Endometriosis and Painful Sex (Dyspareunia)

Endometriosis and Painful Sex (Dyspareunia)

Medically reviewed by Tamer Seckin, MD on September 20, 2019

OVERVIEW

What is dyspareunia?

Dyspareunia is the medical term used to define painful sexual intercourse. It is one of the most common symptoms of endometriosis [1] and yet the one many patients and doctors find most uncomfortable to discuss, causing further emotional distress, and strain on relationships.

How common is dyspareunia among women with endometriosis?

According to a study [2] published in the journal Reproductive Sciences, about two-thirds of women with endometriosis have some sexual dysfunction, including pain during sexual intercourse.

CAUSES

Why does endometriosis cause painful sex?

Endometriosis [3] results when the endometrium, or the lining of the uterus, grows outside the uterus, for example, in and around the ovaries, the fallopian tubes, and the bowels. These misplaced growths can cause inflammation and scarring.

Why does sex cause pain in women with endometriosis?

During intercourse, the endometriosis lesions and nodules can be stretched and pulled and cause pain.

Vaginal dryness and sexual pain

Another cause of pain during sex could be vaginal dryness, which can result from hormonal treatments [4] a woman with endometriosis may take to reduce the symptoms of the condition. Oopherectomy, or the removal of the ovaries, is sometimes performed to treat endometriosis and can also cause vaginal dryness. This occurs because the removal of the ovaries reduces circulating estrogen levels, which in turn can lead to vaginal dryness and discomfort during intercourse. Some women elect not to have hormone replacement and may try new therapies such as hyaluronic acid or lubricants.

SYMPTOMS

Do all women with endometriosis experience painful sex in the same way?

The painful sex experienced by endo women can range from mild to excruciating [6]. They may describe the pain as a sharp stabbing or jabbing, or a deep abdominal ache.

The intensity and duration of dyspareunia or painful intercourse depend on the location and spread of the endometrial lesions.

However, not all women with endometriosis experience pain during sex, and for those who do, the pain they experience may be very different.

  • Some women may experience pain in any sexual position, while others may only feel pain with deep pain and penetration.

  • While some women experience pain during sex only at certain times of the month, i.e., around the time of their period, others can have pain during sex at all times.

  • Some women may experience pain only during intercourse. Others may experience pain up to 24 to 48 hours after intercourse, or only following intercourse [6]. This may be a cramping sensation lasting for a few days afterward.

  • Pain with masturbation. 

DIAGNOSIS

How can I tell my doctor about my pain during sex?

While it may be uncomfortable for a woman to tell her doctor that she is experiencing pain during sex, or detail the sexual positions she experiences pain in, this is an extremely important symptom of endometriosis. These questions can help your doctor zero in on where your endometriosis lesions may be. Any good endometriosis specialist should be asking these questions and examining their patient thoroughly to see if they can target where the pain is emanating from. This provides a surgical road map of where the patient's nodules and endometriosis may be. Pain during sex can be a first sign of endometriosis, so it is crucial to speak to your doctor honestly to help them diagnose the disease early on. Additionally, speaking opening about your pain during sex can help avoid emotional distress in your relationships. 

TREATMENT/OUR APPROACH

Endometriosis treatments such as laparoscopic surgery performed by an expert endometriosis excision surgeon [7] can also help improve dyspareunia.

Remember, there is no way to treat endometriosis-associated dyspareunia without addressing its underlying cause, which is the growth of the lining of the uterus elsewhere in the abdomen. However, there are non-surgical ways to reduce pain during intercourse for women with endometriosis who deserve to increase their quality of life. These include:

  • Trying different positions that may make sex less painful.

  • Having sex around the time of or during the menstrual cycle when sex may be less painful.

  • Being open and talking about the situation with partners. 

  • Sometimes, pain may persist after surgery due to a patient's fear of intercourse-related pain. It is very easy to tense up when you are used to having this pain. Tightening the pelvic floor, however, can cause further pain even though the stimulus or disease is gone. In this case, pelvic floor therapy can help to re-train you to relax the pelvic floor allowing for a more comfortable and pleasurable sexual experience. It is important to remember that not all pelvic floor therapy involves kegel exercises. Kegels are a bad idea for endo patients who likely need to do just the opposite, which is to learn to relax and down-regulate the muscle tone.

A counselor or sex therapist may also be able to help couples navigate the situation. 

PATIENT STORY

"What I've learned in the aftermath of my surgery a little over a year ago with Dr. Seckin, is that it was somehow harder for me to adjust to life without pain, versus life with pain. 

Without a single doubt in my mind, I owe Dr. Seckin my life. My fiancé tells me this repeatedly, that without [Dr. Seckin] we would not be able to live life and enjoy spending time with friends and family. We would not be able to plan for a family or even our wedding. Before Dr. Seckin, I rarely went out of the house. I had extreme anxiety when we made plans, for fear that my pain would cause us to leave early or cancel altogether. [My fiancé and I] couldn't have sex and exercise was completely out of the question. The simplest things would trigger my pain, and our world revolved around it. 

I could tell the difference within the first week after my surgery. I was able to walk up and down the stairs of our apartment building without doubling over in pain. Slowly but surely each day was a little bit better. A month afterward, my fiancé and I went for our first run together across the Brooklyn Bridge. Two months afterward, we went on our first vacation where I was not in chronic, constant pain." –U.B.

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References

[1]: https://www.drseckin.com/symptoms-and-signs-of-endometriosis

[2]://journals.sagepub.com/doi/abs/10.1177/1933719117707054?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

[3]: https://www.drseckin.com/endometriosis

[4]: https://www.endometriosis-uk.org/hormone-treatments-endometriosis

[5]: https://www.drseckin.com/hysterectomy

[6]: //endometriosis.org/resources/articles/painful-intercourse/

[7]: https://www.drseckin.com/laparoscopic-surgery




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