Why are sexual women still being hushed when it comes to the reality of endometriosis and sex? Why is female sexual functioning still being overlooked, dismissed and not prioritised as an integrative part of treatment plans for the condition?
Welcome to the Hey Gyno! Blog Series, by Clinical Sexology Psychotherapist, Orlagh Reid, a sexual wellness blog for women in Ireland living with conditions such as vaginismus, vulvar pain, endometriosis, and sexual dysfunction in Ireland and beyond. Gyno comes from the Greek word gyne, which means woman or female.
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In this blog, I share my opinion on Sex and Endometriosis and the reality that, despite Endometriosis being a gynaecological condition, it is rarely discussed or acknowledged, and that there is a significant impact on women’s sexual functioning. This is a conversation we need to change and not be afraid to have.
‘A recent European cohort study reported that 75.7% of women with endometriosis experience dyspareunia.’
We also know that endometrial tissue affects more than the female reproductive organs, often spreading around the bowels, outside of the uterus and into the pelvic region, even affecting the diaphragm and chest cavity. This condition causes a wide range of complex symptoms, including chronic pelvic pain, inflammation and chronic fatigue.
Fact: Endometriosis affects sexual functioning, desire, and libido
There is a glaring and enraging reality about life with endometriosis and the impact on sexual women of every age and stage. I have noticed over the years, both as a women’s health psychotherapist and endo patient myself, that the most overlooked aspect of life with this chronic condition, which also causes female chronic pelvic pain (CPP), is that rarely is it acknowledged or discussed the real impact on sexual functioning and sexual health. Sex and endometriosis are the one part that gets hushed all the time.
Also noted on numerous occasions, that often there is an overemphasis on the topic of endometriois and fertility and yet still little acknowledgement of what this means for a couple’s sex life. I feel that there is still not enough emphasis on women, gay or straight, at other ages and stages outside of the fertility phase, including those women who may choose not to have children, menopausal women and also younger women who are beginning to explore and experience sex with a partner for the first time. Sex remains the hush-hush topic when it comes to endo, despite it affecting our sexual health and sexual functioning.
When discussing the conditions of Endometriosis and Adenomyosis, it seems that sex and female sexual function are the topics that keep being avoided and dismissed. So much so, in fact, that even the Endometriosis Association of Ireland, which holds an annual conference every year, refrain year on year to address directly the impact on sexual functioning in women which is such a shame.
Women of all ages and stages want to be able to talk, learn and understand what this means for them, how to navigate sex with endo and find ways to embrace and not reject sexual intimacy in other ways. And let’s not forget their partners and the impact on the couple.
Similarly, the ‘National Framework For The Management Of Endometriosis In Ireland‘, published in October 2025, to my shock and disappointment, makes almost no reference or acknowledgement to the impact on female sexual functioning, arousal, libido, and sexual disorders. Endometriois causes pelvic and sexual pain!
“It is very hard to feel relaxed, playful, provocative or sexually carefree when your vagina, vulva and reproductive organs have been the source of so much discomfort for years.”
Now, living in Ireland, I can’t say that this is culturally surprising. But, at what stage do we stop waiting for permission to be honest and openly start to bring sexual health and happiness into the conversation about a condition that is directly related to the female reproductive system – and the intimate partners in our lives?
Let’s be honest
Let’s be even more honest for a moment. When we talk about endometriosis, we talk rightly about pain, fertility, surgery, treatment, fatigue symptoms, hormones and lifestyle medicine to mention the obvious. But one of the most quietly distressing and persistently under-discussed realities for many women is the impact on sexual health and functioning. I’m going to say it again, many aspects of endometriosis affect our sex life….period.
Chronic pain, fatigue, excessive bleeding, persistent bleeding, discharge, penetration pain, heavy periods, painful periods, bloating, endo belly, lower libido and the impact on desire, libido, feeling unsexy, feeling unwell, and generally feeling uugghhh. Sex with endo – no thanks. Foreplay with endo – no thanks. Spontaneity might go out the window for many women.
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In my private psychotherapy practice, these common realities of sex with endo come up far more often than most people would expect. If you have ever felt the same, I guarantee you are not alone. As an endo sufferer, I like to tease out with my clients the frank and honest reality of endo. I am very intentional about asking all women about their sexual health, sexual functioning, their sex life, and how intimacy feels to them – in their head and body. We discuss this topic in detail, not to find a fix, but to create an honest, open space to share the challenges and identify solutions to improve overall sexual health and happiness.
