"Did you know?"

Tips and Information on Endometriosis: A Monthly Feature

Andrew S. Cook, M.D.
EndoZone Advisory Board Member
Reproductive Endocrinologist / Gynecologist
Medical Director / Founder
Vital Health Institute
http://www.vitalhealth.com/
Los Gatos, CA

Endometriosis is Not The Only Reason Women Have Pain With Sex

While it is estimated that about 60% of women with endometriosis experience painful sex, this may not be the only reason intercourse hurts. 

Endometriosis can cause pain severe different ways.  The presence of endometriosis in the posterior cul-de-sac, especially invasive stage III or IV endometriosis, often results in pain with deep penetration. Normally the uterus and cervix moves up and out of the way during intercourse.  Deep invasive endometriosis results in scarring of the posterior cul-de-sac and prevents the cervix and uterus from moving out of the way.  The scarring often pulls the uterus (tilted backwards) as well. This can result in what medically is known as collisional dyspareunia that literally means painful sex when the uterus is hit.  The ovaries are connected to the top of the uterus, thus when the uterus is tilted back, they tend to rest on the top of the vagina.  The ovaries are sensitive just like a man’s testicles.  Most guys know what it means to get hit “down there”.  If your significant other is having trouble understanding what you are going through, this analogy may be helpful.

Other common causes of pain with sex include, interstitial cystitis (IC) or painful bladder syndrome, pudendal nerve entrapment or neuralgia, pelvic congestion, pelvic floor muscle spasm, vulvodynia and vestibulitis.  Vaginal infections and hormone imbalances can also result in pain.  The bladder is located along the front side of the vagina.  For patients with painful bladder syndrome it can be like having a sunburn rubbed.  The pudendal nerve is located roughly at the 3 and 9 o’clock position about half way up the vagina.  This nerve can become damaged a variety of ways, resulting in the nerve constantly sending out pain signals. Patients can actually get varicose veins in the pelvis.  The stretching of the blood vessels can actually result in a fair amount of pain, similar to the pain of bowel gas. Pelvic floor muscle spasm is common in endometriosis patients with pelvic pain.  You can read more about this condition in my January 2011 “Did you know?” essay.  Vulvodynia and vestibulitis are painful conditions of the area right around the opening of the vagina. 

Unfortunately, painful sex is all too often part of having endometriosis and is just one more way this disease disrupts the lives of women with endo.  It is a medical condition that can usually be treated.  You may need to consult with several different doctors before you find the right one that understands these conditions.  However, emotional and relationship issues can persist even after the physical pain is resolved.  A sex therapist can be vary helpful in resolving these issues and get your sex life back on track.