Endometriosis and Painful Sex (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 many patients and doctors find most uncomfortable to discuss, causing emotional distress and strain on relationships.
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.
Causes of dyspareunia
Endometriosis occurs when tissue resembling the endometrium, or the lining of the uterus, grows outside the uterus. These misplaced growths can cause inflammation and scarring. During intercourse, the endometriotic lesions and nodules can be stretched and pulled and cause pain.
Another cause of pain during sex could be vaginal dryness, which can result from hormonal treatments a woman with endometriosis may be taking 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.
Symptoms of dyspareunia
The painful sex experienced by women with endometriosis 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 may be very different. Some women may experience pain in any sexual position, while others may only feel pain with deep penetration. Moreover, 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. This may be a cramping sensation lasting for a few days afterward.
Diagnosis of dyspareunia
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 details 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.
Pain during sex can be the first sign of endometriosis, so it is crucial to speak to your doctor honestly to help them diagnose the disease early on. Additionally, speaking openly about your pain during sex can help avoid emotional distress in your relationships.
Endometriosis treatments such as laparoscopic surgery performed by an expert endometriosis excision surgeon can help improve dyspareunia.
Remember, there is no way to treat endometriosis-associated dyspareunia without addressing its underlying cause of the disease.
However, there are non-surgical ways to reduce pain during intercourse for women with endometriosis. These include trying different positions that may make sex less painful, having sex around the time in the menstrual cycle when sex may be less painful, and 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 your 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. Kegel exercises are a bad idea for endometriosis patients who likely need to do just the opposite, which is to learn to relax and down-regulate their muscle tone.
A counselor or sex therapist may also be able to help couples navigate through the situation.
“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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Dr. Seckin is an endometriosis specialist and women’s reproductive health advocate. He has been in private practice for over 30 years at Lenox Hill Hospital with a team of highly skilled personnel.
Dr. Seckin specializes in advanced laparoscopic procedures and is recognized for his expertise in complex cases of deep infiltrating endometriosis of the pelvis. He is particularly dedicated to performing fertility-preserving surgeries on cases involving the ovaries.
He has developed patented surgical techniques, most notably the “Aqua Blue Excision” technique for a better visualization of endometriosis lesions. His surgical techniques are based on precision and microsurgery, emphasizing organ and fertility preservation, and adhesion and pain prevention.
Dr. Seckin is considered a pioneer and advocate in the field of endometriosis.