Endometriosis/adenomyosis and deep dyspareunia—what should I know?

Deep dyspareunia is one of the most distressing symptoms of endometriosis and adenomyosis. It can feel like a sharp, stabbing sensation deep in your pelvis, a dull ache that lasts for hours, or cramping that persists after intercourse. Many describe the experience as a collision or bruising sensation when penetration reaches certain depths or angles. This pain is not in your head, and it is not something you should simply endure. It is a physical signal from tissues that are inflamed, scarred, or abnormally positioned.

Understanding why these conditions cause deep pain during sex helps you advocate for appropriate treatment. Endometriosis occurs when tissue resembling the lining of your uterus grows outside the womb, commonly behind the vagina in the space between the vagina and rectum, on the ovaries, or on the bowel. Adenomyosis involves similar tissue growing into the muscular wall of the uterus itself, causing the uterus to become enlarged, tender, and sensitive to pressure. Both conditions respond to your monthly hormonal cycle, thickening, breaking down, and bleeding—but with nowhere for the blood to escape, this causes inflammation, adhesions, and scarring.

Why Endometriosis Causes Deep Dyspareunia

When endometriosis grows in the posterior cul-de-sac—the space behind the uterus between the vagina and rectum—it creates inflammation and fibrosis. During intercourse, the upper vagina normally expands and moves freely. However, endometriosis can cause the vagina and rectum to adhere together, restricting this movement. Deep penetration pulls or stretches these irritated, scarred tissues, triggering pain. The sensation is often worse in certain positions, particularly those that allow deeper thrusting or pressure against the posterior vaginal wall.

Over half of women with endometriosis experience dyspareunia, and many describe it as one of the most debilitating aspects of the condition. The pain can vary with your cycle—often worsening in the days before and during your period when inflammation peaks.

How Adenomyosis Contributes to Painful Sex

Adenomyosis causes the uterus to become bulky, swollen, and tender. During sex, the uterus can be jostled or compressed, especially with deep penetration or certain positions. This pressure on an already inflamed, enlarged uterus creates a deep, aching pain. Some describe it as feeling bruised internally. The pain may begin during intercourse or develop afterwards, sometimes lasting for hours or even days. Unlike endometriosis, where adhesions are the primary issue, adenomyosis pain stems from the uterus itself being tender and reactive.

Around one in ten women with adenomyosis report dyspareunia, though many more experience chronic pelvic discomfort that affects intimacy indirectly.

The Emotional and Relational Impact

Deep dyspareunia does not only affect your body—it can erode confidence, create anticipatory anxiety, and strain relationships. Many women begin to avoid sex entirely, which can lead to feelings of guilt, isolation, or inadequacy. Partners may feel confused or helpless, unsure how to provide support without causing pain. It is important to recognise that this is a medical symptom with legitimate physical causes, not a reflection of desire, attraction, or emotional connection.

Open communication with your partner is essential. Explaining what you feel, when it hurts, and what positions or depths are tolerable helps both of you navigate intimacy with care. Many couples benefit from exploring alternative forms of intimacy or adjusting the timing of sex to avoid the worst days of your cycle.