Pain during penetrative sex, also known as dyspareunia, is a common symptom of endometriosis. It’s also a symptom of vaginismus, which is a separate gynecological condition. Although some experience both conditions, it’s unclear how common this is.

Endometriosis occurs when uterine-like tissue grows outside of the uterus. Vaginismus occurs when the vaginal muscles automatically tighten when penetration is attempted.

It’s possible that for some, this pain would be diagnosed as vaginismus — particularly because people may become anxious during sexual encounters, which may then trigger the tightening of the vaginal muscles.

But pain during sex for people with endometriosis isn’t always vaginismus. It may be caused by the lesions themselves or a symptom of another pain disorder.

In a 2023 study of 2,060 people with endometriosis, 80% of participants reported that the condition had a negative impact on their sex lives. Roughly 67% of participants reported avoiding penetrative sex due to their endometriosis.

A small 2011 study found that 40% of people who had chronic pelvic pain due to endometriosis also experienced sexual symptoms, including vaginismus.

But it’s hard to say how strong the link between endometriosis and vaginismus is. Vaginismus is often undiagnosed or misdiagnosed as purely psychological.

Plus, pain during or after sex in people with endometriosis isn’t always vaginismus, as other research points out.

A lack of lubrication and vulvodynia — which is unexplained pain in the vulva — may also be the root cause of such pain. Lesions from endometriosis itself may also cause a similar kind of pain.

Pain during or after sexual activity can have many causes. For example, illnesses and infections can trigger sexual pain. Stress, anxiety, and other mental health conditions can have a similar effect.

Generally, pain in this area is split into pain felt in the vagina and pain inside the pelvis.

As well as infections, pain in the vagina can be caused by the likes of vaginal dryness, which can be a result of changing hormone levels or lack of arousal.

Irritations and allergies to cleansing products or condoms can also play a role.

Pelvic pain may have more serious or long-term causes. Endometriosis is one of those, along with pelvic inflammatory disease and fibroids.

People who have gone through menopause may take medications that can lead to vaginal dryness. Ad those with a viral or bacterial infection are generally thought to have a higher risk of pain during or after sex.

It can be difficult to figure out whether sexual pain is the result of endometriosis or a pain disorder.

Endometriosis pain can be more deep-set due to the location of lesions. People may feel pain in their stomach area, for example.

Depending on where the endometrial lesions are, people may find certain sex positions more painful than others, particularly if they stretch or pull on the growths.

Sharp, stabbing-type pain, along with cramping, can also be linked to endometriosis. However, the severity can vary from person to person.

A person with a sexual pain disorder may be more likely to experience pain in the vaginal area after penetration. This could present as a burning or stinging sensation.

Vaginismus may produce feelings of tightness in addition to pain.

But it’s not impossible to experience deeper types of pain with these disorders, along with stabbing or aching sensations similar to endometriosis-type pain.

Can endometriosis cause tight pelvic floor muscles?

One 2016 study found that people with deep infiltrating endometriosis were more likely to have pelvic floor muscle spasms than people without endometriosis.

Endometriosis-related pain can cause surrounding muscles to contract to protect the area. If this continues, the muscles can feel tighter.

This may affect not just the pelvic floor muscles but also the muscles around the stomach and back.

Does endometriosis make your vagina tighter?

Yes, endometriosis can make your vagina feel tighter, whether you’re having penetrative sex or trying to insert a tampon.

It may also stem from vaginal dryness, which may be a result of treatments like hormone therapy or a hysterectomy.

What are three potential symptoms of endometriosis?

Pain is a common endometriosis symptom. This includes:

  • severe period pain
  • pain during or after penetration
  • long-term pain in the pelvis, lower stomach, or lower back

You may also notice some bleeding between periods or experience difficulty becoming pregnant.

Is vulvodynia linked to endometriosis?

Endometriosis is linked to vulvodynia and other pain conditions, like vaginismus. Vulvodynia is vulvar pain that has lasted for at least 3 months without a clear cause.

A 2020 study suggests that vulvodynia and endometriosis co-occur in around 11% of affected people.

This doesn’t mean that one condition causes the other. However, the increased pain and sensitivity that comes with endometriosis may contribute to vulvar pain.

If you have pain during penetrative sex or while trying to insert menstrual products, there are lots of ways to help —whether you have endometriosis, vaginismus, or something entirely different.

Consult a healthcare professional for advice on reducing and preventing pain and making life more enjoyable.

Lauren Sharkey is a U.K.-based journalist and author specializing in women’s issues. When she isn’t trying to discover a way to banish migraine, she can be found uncovering the answers to your lurking health questions. She has also written a book profiling young female activists across the globe and is currently building a community of such resisters. Catch her on Twitter.