Sex File: I have endometriosis and feel guilty that we can't have proper sex

My endometriosis means penetrative sex can be very painful

Mon, 02 Feb, 2026 - 15:38

Suzi Godson

I have endometriosis, which means that penetrative sex can be very painful. My partner is very understanding but the guilt I feel for depriving him of "proper" sex never seems to leave me. How do I get over this?

One in 10 women worldwide has endometriosis, but by the time they get a diagnosis, most have been suffering for years. It is a chronic condition where tissue similar to the uterine lining grows outside the uterus, often on the ovaries, fallopian tubes or the pelvic lining, causing a range of symptoms including inflammation, pain, bleeding, bladder and bowel issues, and fatigue. Sexual pain is the third most commonly cited symptom.

When sex is repeatedly painful, many women can become stuck in a vicious cycle. Anxiety and fear lead to avoidance, which dampens libido and impairs arousal. Even when women with endometriosis really want to have sex, fear of pain can make them tense up, causing the pelvic floor muscles to contract, which makes penetration more difficult. Even certain aspects of foreplay can trigger anticipatory anxiety that closes down arousal.

The physical symptoms of endometriosis can be horrendous but the psychological impact can be just as problematic. In 2023, a systematic review of research on the impact of the disease found a strong association between higher rates of depression and anxiety symptoms and pain associated with endometriosis.

The condition doesn't only affect the woman who endures it — her relationship also bears the weight of her pain. Being unable to engage in intercourse leaves you feeling inadequate, guilty and less confident.

I'm sure your partner feels empathy for you but he probably also feels a certain amount of sadness and impotence because he can't help. He may also be reluctant to initiate sex for fear of causing you pain. Talking to each other about the complexity of your situation is crucial to maintaining intimacy and closeness.

You've clearly got medical support in place, and hopefully you are seeing a pelvic health physiotherapist. Dealing with your feelings requires psychological support — it would be a good idea for you to seek some professional help with this together.

That you have a debilitating condition is not your fault, and penetration is not the be-all and end-all. Bear in mind the majority of women don't orgasm through penetrative sex. Research suggests fewer than one in five women report intercourse alone is sufficient for orgasm. Most require or prefer clitoral or other forms of stimulation.

When you expand your understanding of what constitutes "sex" so that you include everything besides intercourse, you realise penetration is actually a very small part of your erotic life. As long as you are both satisfied and feel sexually and emotionally connected, there is nothing to feel guilty about at all.