Endometriosis: how does it affect women's sex life?

What is endometriosis?  

Endometriosis is a chronic inflammatory gynecological disease. Fragments of the uterine lining, the endometrium, migrate outside the uterus and are deposited on other organs in the abdomen, where they cause an inflammatory reaction and form lesions and scars.

It is a disease that develops in women of childbearing age, which is why it is called an estrogen-dependent disease. It is linked to variations in the ovarian hormones, estrogens. With each menstrual cycle, because the endometrium is sensitive to these hormones, endometriosis lesions form and start bleeding. 

Locations of these lesions vary from patient to patient, and can be found on the uterus, ovaries, fallopian tubes, uterine ligaments, digestive organs, rectum and also on the junction between the rectum and the colon. More rarely, these lesions involve a larger part of the colon or small intestine, the cervix, vagina, vulva, internal abdominal wall, bladder and ureters.

Endometriosis does not develop in the same way from one woman to another. However, common symptoms exist:

• Severe pelvic abdominal pain, the intensity of which does not correlate with the extent of endometriosis, and which is regulated by the menstrual cycle, 
  
• Pain when urinating (dysuria), 
  
• Painful bowel movements, 
  
• Pain similar to sciatica, 
  
• Pain during sexual intercourse (dyspareunia),
  
• Chronic fatigue, 
  
• Symptoms similar to those of irritable bowel syndrome.
  

For some women, endometriosis may go unnoticed and have no effect on fertility. For others, on the contrary, one of the consequences of endometriosis is hypofertility. The presence of inflammation, adhesions, endometriomas (cysts), ovulation problems and the absence of regular sexual intercourse affect fertility. 

The diagnosis of endometriosis is often made late, after a period of medical wandering of 7 years on average. Menstruation and sexual intercourse may often be wrongly labelled as "normally painful". 

Treatment of endometriosis is symptomatic and patient-tailored, various drugs can be prescribed to reduce pain: treatment plan may combine hormonal drugs and analgesics. Surgery may also be necessary.

Endometriosis is not life threatening, but it can be extremely painful. It is an invisible disease that significantly affects the daily lives of those who suffer from it. The pain it causes alters social, professional and intimate life of patients. 

How does endometriosis affect the sex life of women who suffer from it?  

Endometriosis complicates sexual intercourse, the reasons for it being: 

• Physical: in case of a penetrative intercourse, the penetrating object may press on sensitive lesions and areas, 
  
• Chemical: sexual stimulation increases the inflammatory reaction, so the patient's libido is disturbed by the treatments,
  
• Psychological: the disease and its treatments make changes to the body and the woman's self-esteem and self-image suffer; psychological distress decreases the libido.
  

One of the main symptoms of endometriosis is dyspareunia: persistent or recurrent genital pain, experienced during or after sexual intercourse. 

This pain can occur at different times during intercourse: penetration, deeper penetration, when changing positions and after the intercourse.

If dyspareunia is not properly managed, there is a risk that the pain will become even more significant and that vaginismus will set in. Vaginismus is involuntary muscle contractions of the perineum that prevent sexual intercourse. 

In the case of endometriosis, we often speak of deep dyspareunia. The pain is located in the lower abdomen, when a penis or another penetrating object touches the bottom of the vagina. These dyspareunias can be explained by the presence of lesions near the vagina and the recto-vaginal septum, but also by the uterine and vaginal inflammation caused by the disease. 

Dyspareunia affects women's sex lives because: 

• The pain may make sexual intercourse impossible or infrequent, 
  
• Some women anticipate the pain of penetration and are afraid of it; this can lead to a vicious circle, fear increases pain, sexual arousal is broken, the vagina is not lubricated, penetration is painful. 
  

Sexuality can also be impacted due to endometriosis treatments, as they can disrupt the woman's mood and libido, especially hormone drugs, which may also lead to vaginal dryness, making intercourse more complicated and painful.

Chronic fatigue associated with the disease does not encourage sexual relations and is a frequent symptom of endometriosis and a disturbing factor in patients' sex life.

Love life can be impaired. Because of the significant impact of the disease on a woman's sex life, she should discuss endometriosis with her partner. Women often feel guilty about the fact that it is impossible or difficult for them to offer their partner penetrative sex.

Gradually, women modify their sexuality to avoid pain. They restrict themselves in the possibilities of sexual positions or decide not to have penetrative sex, or even stop having sex at all.

What are the possible solutions for a normal sex life for endometriosis sufferers?  

There are several types of endometriosis, the lesions' locations being different from woman to woman, the pain varying in its intensity, etc. Not all women are affected in the same way, and that includes their sex life. So how can one regain a fulfilling intimacy and normal sex life?  

Get informed and communicate  

Pain and illness can take up all the attention. However, communication is the key: patients should not hesitate to discuss the disease with their partners, and partners should be receptive. There are numerous support groups for people with endometriosis and their relatives (such as Endometriosis Association, My endometriosis team, etc.).

Surround yourself with a qualified healthcare team

Treating dyspareunia requires proper management, and a gynecologist can help determine the physical cause of it and possibly prescribe some treatments, such as topical hormonal cream, topical lidocaine gel, oral drugs and botulinum toxin type A for certain forms of vaginismus. The doctor may also recommend lubricants to reduce vaginal dryness. 

To limit reflex contractions around the endometriosis lesion areas, physiotherapy or ostheopathy sessions can help: some of these healthcare providers specialize in perineal care. If the problem is of muscular origin, such sessions may allow patients to relax their muscles.

Psychological care (therapy sessions with a psychologist or a sexologist) may also help the affected women and their partners. 

Take care of yourself 

The symptoms of the disease, examinations necessary for establishing a proper diagnosis, treatments - all this may provoke a sort of detachment from one's relationship with oneself, so one should try to reappropriate one's own body to regain a certain level of intimacy. Several methods can help you feel better: massages, meditation, sophrology, etc. 

Use progressive vaginal dilators

They help women with dyspareunia and vaginismus, among other things, to treat pain and discomfort during penetration. A vaginal dilator, also known as a vaginal candle, helps to relax and massage all the muscles of the vagina. A recent study has also demonstrated the therapeutic virtues of sex toys for women suffering from these disorders.

Moving beyond penetration-centered intercourse

The classic pattern of sexual intercourse consists of a foreplay, a vaginal penetration, and an orgasm (or not). However, there are many different ways of making love. Increasingly, another vision of sexuality is emerging in which vaginal penetration is no longer a requirement for fulfilling sexual intercourse and an orgasm.

For some women affected by endometriosis, sexual acts may have to be rethought and adapted.