Endometriosis and the unspoken cost of painful sex

Sex isn’t supposed to hurt. And yet, for more than half of people with endometriosis, pain during sex, or dyspareunia, isn’t just an occasional discomfort—it’s a given. A sharp, deep ache that makes penetration unbearable, a searing burn that lingers long after, a pelvic tightness so unrelenting it feels like a muscle cramp you can’t shake.

Despite how common this is, most people struggling with painful sex get the same tired responses: “Just try to relax.” As if a little mindfulness could override the fact that their organs are inflamed.

Endometriosis affects between two and 10 women out of every 100. Yet, for all its prevalence and debilitating symptoms, research into the condition remains shockingly underfunded. Social media has been buzzing with a claim that male pattern baldness received five times more research funding than endometriosis in the US—since a receding hairline is more medically urgent than a condition that can fuse organs and hijack someone’s quality of life. Underfunded research into endometriosis means decades-long diagnostic delays, dismissed pain and a glaring lack of resources for symptoms like painful sex.

So what’s actually happening in the body that makes sex feel unbearable? And, more importantly, what can be done about it? We spoke to Dr Sheetal Jindal, senior consultant and medical director at Jindal IVF, and Dr Vanshika Gupta Adukia, founder of Therhappy and a pelvic floor physiotherapist, to break it all down.

What’s causing the pain?

“Endometriosis causes painful sex, particularly deep dyspareunia, due to the growth of endometrial-like tissue outside the uterus,” explains Dr Jindal. “This ectopic tissue can attach to surrounding organs such as the ovaries, fallopian tubes, or pelvic walls, creating inflammation, adhesions, and scar tissue. During deep vaginal penetration, pressure is applied to these affected areas, triggering pain and discomfort.”

Not all pain is the same, though. Deep pain happens when endometriosis lesions spread to ligaments, ovaries, or the rectovaginal area, making penetration feel like a sharp internal wound. Superficial pain (closer to the vaginal entrance) may result from nerve involvement, inflammation, or scarring. Some also experience burning, stinging, or post-sex cramping, thanks to irritated pelvic nerves.

Endometriosis lesions also respond to hormonal changes, which means pain levels can fluctuate throughout the cycle. “As a result, pain often intensifies during menstruation when these tissues swell, break down, and bleed, causing inflammation and irritation in surrounding areas,” says Dr Jindal​.

How the pelvic floor gets involved

Pain triggers a cycle. If sex is painful, the body starts anticipating that pain, causing the pelvic floor muscles to tighten involuntarily, which makes penetration even more painful. “Endometriosis can cause inflammation & adhesions in the pelvic floor that lead to pain and muscle spasm,” explains Dr Adukia. “It can feel like having a muscle spasm in your pelvis, especially after intercourse. The pelvic floor can become tight, weak, or develop trigger points, therefore causing further pain during intercourse.”