What is endometriosis?
“The lining of the uterus is called Endometrium. This is the tissue that grows inside the uterus each month and bleeds away with a period. When tissue like this is found in other areas around the pelvis, not just inside the uterus, it is called Endometriosis.
The areas of endometriosis are called lesions.
Endometriosis lesions form a spotty covering on the sidewalls of the pelvis, or on the surface of the pelvic organs. More severe endometriosis grows into the pelvic organs themselves or forms round ‘cysts’ called ‘Chocolate Cysts in the ovaries. Most endometriosis lesions can’t be seen on an ultrasound scan.
Endometriosis is a pain you can see at a laparoscopy, but often it is only one part of pelvic pain. Many girls and women with endometriosis have a mix of different symptoms, not just period pain.” (Pelvic Pain Foundation of Australia)
The latest figures say that one in 9 women have endometriosis. Some of these women live with severe pain, others have minimal symptoms but everyone’s experience with endometriosis is difficult. Many wait 9 years or more for an accurate diagnosis.
Symptoms of endometriosis include but not limited to;
lower abdominal aching
pain during and after a bowel motion
nausea and/or vomiting
Cramps are not unusual when it comes to having your period, however pain that stops you from living everyday life is not normal.
A study published in 2017 found that two-thirds of women with endometriosis experience some form of sexual dysfunction, which includes painful sex, known as dyspareunia. There have actually been quite a few studies about sexual function and satisfaction in women with endometriosis, before and after laparoscopic surgery. More recently there have been a couple of studies (still to be published) about sexual satisfaction of partners. All these are an important studies in order to work towards the quality of life of all those impacted by endometriosis. Hopefully, there will be similar studies conducted soon that include same-sex couples and trans and gender nonconforming people.
Being a sexologist who came to be a sexologist because of my own personal experience with endometriosis. I was one that experienced pain with sex as a result of my endometriosis (although it is important to note that not everyone with endometriosis experiences pain during sex). I would describe pain with sex to have ranged from a dull ache to sharp, stabbing pain, they are common descriptors of the pain. I have had clients describe the pains as feeling like a hot poker was stabbing them through there vagina and into their pelvis and abdomen. Others have used the term knife stabbing followed by sharp nails scraping from the inside out. Penetrative sex or thrusting during intercourse can stretch, pull or push against the misplaced endometrial tissue and scar tissue in the pelvis. The severity of the pain may vary depending on a number of factors: how deep the penetration is, when sex is happening and where the implants are located. There can also be a psychological part that may also play a role in pain. When dealing with endometriosis and repeated periods of pain, the body can start to equate sexual stimulation with pain. When we are in pain we automatically go into postures and behaviors to protect us, our body braces for pain which equals tension including tension in the pelvis. As a consequence, this protective action or fear reaction can negatively impact libido, cause reduced vaginal lubrication, pelvic floor tension, one or all of these can make sex more painful and continue to feed into the pain cycle.
Sex is suppose to be pleasurable and enjoyable, chronic pain or episodes of severe pain will take away from that for all those involved. Pain that we as vulva owners experience and also because our partners do not want to be the reason we hurt.
Here are some tips to boost intimacy while avoiding pain;
- Communicate with your partner.
- Position, Position
The missionary may be extremely painful, this has to do with how your uterus is positioned in this position. For some women, being on top allows them to have more control over the depth of penetration and can reduce pain. If you and your partner like the connection you have in the missionary position you can try using pillows or a wedge to adjust the position of your hips. The other tip would be no feet on shoulders, keep them down to control the depth of penetration. The other way you can control the depth of penetration is by using a product like the Ohnut. The Ohnut is like a cushion and allows you to adjust the number of rings to control the depth of penetration. Try different positions and see what works for you.
- Time it right.
- Use lube.
- Try new things
- Erotica and sexy images.
- Consider talking to a health professional.
Your team of health practitioners is important in your care, in talking about medical treatment options but also for talking about sexual issues. Useful additions to this team include a pelvic physiotherapist and a sexologist who has knowledge of endometriosis. They can help you find ways to reduce your pain, improve your quality of life, inside and outside the bedroom and give you tools to improve communication with your partner(s).