What is dyspareunia?
Dyspareunia is the medical term used to define painful sexual intercourse. It is one of the most common symptoms of endometriosis  and yet the one most uncomfortable to discuss, causing further emotional distress, and strain on relationships.
How common is dyspareunia among women with endometriosis?
According to a study  published in the journal Reproductive Sciences, about two-thirds of women with endometriosis have some sexual dysfunction, including pain during sexual intercourse.
Why does endometriosis cause painful sex?
Endometriosis  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. The 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  a woman with endometriosis may take to reduce the symptoms of the condition. Oopherectomy, or the removal of the ovaries, which is sometimes performed to treat endometriosis, 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 to help this.
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 . 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, but for others, this can last for up to 24 to 48 hours after intercourse, or only occur following intercourse . This may be a cramping sensation lasting for a few days afterward.
- Pain with masturbation
How can I tell my doctor about my pain during sex?
While it can be embarrassing for a woman to tell her doctor that she is experiencing pain during sex, or detail the sexual positions she experiences the pain in, this is an extremely important symptom of endometriosis! These questions and answers can help the doctor zero in on where your endometriosis lesions may be. Any good endometriosis specialist should be asking these questions and examining the patient thoroughly to see if they can target where the pain is emanating from. This provides a surgical road map of sorts of where nodules and endometriosis lie within.
Importance of talking about the symptoms of pain
It is however very important to discuss this symptom with a doctor as identifying the problem and talking about it can help couples avoid additional emotional distress.
Most importantly, pain during sex can be the first sign of endometriosis, so telling the doctor about it can help them diagnose the disease early on and therefore take the necessary measures to treat it.
TREATMENT/ OUR APPROACH
Endometriosis treatments such as laparoscopic surgery performed by an expert endometriosis excision surgeon  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 desire 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 between 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 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 deal with the situation and help them have a more fulfilled sexual, relationship.
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.
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