Fisting and Endometriosis
I recently saw an Instagram post that went viral about a young woman with endometriosis sharing her personal experience: She reports that fisting has improved her endometriosis symptoms. There is a scientific reason behind this, so before you kink shame, hear me out.
Manual therapy for pelvic floor dysfunction in endometriosis encompasses various hands-on techniques that target myofascial pain, trigger points, and connective tissue restrictions that contribute to chronic pelvic pain (As-Sanie et al., 2026). This type of hands-on modality can look like abdominal massage, perineal massage, desensitization of introital tissues, internal pelvic floor massage, and trigger point massage.
Nazari et al. (2010) found that manual therapy significantly reduced dysmenorrhea associated with endometriosis. In a semi-experimental clinical trial, researchers evaluated whether manual therapy could reduce dysmenorrhea (menstrual pain) associated with surgically confirmed endometriosis. Findings revealed that menstrual pain significantly decreased following manual therapy. Researchers found the pain reduction was statistically significant (p < .001) immediately after treatment and six weeks after treatment as compared with baseline. Manual therapy can improve circulation, reduce muscle tension and spasms, promote relaxation, and reduce perceived pain. Another study by Valiani et al. (2010) found similar results using the same statistical parameters, with the proportion of people reporting no pain increasing from 34.8% immediately after treatment to 65.2% six weeks later.
A randomized controlled trial by Muñoz-Gómez et al. (2023) found that an 8-week manual therapy protocol significantly reduced endometriosis-related pelvic pain and improved physical quality of life, with pain reductions maintained for up to six months. With their protocol, manual therapy significantly improved pelvic pain intensity, lumbar mobility, feelings of powerlessness, and physical quality of life. In addition, pain improvements remained significant at 1 month and 6 months after treatment. Participants receiving manual therapy reported greater overall improvement than the control group.
In a retrospective longitudinal study, Shrikhande et al. (2023) found that a multimodal treatment protocol addressing pelvic floor dysfunction, nerve sensitization, and chronic pain mechanisms significantly improved pain and functional outcomes in women with persistent pelvic pain after endometriosis surgery. Mean pain scores improved significantly (p < .001) after treatment, from 7.45/10 before treatment to 4.12/10 at their 3-month follow-up. Functional impairment (FPPS) also improved (p < .001) from 14.35 before treatment to 10.3 at the 3-month follow-up. The largest areas of improvement occurred in reduced sleep disruption, improved sexual function-related pain outcomes, and improved ability to participate in occupational roles and productivity.
So, should we go around telling our endo patients to go get fisted? No (not unless they are into that sort of thing… then dig deep, more power to you!). However, given the state of our current healthcare system where care can be costly and inaccessible, it’s our duty as therapists to educate people on the options available to them. This especially includes affordable, evidence-based, conservative treatment options like manual therapies that can improve symptoms and improve quality of life.
References
As-Sanie, S., Ross, W. T., & Till, S. R. (2026). Evaluation and treatment of chronic pelvic pain. Obstetrics and Gynecology, 147(3), e1–e13. https://doi.org/10.1097/AOG.0000000000006123
Muñoz-Gómez, E., Alcaraz-Martínez, A. M., Mollà-Casanova, S., Sempere-Rubio, N., Aguilar-Rodríguez, M., Serra-Añó, P., & Inglés, M. (2023). Effectiveness of a manual therapy protocol in women with pelvic pain due to endometriosis: A randomized clinical trial. Journal of Clinical Medicine, 12(9), 3310. https://doi.org/10.3390/jcm12093310
Nazari, F., Sadat, Z., & Arbabi, S. (2010). The effects of massage therapy on dysmenorrhea caused by endometriosis. International Journal of Preventive Medicine, 1(4), 216–220. https://pmc.ncbi.nlm.nih.gov/articles/PMC3093183/
Shrikhande, A., Patil, S., Subhan, M., Moody, E., Natarajan, J., Tailor, Y., Mamsaang, M., James, N., Leishear, K., Vyas, R., Sandhu, S., Ahmed, T., Filart, R., Daniel, G., Orbuch, I. K., Larish, Y., & Liu, L. (2023). A comprehensive treatment protocol for endometriosis patients decreases pain and improves function. International Journal of Women’s Health, 15, 91–101. https://doi.org/10.2147/IJWH.S365637
Valiani, M., Ghasemi, N., Bahadoran, P., & Heshmat, R. (2010). The effects of massage therapy on dysmenorrhea caused by endometriosis. Iranian Journal of Nursing and Midwifery Research, 15(4), 167–171. https://pmc.ncbi.nlm.nih.gov/articles/PMC3093183/
