Endometriosis & Sexuality

When sexuality is linked to pain or uncertainty

Endometriosis can affect sexuality and intimacy in very different ways. Many people report pain during sex (dyspareunia), reduced sexual desire, or the feeling that touch no longer feels relaxed or easy.

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Sometimes this creates an inner tension: on the one hand there is a desire for closeness and sexuality, and on the other hand there is concern about pain or about the body “not responding.” Even the expectation or memory of discomfort can lead to tension building up before intimacy begins.

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These reactions are not a matter of “not being relaxed enough,” “lack of sexuality,” or problems within the relationship. They are a understandable physical and psychological adaptation to recurring pain, strain, and uncertainty related to endometriosis.

Sexuality may change as a result – and it can also be carefully rediscovered, at a pace that feels safe and right for you.

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Endometriosis explained briefly

Endometriosis is a chronic condition in which tissue similar to the lining of the uterus can grow outside the uterus.

Possible symptoms include severe menstrual pain, persistent pelvic pain, fatigue, digestive issues, or difficulty becoming pregnant.

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One aspect that is often confusing: the intensity of pain does not always match what is seen in medical examinations. Research also suggests that, in some people, the nervous system’s pain processing becomes more sensitive – especially when symptoms persist over time. This indicates that the body and nervous system can change their response to stimuli over time.

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How endometriosis can affect sexuality and relationships

Pain during sex is commonly reported. In addition, the body may unconsciously tense up as a protective reflex. Some people notice that arousal becomes harder to access, or that relaxation no longer happens “automatically.” Fatigue also plays a role. When everyday life already requires a lot of energy, less capacity remains for desire or curiosity.

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When sex is associated with pain, pressure can build quickly. Fear of discomfort may lead to avoidance of closeness, followed by guilt or misunderstandings – making the next situation no easier.

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In relationships, this can create uncertainty on both sides. One person wants closeness, the other does not want to cause pain. Or things become unspoken because no one wants to say the “wrong” thing. This dynamic is common – and it can be worked through.

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Many people also report that medical consultations leave little space for sexual topics. This can add to feelings of isolation, even though the issue is widespread.

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How I support you with endometriosis and sexuality

Endometriosis does not only affect the body. Many people experience that pain, fatigue, and ongoing uncertainty also influence sexuality, intimacy, and relationships.

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In sex therapy, the goal is not to “remove” symptoms or to restore sexuality to how it used to be. Instead, we look together at what has changed, how this affects your experience, and what feels meaningful and possible today.

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My approach is evidence-based, trauma-informed, and oriented toward the lived experiences many people with endometriosis face in everyday life.

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Rebuilding a sense of safety in your body

When sexuality has been linked to pain or uncertainty over time, the body often becomes more cautious. Some people notice tension already when thinking about intimacy. Others feel tense during sexual situations, monitor their body closely, or find it difficult to engage in closeness.

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Together, we explore what happens for you: What thoughts arise? How does your body respond? What creates stress or pressure?

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The aim is not to force anything, but to gradually rebuild a sense of safety and trust in your own perception. Body-based exercises, mindfulness approaches, or strategies for dealing with rumination and tension can be helpful here.

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Talking about pain, needs, and boundaries

Endometriosis can also put strain on relationships. Many people do not want to disappoint their partner, feel misunderstood, or struggle to talk about pain and uncertainty.

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In therapy, we can develop a shared language for these experiences. How can you talk about symptoms without having to justify yourself? How can boundaries be communicated without guilt? And how can the need for closeness and consideration both have space?

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If desired, partners can be included in individual sessions.

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Redefining intimacy

Many people feel relief when sexuality is no longer under pressure to follow a specific script.

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Intimacy can take many forms: touch, closeness, physical contact, shared sensuality, or sexuality at a pace that feels safe. Often, more space opens up when the focus is no longer on whether pain might occur or whether everything “has to work.”

Sex therapy often involves discovering new possibilities for closeness and understanding what feels comfortable, safe, and right for you.

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Collaboration with other healthcare professionals

Endometriosis is a physical condition. Therefore, it can be helpful to combine sex therapy with medical treatment.

Depending on the situation, collaboration with gynecology, pain medicine, or pelvic floor physiotherapy may be useful. This can help differentiate which symptoms are medically treatable and where psychological or sex-therapeutic support can provide relief.

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Limitations

Sex therapy is not a medical treatment for endometriosis. I do not provide diagnoses and do not replace medical assessment.

Please seek medical evaluation if, for example:

• pain is new, significantly worse, or unusually persistent

• bleeding is unusual

• fever or signs of acute inflammation occur

• or you are unsure about what is happening in your body

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Safety note: In case of acute crisis or suicidal thoughts, please seek immediate help (emergency number 112 in Germany) or anonymous support, e.g. TelefonSeelsorge (116 123). In Berlin, the Berliner Krisendienst is also available.
 

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How the process works

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• Free initial consultation (approx. 20 minutes): We clarify your concerns and whether the offer feels right for you

• Sessions: 50 minutes, weekly or biweekly

• Format: primarily online; in-person sessions in Berlin are possible

• Confidentiality / data protection: confidentiality and GDPR-compliant procedures

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If you would like to explore whether this form of support feels right for you, you are welcome to book a free initial consultation.

