Endometriosis occurs when the tissue that normally lines your uterus begins to grow outside of it. Most people know that this can cause painful cramping during menstruation and spotting between periods, but its effects don’t stop there.

Many women experience chronic pain and fatigue regardless of the time of the month — and for some women, intercourse can amplify this discomfort. That’s because penetration can push and pull any tissue growth behind the vagina and lower uterus.

For New York-based photographer Victoria Brooks, the pain from sex was “so much that reaching climax didn’t seem worth it,” she said. “The pain outweighed the pleasure of sexual contact.”

Although symptoms vary from woman to woman, there are things you can do to lessen your pain. Trying different positions, using lube, exploring alternatives to intercourse, and open communication with your partner can help bring the pleasure back to your sex life. Keep reading to learn more.

For most women, discomfort caused by endometriosis is constant. But the pain becomes even more excruciating during your period — and sometimes during ovulation, as in Brooks’ case. When you keep track of your cycle, you can also keep track of any symptoms related to endometriosis. This will help give you a better understanding of what time of the month influences potential pain the most, and when you’re more likely to be pain-free.

There are free mobile apps you can download, such as Clue or Flo Period Tracker, to log your cycle. Or you could keep track of your period by creating your own menstruation calendar. The Center for Young Women’s Health also has a My Pain and Symptom Tracker sheet that you can print out to map out any pain or discomfort you feel.

No matter the method, make sure to also rate the pain you feel so you can track what times of the month the pain is worse.

You may be able to reduce the pain you feel during sex if you take an over-the-counter pain reliever, such as an aspirin (Bayer) or ibuprofen (Advil), at least an hour before intercourse. You could also take a pain reliever, as directed, after sex if your discomfort persists.

If you have endometriosis, then lube is your best friend, Brooks told Healthline. Some women with endometriosis feel pain during sex because of vaginal dryness or lack of lubrication — whether from being aroused or from an artificial source. Brooks told Healthline that she also felt as if her vagina was “extremely tight.”

But using water-based or silicone-based lubes during sex can really help ease any discomfort. You should use as much lube as possible so that you’re sufficiently wet, and remember to reapply when you feel your vagina drying out. “Don’t be afraid of lube, even if you don’t think you need it,” Brooks said. “Lube, lube, lube, and then throw on more lube.”

If you have endometriosis, you may find that some sex positions will cause you intense pain. The missionary position tends to be the most painful for women with endometriosis because of how your uterus is tilted and the depth of penetration.

Experimenting with different positions can teach you and your partner which ones hurt and which ones to avoid forever so you can have the most pleasure during sex.

Although which positions are considered better will vary person-to-person, Brooks said those that had shallow penetration worked best for her. Think modified doggy style, spooning, raised hips, face-to-face, or with you on top. “Make a game of sex,” Brooks told Healthline. “It can actually be really fun.”

Deep penetration and quick thrusting can exacerbate pain for many women with endometriosis. Finding the right rhythm can help you experience less discomfort during sex.

Talk with your partner about slowing down and not thrusting as deeply during intercourse. You can also switch positions so that you can control speed and limit penetration to a depth that feels best for you.

Bleeding after sex, known as postcoital bleeding, is a common symptom of endometriosis. Postcoital bleeding can happen because penetration causes the uterine tissue to become irritated and tender. The experience can be frustrating, but there are ways you can prepare for potential bleeding.

You can:

  • lay a towel down before initiating sex
  • keep wipes nearby for easy cleanup
  • focus on positions that cause less irritation

You should also prepare your partner ahead of time so they’re not caught off guard and wonder what happened during sex.

Sex doesn’t have to mean intercourse. Foreplay, massage, kissing, mutual masturbation, mutual fondling, and other arousing alternatives to penetration can bring you and your partner closer together without triggering your symptoms. Talk with your partner about the stuff that turns you on, and experiment with all the many activities that can bring you pleasure. “Allow yourself to enjoy all the different levels of intimacy,” Brooks said.

Although endometriosis can have a negative impact on your sex life, it doesn’t have to stay that way. Brooks told Healthline that communicating with your partner about having endometriosis and its impact on your sexual desire, as well as pleasure, is key to an open and honest relationship. “Don’t let [your partner] view you as some fragile doll,” Brooks advised.

When talking to your partner about having endometriosis and its effects on your sex life, Brooks offers the following tips:

You should

  • Tell your partner how you’re feeling physically and emotionally, even during the most painful times.
  • Sit down together to figure out ways you can make sex work, but center your experiences and symptoms.
  • Talk openly about your feelings around sex and penetration, and what would help to ease your concerns.
  • Hold your partner accountable if they aren’t following through or listening to your issues. Don’t be afraid to bring up the issue as often as you need to.

But, in the end, there’s one important thing to remember: “Don’t ever judge yourself for having endometriosis,” Brooks told Healthline. “It doesn’t define you or your sex life.”