What is painful sex?
Painful sex is known as Dyspareunia. It can be distressing for those experiencing that pain as well as their partners. It can result in the loss of sexual interest and relationship problems. Dyspareunia is the term used to describe pain before, during or after vaginal intercourse. There are many causes of dyspareunia including physical ones like not enough lubrication, a skin infection, illness or surgery. Psychological causes/contributors like relationship issues, stress and anxiety can make it worse. We will be talking about Dyspareunia in relation to endometriosis here.
Dyspareunia can affect women of all ages with young women most likely to be affected. However menopausal and postmenopausal women (natural or surgical) can also suffer with it due to hormonal changes that decrease the elasticity of their vaginal walls, increased vaginal dryness and narrowing of the vaginal opening.
Dyspareunia is a common symptom of endometriosis. This can be a difficult subject for some and even harder to discuss with their doctors. By telling your doctors about this pain you can help them determine the level of pain and the anatomical location to which endometriosis lesions are located.
Endometriosis and Dyspareunia - how are they connected?
The area behind the uterus is called the cul-de-sac, or Pouch of Douglas. Normally it is lined by the smooth peritoneum, the skin-like sheet of tissue that covers the uterus and vagina anteriorly (in front), and the rectum posteriorly (in back), keeping the rectum, vagina, and uterus free from each other (3). In the case of endometriosis, it is common for endometriosis adhesions to adhere the vagina to the rectum.
The pain caused by endometriosis during sex is deep. One person living with it described it as;
“That’s really hard to explain, because I can’t really pinpoint where it is. It’s not on the outside, it’s the inside where, if I was pointing at my pelvis, like a couple inches in.” (1)
“I experience the 3 types of penetrative pain so like the penetrative pain in my vagina, and then deep vaginal pain, and I also experience uterine pain with arousal and orgasm.” (1)
The pain comes from the inflammation and fibrosis fusing the front wall of the rectum to the back wall of the vagina. The vagina, cervix and uterus move as we become aroused. When there are adhesions caused by endometriosis this movement is restricted. Certain positions can be more painful than others. This can be influenced by the amount and location of endometriosis, if the endometriosis is widespread there may be no position that is comfortable.
Discussing sex is a very personal thing and discussing painful sex can be extremely difficult. Sex isn’t a common topic discussed in doctors’ appointments, but it is an important topic. It is important not only your physical health, that it can be a diagnostic tool for your doctor but also because not talking about it and getting help can cause tension in, or even break up, a relationship. That trip to the emergency room can be one of the hardest you experience but it is an important one.
“The worst pain I’ve ever felt. Nothing could be done, I can’t have people around me, I don’t like noises, I just want everyone to just leave me alone. There’s nothing that can be done for it to really go away you know, until it goes away. I don’t know, it’s scary.” (1)
“I feel insignificant, you almost feel broken or something.” (1)
“It got to the point where I was in pain so often from inter-course, that my partner and I basically decided that we just weren’t going to anymore, that it just wasn’t worth me going through the pain [.] It contributed to the end of that relationship.” (1)
Can surgery help?
You have probably heard of laparoscopic surgery for endometriosis. Laparoscopic excision of endometriosis is the gold standard for conservative surgical treatment. If the aim is to help with painful sex symptoms then laparoscopic excision surgery that focuses on endometriosis infiltrating the anterior and posterior cul-de-sac is what should be discussed with your doctor. Studies have found that removal of endometriosis using excision surgery has improved, dyspareunia symptoms and quality of their sex life (2).
Other ways of managing painful sex
While dealing with painful sex can be difficult, here are a couple of tips to help;
- Communication: Sex is meant to be pleasurable for all those involved. If it is causing you pain it is important to talk to your partner about what is going on for you.
- The timing of sex: Pain often varies depending on the time of the month or where you are up to in your menstrual cycle. When tracking your cycle you can include painful sex in your tracking – position, where the pain was, when it happened, how long it lasted, are just a few things you can track to find a time of the month that works best for you.
- There is more to sex than penetration: Couples have found relief from dyspareunia symptoms by engaging in other forms of intimacy, especially during the period. Don’t forget things like oral sex, mutual masturbation, or using aids like the Ohnut.
Putting up with the pain is not the answer. It is common for those with dyspaurenia to suffer through because they want to be intimate with their partner or they feel they have no choice. It is important for you to know that dyspareunia is a real symptom of endometriosis and that it can be treated. It is important that you know that your pleasure is important.
For partners
It can be difficult to know your partner is in pain or to understand what they are going through. Even more so if they are reluctant to talk about it. Even the strongest relationship can face struggles if the endometriosis has a negative impact on their sex life. If you r partner has endometriosis your support is crucial. This means being mindful and listening to your partner if they say they are in pain. Encourage them to talk about what is going on for them. If you are able and your partner will allow you accompanying them to gynaecologist appointments can be a great support and a good learning experience for you.
In the coming weeks I will write articles about;
- Chronic Fatigue and Sex
- 5 Sex Positions That Can Help With Painful Sex Due To Endometriosis
- Other Bits And Pieces That Can Help When You Have Pain With Sex Due To Endometriosis
References
- Wahl, K., Imtiaz, S., Lisonek, M., Joseph, K., Smith, K., Yong, P., & Cox, S. (2021). Dyspareunia in Their Own Words: A Qualitative Description of Endometriosis-Associated Sexual Pain.Sexual Medicine, 9(1), 100274. doi: 10.1016/j.esxm.2020.10.002
- Shum, L., Bedaiwy, M., Allaire, C., Williams, C., Noga, H., & Albert, A. et al. (2018). Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis.Sexual Medicine, 6(3), 224-233. doi: 10.1016/j.esxm.2018.04.006
- Paul J. Yong et al., "Anatomic sites and associated clinical factors for deep dyspareunia." The International Society for Sexual Medicine. September 2017 Volume 5, Issue 3, Pages e184-e195.