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References​​

Amza, M., Sima, R.-M., Conea, I.-M., et al. (2025). The impact of endometriosis on patients’ quality of sexual life. Journal of Medicine and Life, 18(2). https://doi.org/10.25122/jml-2024-0262

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Capezzuoli, T., Maseroli, E., Barra, F., et al. (2023). Endometriosis and sexual disorders: The effect of surgical and medical treatment, a multicentre cross-sectional study. F1000Research, 12, 1424. https://doi.org/10.12688/f1000research.141537.1

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Davenport, R. A., Mills, J., McHardy, H., et al. (2025). “No doctor ever asked me…” Barriers and facilitators to sexual health communication in general practice. Journal of Sexual Medicine, 22(1), 26–35. https://doi.org/10.1093/jsxmed/qdae145

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Nikseresht, M., Hafizi, L., Erfanian Arghavanian, F., et al. (2025). CBT and sexual satisfaction in women with endometriosis: A randomized clinical trial. Journal of Midwifery and Reproductive Health, 13(3), 4897–4909. https://doi.org/10.22038/JMRH.2023.72973.2134

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Law, C., Hudson, N., Mitchell, H., Culley, L., & Norton, W. (2024). ‘You feel like you’re drifting apart’: Impacts of endometriosis on sex and intimacy in heterosexual couples. Sexual and Relationship Therapy. https://doi.org/10.1080/14681994.2024.2306316

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Shinan-Altman, S., et al. (2024). Her, his, and their journey with endometriosis: A qualitative study. Frontiers in Global Women’s Health, 5, 1480060. https://doi.org/10.3389/fgwh.2024.1480060

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Jia, S.-Z., Leng, J.-H., Sun, P.-R., & Lang, J.-H. (2013). Prevalence and associated factors of female sexual dysfunction in women with endometriosis. Obstetrics & Gynecology, 121(3). https://doi.org/10.1097/AOG.0b013e3182835777 (PMID: 23635624)

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Szypłowska, M., et al. (2023). The impact of endometriosis on depressive and anxiety symptoms and quality of life: A systematic review. Frontiers in Public Health. https://doi.org/10.3389/fpubh.2023.1230303

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ESHRE Guideline Group. (2022). ESHRE guideline: endometriosis. Human Reproduction Open, 2022(2), hoac009. https://doi.org/10.1093/hropen/hoac009

World Health Organization. (2025). Endometriosis – Key facts. (Fact sheet).

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Zhu, X., Wu, Y., Jia, J., Zhao, X., & Zhao, X. (2023). Impact of endometriosis on female sexual function: An updated systematic review and meta-analysis. Sexual Medicine, 11(2), qfad026. https://doi.org/10.1093/sexmed/qfad026

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del Pino-Sedeño, T., Cabrera-Maroto, M., Abrante-Luis, A., et al. (2024). Effectiveness of psychological interventions in endometriosis: A systematic review with meta-analysis. Frontiers in Psychology, 15. https://doi.org/10.3389/fpsyg.2024.1457842

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Evans, S., Fernandez, S., Olive, L., Payne, L. A., & Mikocka-Walus, A. (2019). Psychological and mind-body interventions for endometriosis: A systematic review. Journal of Psychosomatic Research, 124, 109756. https://doi.org/10.1016/j.jpsychores.2019.109756 (PMID: 31443810)

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Orr, N. L., et al. (2023). Association of Central Sensitization Inventory scores with pain outcomes after endometriosis surgery. JAMA Network Open, 6(2), e230780. https://doi.org/10.1001/jamanetworkopen.2023.0780 (PMID: 36848090)

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NICE. (2017, aktualisiert). Endometriosis: diagnosis and management (NG73). National Institute for Health and Care Excellence.

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FAQ​

Should I have symptoms medically checked before starting sex therapy?

If pain is new, worsening, or clearly changing, medical evaluation is recommended. Endometriosis can cause a range of symptoms, but other physical factors can also contribute to pelvic or abdominal pain.

Medical assessment can help identify treatable causes and provide more clarity and safety in dealing with symptoms.

Sex therapy does not replace medical diagnosis or treatment, but it can be a valuable complement – especially when pain, anxiety, or distressing experiences affect sexuality, intimacy, or relationships. Often, the focus is on dealing with fear of pain, avoidance, tension, shame, or difficulties expressing needs and boundaries.

Medical and psychosexual support do not exclude each other – many people find the combination particularly helpful.

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Can sex therapy help with pain during sex?

Sex therapy can be helpful when pain during sex, fear of pain, or the ongoing expectation of discomfort begins to affect sexuality and intimacy.

We look together at how symptoms influence your experience: Do you feel tension before sexual situations? Do you avoid certain forms of closeness? Do you feel pressure or shame about the changes?

The goal is to develop more safety, self-determination, and choice in dealing with sexuality. Many people experience relief when sexuality is no longer shaped by fear, performance pressure, or constant caution.

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Does my partner need to come along?

No. Many people begin sex therapy on their own.

Often, the first step is to better understand one’s own experience, find words for what is happening, and develop more safety in dealing with pain, boundaries, or uncertainty.

If helpful, partners or other relationship figures can be included in individual sessions later on, especially when misunderstandings, withdrawal, or uncertainty affect the relationship.

The aim is to develop a shared way of dealing with challenges so that closeness remains possible and the needs of everyone involved are taken into account.

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What if I have little or no sexual desire?

Many people with endometriosis experience phases of reduced sexual desire. This is often a understandable response to pain, exhaustion, stress, or fear of symptoms.

Reduced desire does not automatically mean that something is “wrong” or that sexuality is permanently lost.

Sex therapy is therefore not about producing or restoring desire. It is often more helpful to understand what conditions make desire difficult and what the body currently needs to feel safe and relaxed. From there, new possibilities for intimacy can often emerge.

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What does “intimacy without penetration” mean?

Many people unconsciously equate sexuality with penetration. When penetration is painful or anxiety-provoking, this can quickly create the feeling that sexuality itself is limited.

However, intimacy is much broader. It can include touch, cuddling, massage, mutual erotic attention, shared sensuality, or other forms of physical and emotional closeness.

In sex therapy, the focus is often on expanding this perspective and discovering which forms of intimacy feel comfortable, safe, and right for you.