9 Root Causes of Painful Sex with Endometriosis This EndoLife

Today’s episode is another in the root causes series and I’m talking about the root causes of painful sex with endometriosis.
92% of you voted for this episode, so I’m assuming that if you voted, you likely struggle with this symptom. But having painful sex isn’t just part and parcel of having endometriosis - there are things that can be done, and it begins with identifying why you’re experiencing pain in the first place.
Endo is complex and the stress it puts on the body can lead to other conditions and complications developing, so we’re going to explore some of these here. If you can begin identifying even just one root cause, the road ahead to healing pain will become clearer. 
Again, this is about shining a light on the root causes so you’re no longer in the dark about your health. You don’t have to deal with them all and it’s unlikely you’ll have them all, just begin with one area and take baby steps there. 
As I’ve mentioned with all these episodes, this list isn’t exhaustive, but it does include some of the most common conditions associated with painful sex and associated with endometriosis.
TRIGGER warning: This episode briefly discusses sexual trauma.
Vulvodynia - Vulvodynia is a condition of chronic pain in the vulva area, that is usually worsened by sitting, sex, going to the toilet and movement. You may not have the pain all the time, but it is reoccurring, though some can experience the pain constantly. Many report the pain as a burning/stinging/itching/aching/throbbing sensation.
Causes can include untreated or resistant infections like candida, nerve hypersensitivity, damage or trauma to the area, pelvic floor dysfunction and chronic inflammation.
In the case of developing vulvodynia with endometriosis, I would argue that the amount of inflammation and an upregulated nervous system from years of chronic pain could in time affect the vulva area, as well as having a tight pelvic floor, which is common with endo patients.

Vaginismus - Vaginismus is a condition where the vaginal canal involuntarily spasms and closes, usually in response to some kind of penetration, though I’ve spoken to many people with vaginismus and they report this spasming to eventually happen all the time.
This is thought to occur as the body’s response to fear of penetration, even if you don’t mentally feel scared.
Vaginismus can be caused by multiple issues. It could be that endo has created so much pain internally that your body now has a fear of sex hurting and so essentially closes up shop. Constant painful, traumatic, invasive and embarrassing medical examinations that you may have endured whilst trying to get an endo diagnosis, or following one, may have triggered the onset of vaginismus as well. Uncomfortable or distressing feelings about sex like shame, guilt or trauma can also cause the condition too.

Adhesions or distorted fascia - Adhesions are web like scar tissue structures that do not show up on scans as they’re made of collagen. They grow in response to a wound or trauma and attempt to ‘knit’ an area back together, but can often continue to grow and extend, attaching to organs, wrapping around organs and sticking to surfaces.
Adhesions are VERY strong and will cause pain and discomfort, and can pull and tug on organs, restricting their movement and even function.
Fascia is a thin sheet of tissue which covers the entire body, sits below the skin and encases the muscles, bones and organs. Endo can grow on the fascia and cause puckering in the surface of it, and excisions form surgery can also cause the fascia to pucker from scar tissue. This puckering pulls the fascia out of shape and can distort the fascia across the rest of the body - think of what happens when you pinch a nice neat bed sheet.
If you have adhesions or your fascia is tight and distorted, this could result in painful sex. There may be pulling on your vagina or uterus, they may be putting pressure or c