very fragile and sometimes life throws things our way that require us to change it up. There are many couples who could benefit from looking outside the box when it comes to their sex life. If what you do behind closed doors suits you and your partner, more power to you.

Sex and physical connections are essential to relationships and I regret to say that I wasn’t making it a priority. I value and respect my husband a great deal. The lack of sexual intimacy would have torn many other couples apart. My husband is a wonderful man and I appreciate his willingness to work through this challenge together with me. Forcing painful sex on a partner is never a good long term solution and it makes both partners feel negative energy toward this important physical connection.

That is why I registered and commented on your site. My registration quickly turned into this of which I am grateful. Thank you Emma. Let me know if you want anything else.

Your story was incredible, thank you so much for sharing it with us. I really appreciate you taking time to answer my questions and share your thoughts. I did remove, combine and rephrase a few of the questions and reword a few of your responses for clarity. I hope that others with sexual challenges will read your story. It might just save a relationship or two. If you have questions, please ask below in the comments.

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Eve

This turned out great. Thank you Emma. I can answer some questions if anyone has them.

Vikter

Thank you for sharing. I feel like this is a topic that I know so little about that I don’t even know where to start with questions.

Is endometriosis something that can develop independently. Or is it something that is predisposed and is a matter of time before it appears?

I think it is amazing that you have found a way to conquer something that would have broken lesser couples apart. That took incredible strength and openness from both of you.

Eve

It has been difficult but we are finding our way through it together instead of separately. Thanks to you for your support.

The scary thing about endo is doctors really dont know what causes it. Here are some things I found about it from mayoclinc. Mine first started when I was 17 years but went away until this last bout.

Causes
Although the exact cause of endometriosis is not certain, possible explanations include:

  • Retrograde menstruation. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
  • Transformation of peritoneal cells. In what’s known as the “induction theory,” experts propose that hormones or immune factors promote transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial-like cells.
  • Embryonic cell transformation. Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial-like cell implants during puberty.
  • Surgical scar implantation. After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
  • Endometrial cell transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
  • Immune system disorder. A problem with the immune system may make the body unable to recognize and destroy endometrial-like tissue that’s growing outside the uterus.

Risk factors
Several factors place you at greater risk of developing endometriosis, such as:

  • Never giving birth
  • Starting your period at an early age
  • Going through menopause at an older age
  • Short menstrual cycles — for instance, less than 27 days
  • Heavy menstrual periods that last longer than seven days
  • Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces
  • Low body mass index
  • One or more relatives (mother, aunt or sister) with endometriosis
  • Any medical condition that prevents the normal passage of menstrual flow out of the body
  • Reproductive tract abnormalities

Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis may temporarily improve with pregnancy and may go away completely with menopause, unless you’re taking estrogen.

jd

Hi Eve,

Great story and thanks for sharing it. For me two related things make it so interesting or impressive. One, that you turned painful but traditional sex upside down or inside out to make it pleasurable and more importantly that through chastity or male orgasm control you (or you both) found your way back from perspectives of strong mutual resentment. Obviously love and a desire to find something that would work was a part of this success but your story speaks to the power of a woman controlling a man’s orgasm. I’m curious whether prior to the point where endometriosis and pain made sex unpleasant, and the point where your husband was masturbating regularly had you previously desired to be in control of his orgasms or had you no prior reason to consider it.

JD

HerNeeds

Did he struggle with social stigma of giving up control or manhood? Giving you control of his penis and allowing you to fuck him in the ass is a big step. You have completely turned the tables on the traditional relationship. I support it but this change must have been a big pill for him to swallow.

Eve

I think we were both ready to try anything. This was a stretch from where he was comfortable but he was excited about anything that shifted the focus to sex. Neither of us saw it as giving up manhood. We do make jokes about him being the girl in the bedroom sometimes but those are only jokes. This is purely sexual and neither of us has a desire for panties or cross-dressing or anything like that. Chastity is a bigger pill for him to swallow. To see a grown man whine and complain about being locked up is a sight to see.

We have shifted the relationship to be more female empowered and I make more of the decisions which is part of having a higher level of self confidence. I was feeling very depressed before we made these changes.

HerNeeds

I don’t like your title of painful sex. I almost didn’t click on the email since I thought it would be about some sort of BDSM kinky sex. Maybe something like
living with sexual discomfort
Sexual discomfort reimagined
What to do when sex is painful
When sex hurts how to cope
If your pussy hurts fuck him in the ass

ok skip the last one but I think you can do better with your title.

Eve

Ouch that last one!!! You are too much.

About the title I thought the same thing too but I thought it was just me.

sexual discomfort re-imagined or maybe
endometriosis- sexual discomfort re-imagined

Kevin

Hello, Very nice article (again)! I find myself in your interview (guy side). My girlfriend suffers from vaginismus and we haven’t been doing PIV sex for several years … Unfortunately, we don’t have a relationship as enriched as yours. Very little caress between us and I masturbate to make up for the lack …

Kevin

of course I feel a huge negative resentful … the problem is that I do not live up to my fantasies … I already have a hard time hearing friends say that my girlfriend is in charge, so imagining myself in chastity and sodomizing regularly is really complicated for me even if it turns me on deep down!

Kevin

Hello, your article made me think so I decided to tell my girlfriend about my resentful. Unfortunately she took me on the wrong foot and told me that she definitely no longer wanted PIV sex … It casts me a little more and I do not know what to answer …