Endometriosis, Sex & Pelvic Health: Finding Hope Through Physiotherapy

By Kristen Parise, Pelvic Health Physiotherapist

For many people living with endometriosis, the journey can feel isolating, frustrating, and at times, hopeless. The pain during your period might be just the beginning—pain with sex, urinary issues, bowel problems, and overwhelming fatigue can become unwelcome companions in your daily life. If this sounds familiar, I want you to know something important: You're not alone, and there is help available.

At Blueberry Therapy, we see many clients with endometriosis, and we understand the complex physical and emotional challenges that come with this condition. Today, I want to share some insights about endometriosis, how it affects intimacy and pelvic function, and most importantly, how pelvic health physiotherapy can offer real hope and relief.

Understanding Endometriosis: Beyond "Just Period Pain"

Endometriosis occurs when tissue similar to the endometrial lining of the uterus grows outside the uterus. This tissue responds to hormonal changes throughout your cycle, potentially causing inflammation, adhesions (internal scarring), and pain.

Where is this tissue found? Common locations include the ovaries, fallopian tubes, the outside of the uterus, the ligaments around the uterus, and the space between the bowel and bladder. These adhesions can impair mobility of pelvic structures or cause organs to "stick" together.

It's far more common than you might think. Approximately 1 in 10 people with uteruses has endometriosis—that's roughly 190 million people worldwide. And yet, it typically takes 8-12 years to receive a diagnosis. This delay means many suffer needlessly for years, often being told their symptoms are "normal" or "just part of being a woman."

When Sex Becomes Painful: The Endometriosis Connection

One of the most common yet least discussed symptoms of endometriosis is pain with sexual activity. This pain can range from mild discomfort to severe, burning pain that might linger for days after intimacy.

Why does this happen? There are several reasons:

• Limited mobility due to adhesions: Endometrial lesions or adhesions behind the uterus limit the normal movement of pelvic organs during penetration.

• Inflammation: Endometriosis causes chronic inflammation within the pelvis, which can heighten sensitivity and pain responses.

• Muscle guarding: Your pelvic floor muscles wrap around the vaginal opening and anus. When there's pain or inflammation in the pelvis, these muscles can tense up as a protective response.

• Pain-guarding cycle: When sex is painful, your brain remembers this experience and may signal your muscles to tense up in anticipation, creating a cycle of increasing tension and pain.

  
  

This experience can deeply affect intimate relationships and self-esteem. Many clients tell us they've started avoiding sex altogether, leaving them feeling disconnected from their partners and their own bodies.

Beyond Sex: Bladder and Bowel Symptoms

Endometriosis doesn't just affect sexual function. Many people also experience urinary urgency, frequency, and even incontinence. Bowel symptoms like painful bowel movements, constipation, or diarrhea (especially during periods) are also common.

These symptoms occur because:

• Endometrial tissue may directly affect the bladder or bowel

• The pelvic floor muscles that help control bladder and bowel function can become dysfunctional when they're chronically tight or in spasm

• The nervous system can become sensitized, amplifying normal sensations and creating urgency

  
  

How Pelvic Health Physiotherapy Can Help

This is where the hopeful part of our story begins. Pelvic health physiotherapy offers evidence-based, non-surgical approaches that can significantly improve quality of life for people with endometriosis.

Here's how we help:

1. Addressing Muscle Tension and Pain

Your pelvic floor muscles can become tight, tender, and protective in response to endometriosis pain. Through gentle, specialized techniques, we help release this tension, decrease pain sensitivity, and restore normal muscle function.

2. Breaking the Pain-Guarding Cycle

We work with you to retrain your nervous system and pelvic floor muscles to respond differently. Through breathing exercises, mindfulness techniques, and gentle progressive exercises, we help reduce the automatic guarding response that contributes to pain.

3. Improving Pelvic Organ Mobility

Specialized manual therapy techniques can help improve the mobility of pelvic organs affected by adhesions, reducing pain with movement and during sex.

4. Reconnecting With Your Body

Many people with chronic pelvic pain become disconnected from their pelvis as a protective mechanism. We provide safe, supportive guidance to help you reconnect with and reclaim this part of your body.

5. Managing Bladder and Bowel Symptoms

Through targeted exercises and behavioral strategies, we can help reduce urinary urgency, frequency, and improve bowel function.

6. Education and Self-Management

Perhaps most importantly, we empower you with knowledge and practical tools to understand and manage your symptoms day-to-day.

Real Hope, Real Results

While endometriosis is a chronic condition without a simple cure, pelvic health physiotherapy can make a significant difference in symptom management and quality of life. Many of our clients who once thought they would have to live with painful sex forever have been able to return to comfortable, pleasurable intimacy. Others who struggled with constant bladder urgency or bowel issues have found reliable management strategies that have given them freedom and confidence.

Here's what can change with proper treatment:

• Reduced pain during and after sex

• Improved pelvic floor muscle function

• Better bladder and bowel control

• Decreased overall pelvic pain

• Improved ability to engage in desired activities

• Greater understanding of your body and symptoms

  
  

A Compassionate Approach to Treatment

At Blueberry Therapy, we understand that discussing intimate issues like painful sex or incontinence can feel uncomfortable. Our team creates a safe, judgment-free environment where you can speak openly about your symptoms and concerns.

Treatment plans are always individualized to your specific needs and comfort level. For some, this might include:

• External and internal pelvic floor muscle assessment and treatment

• Breathing and relaxation techniques

• Guidance on resuming comfortable sexual activity

• Dilator therapy for painful penetration

• Education about tools like The Ohnut (a penetration buffer)

• Coordination with your medical team

  
  

Finding Joy Again: Beyond Pain Management

An aspect of treatment that's often overlooked is helping people reconnect with pleasure and joy. After experiencing chronic pain during intimate activities, many develop fear and anxiety around sexuality.

Part of our approach involves helping you rediscover non-sexual pleasures first—enjoying a warm bath, savoring a delicious meal, or feeling the comfort of soft fabric against your skin. These experiences help retrain your brain to associate touch and sensation with pleasure rather than pain.

From there, we can gradually work toward comfortable, enjoyable sexual experiences, whether solo or with a partner. The goal isn't just to reduce pain but to help you reclaim a fulfilling, joyful intimate life.

You Don't Have to Face This Alone

If you're living with endometriosis and struggling with painful sex, urinary issues, or other pelvic symptoms, please know that help is available. Pelvic health physiotherapy can be a crucial part of your care team, working alongside medical management to improve your quality of life.

At Blueberry Therapy, we're committed to providing the compassionate, expert care you deserve. Our team understands the complex nature of endometriosis and works with you to develop personalized strategies that address your specific concerns and goals.

Your pain is real. Your experiences matter. And there is hope for improvement.

Take that first step toward reclaiming your body and your life. Reach out to our team to learn more about how pelvic health physiotherapy can help you navigate life with endometriosis.

Want to learn more about endometriosis and pelvic health? Check out our podcast "The Hole Shebang" where we dive deeper into topics like these with experts in the field. And don't miss our upcoming conference "The Pleasure Principle" on May 30, 2025, at McMaster Innovation Park where we'll be discussing women's sexual health throughout all life stages.