What women say about sex and endometriosis
Women will often lean in and say some version of: “It’s not that I don’t love my partner…” or “I do still fancy them…” — and then comes the sentence they’ve usually never said out loud before.
Sex has started to give them the ick.
Sex is complicated now.
Sex is off the table for me.
Endometriosis took my sex life.
I don’t trust my body any more.
I bleed too often now and avoid intimacy, just in case.
Sex is so far from my mind, but I feel… guilty, bad, embarrassed, bloated, unsexy all the time.
It’s often not because desire has disappeared. Not because attraction is gone. Not even because libido is low, but because living in a body with endo, inflammation, chronic pelvic pain, fatigue, unpredictable bleeding, discharge, and medication side effects makes sex feel rather… unsexy. Spontaneity feels almost impossible. Pain overrides arousal.
You might like to read...[Endometriosis: Your Pain is Real. Period.]
It is very hard to feel relaxed, playful, provocative or sexually carefree when your vagina, vulva and reproductive organs have been the source of so much discomfort for years. Or what about when you are worrying about your lovely, clean bed sheets and fear that due to bleeding during intimacy, it might be awkward or messy after. That is a reality, right?
Endometriosis directly affects our sex life and sexual functioning
This is the piece that is so often missing from the conversation.
European research has been clear for some time that endometriosis significantly affects sexual function. A large meta-analysis published in Archives of Gynaecology and Obstetrics found that women with endometriosis scored significantly lower across all domains of the Female Sexual Function Index — not just pain, but desire, arousal, lubrication, orgasm, and satisfaction.
In other words, this is whole-body, whole-experience sexual disruption.
We also know how common painful sex is. A recent European cohort study reported that 75.7% of women with endometriosis experience dyspareunia. That is three out of four women navigating intimacy alongside pain.
And importantly, research from Italy has shown that poorer sexual function in endometriosis is strongly linked not only to deep and introital dyspareunia, but also to infertility stress, fatigue, and psychological factors. This fits very closely with what many of us see clinically: sexual wellbeing in endometriosis is biopsychosocial, not purely physical. The literature we all ready just keeps overlooking these facts, leaving women feeling well… left out
The day-to-day reality of endometriosis
But here is what the research papers don’t always capture — the day-to-day lived reality of many endo sufferers.
Many of my clients describe the quiet logistical barriers that slowly erode sexual confidence over time.
It is a need to shower frequently because of ongoing spotting or discharge.
It is wearing pads daily, not just during periods, due to breakthrough and persistent bleeding or simply to feel clean and safe.
It is the mental load of wondering, Will I bleed? Will it hurt later? Will I flare tomorrow?
It is the reality that “sexy underwear” quietly drops down the priority list when comfort, protection, and pain management become daily negotiations.
None of this is about women being uninterested in sex. It is about how difficult it can be to access spontaneity, embodiment, and sexual ease when you are managing a chronic pelvic pain condition in real time.
Add in hormonal treatments, pain medications, fatigue, fertility stress, and nervous system dysregulation, and it becomes very understandable why desire can feel more complicated — or why sex can start to feel emotionally loaded even when love and attraction are still very much alive.
This is exactly why we need a more compassionate, sex-positive, whole-person conversation in endometriosis care. Because difficulty with sexual wellbeing in endometriosis is common, and it is supportable.
Support might look like pain-informed sex education, pelvic health physiotherapy, psychosexual therapy, medication review, better partner communication, or simply giving women permission to redefine what intimacy looks like at this stage in their lives.
Take a read of the Hey Gyno! Blog and Vaginismus Blog Series for more articles and a special guest interview on endometriosis and female sexual health and wellbeing with Orlagh Reid.
There is no one-size-fits-all pathway here. Your journey is about what feels best for you. But silence, shame, retreating from sex and white-knuckling through painful sex are absolutely not solutions. It is important to start talking about what you are going through to find the right solution or solutions for you
Women with endometriosis are adults with sexual lives, sexual identities, relationships, and bodies that deserve pleasure as well as pain relief. Women, it’s time we started making space for both of these realities and take small, simple steps to make you feel more comfortable in your body, more comfortable in intimacy, whatever that looks like for you today and to feel back in control of your sex life.
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