Written by Dr Mafe Peraza Godoy
Translated from Spanish to English
Endometriosis is a benign disease that affects women during their reproductive life and there is still no concrete explanation of the reasons why some women suffer from endometriosis and others don´t. Then the endometrium (internal uterus mucosa layer sensitive to hormonal changes and what is the one expulsed during the period) is located outside from its original place (uterus ) and this incorrectly developed ectopic tissue is able to settle in anywhere in the abdomen.
There is an increasing incidence and by today 1 in 10 worldwide women suffer from endometriosis. The symptoms are broad and affect both, physically and psychologically: even some cases may not have any symptoms and endometriosis is diagnosed casually when women go under abdominal surgery for other reasons. However, in other cases, abdominal internal irritation and adherences could produce: menstrual pain, abdominal pains not related with menstrual period, pain during sexual intercourse (dyspareunia), more profuse menstruations, pain during defecation, urinary urgency, frequency, and sometimes painful voiding, fertility issues and general symptoms such as nausea, vomiting, weakness, fatigue and or dizziness.
It can present as implants when they are small, nodules when they are bigger and they could appear as cysts in the ovaries. Unfortunately, control of the disease is currently limited to relieve pain and other symptoms, preventing injuries from progressing and preserving or re-establishing reproductive function, but there is no definitive cure.
Today I will talk about how endometriosis affects sexual life because it is clear that pain during sex directly affects the quality of life and secondarily sexual interest and sexual desire, in addition, disturbing orgasmic phase. We must take into account that not all women with endometriosis have dyspareunia and that the severity and infiltration of the endometriosis plaques will determine the severity of the dyspareunia. However, the pain itself reflexively activates the contraction of the pelvic musculature (pelvic floor hypertonia) as an involuntary response to a stressful situation ( the same with cervical muscles group) which could worsen or give continuity to the discomfort and genital pelvic pain during and after sexual intercourse.
It is known that women with deep infiltrating endometriosis have a sexual function impairment, correlated with the overall well‐being decrease. Moreover, the presence of dyspareunia and vaginal endometriotic lesions seems to be involved in sexual dysfunction.
Pain´s experience is very subjective but it is clear that it interrupts the possibility of living a pleasurable sexual relationship, that is, a biological factor interferes directly itself and generates an emotional response that secondarily affects the entire sexual response. We can see, an image below, where I modified R. Basson's description about the circularity of the female sexual response and how the pain would affect the whole response.
There is increasing evidence that today 1 in 10 worldwide women suffer from endometriosis.
Now, once explained how all the female sexual response could be affected, What we do? How we can improve and minimize pain to improve the quality of life and the domains of the sexual response: interest and sexual desire, arousal and orgasm phase.
Studies show that Sexual desire, satisfaction with sex and pelvic problems with intercourse are significantly improved after 6 months from laparoscopic excision of DIE combined with postoperative combined oral contraceptives therapy. However, not all women have an indication for exploration and surgical treatment, so: based on what pain means and generates on the body as a stress agent, I suggest some palliative actions around this altered sexual response:
1. Perform guided physical activities (if not are contraindicated) including physiotherapy to relax the pelvic floor (yoga, pilates and others) not to strengthen it but to relax it.
2. Anything that could act as anxiolytic brings well-being: the anxiety generated by the underlying disease, the persistent dissatisfaction by sexual issues and pain, generates a “hyperadrenergic state” similar to stress and anxiety, so any activity that connects you with well-being will liberate endorphins and the experience of the situation could improve indirectly. Yoga meditation, mindfulness.
3. Use of lubricants during intercourse
4. Analgesic ( painkillers) guidelines supervised and indicated by the physician to be taken before intercourse. (don´t try to self-medicate).
5. Take care of the vulva and vagina daily. Most women with endometriosis are under Hormonal Contraceptives treatment and are well known that some of them could be related to vulvo-vaginal dryness, so use vulvovaginal moisturizers as routine.
6. Change the dynamics of sexual relationship, if the penetration means pain, it is important not to centralize the sexual relationship with penetrative activities. Also, women could try to change to some sexual posture that are better tolerated or don´t trigger any pain.
7. Psychological therapy: Yes, maybe you are asking yourselves Why? It is very simple, pain affects the experience of many aspects of life, so by talking about them and changing the way people face pain quality of life improves. Everything we think and feel has a neurobiochemical translation. Many times therapy helps to learn how to live with pain and from this point have an acceptable quality of life. It will not treat endometriosis but the psycho-emotional consequences of it and this could have a direct impact on the subjective experience of pain.
Endometriosis is a complex disease and many women suffer it in silence, especially the sexual consequences. Share and talk about it could be helpful for all those women.