In this guest blog, sex educator specialist and sexologist Kiki Maree, one of Comfortable In My Skin’s Recommended Providers, shares what you need to know about pelvic pain during penetration.

For people with endometriosis, deep pelvic pain during penetration is a common and frustrating experience. This pain often occurs because endometrial lesions, adhesions, or inflammation make the pelvic tissues more sensitive. The uterus, ovaries, and ligaments can be affected, leading to discomfort when pressure is applied in certain areas. However, the right sexual positions and adjustments can significantly reduce pain and enhance pleasure.

Why Does Penetration Cause Deep Pelvic Pain?

Endometriosis can cause:

• Inflamed or scarred tissue, making deep pressure painful.
• Tension in pelvic floor muscles, leading to tightness and spasms.
• Adhesions pulling on internal organs, increasing discomfort with movement or pressure.
• Increased nerve sensitivity, making even light penetration painful.

If deep penetration triggers pain, experimenting with positions that allow you to control depth and angle can help.

Sex Positions That Can Reduce Pain

Not all positions will feel the same for everyone, but these adjustments may help:

1. Spooning (Side-Lying)

• Why it helps: Allows for shallow penetration and minimizes direct impact on tender areas.
• How to do it: Both partners lie on their sides, with the receiving partner’s back against the giver’s front. The receiving partner can adjust their leg position to control penetration depth.

2. Face-to-Face (Partner on Top)

• Why it helps: Being on top allows you to control depth and speed.
• How to do it: Lay on your partner, which gives you more ability to control depth, tilt your pelvis, and find the most comfortable angle.

3. Modified Missionary (Pillow Support)

• Why it helps: Adjusting hip elevation with a pillow can shift the angle away from painful areas.
• How to do it: Place a pillow under your lower back or hips and ask your partner to go slower while focusing on external stimulation.

4. Cowgirl and Reverse Cowgirl (Leaning Forward)

• Why it helps: These positions allow you to control depth and rhythm. Leaning forward can reduce pressure on the pelvic floor.
• How to do it: Instead of sitting upright, lean forward onto a pillow or bed while straddling your partner to minimize deep impact.

5. Doggy Style (Modified Angle)

• Why it helps: Traditional doggy style may be too deep, but modifying the angle can make it gentler.
• How to do it: Tilt your pelvis to one side for a softer entry and avoid deep penetration.

Other Tips for More Comfortable Sex

• Wait until aroused: Extend foreplay for at least 20 minutes before penetration so your vaginal canal has lengthened and widened.
• Use plenty of lubricant: Pain can be worsened by dryness. A high-quality water- or silicone-based lubricant can reduce friction.
• Move slowly and mindfully: Communicate with your partner about going slow and checking in on what feels good.
• Engage in external play: If penetration is painful, focus on outer stimulation, including oral, fingers, or toys that don’t require deep insertion.
• Try the OhNut: This tool can help by shortening the length of the penetrative object.
• Consider pelvic therapy: Working with a pelvic floor physical therapist or a yoni massage practitioner can help relax tight muscles and reduce discomfort.

Sex with endometriosis doesn’t have to be painful or avoided altogether. By experimenting with different angles, depths, and movements, you can reduce discomfort and find what works best for your body.

Kiki Maree (she/her) is an inclusive Sex Educator specialising in female sexuality, and intimate relationships. She has a PgD in Sexology and is the CEO of the Yonilicious Academy, where she offers high quality, internationally recognised certified trainings. Kiki is a trauma-informed practitioner and educator, and is known for her holistic, playful and vastly knowledgeable approach to sex education. Book with her here.