Endometriosis and sexuality

Endometriosis is a chronic inflammatory, oestrogen-dependent condition that remains far too little known. Women who suffer from it often wait a long time before receiving a diagnosis — on average, seven years.

The most commonly reported symptoms are as follows: 

• Dysmenorrhoea: These are pains during periods, but which can also develop outside the cycle. 
• Dyspareunia: These are pains deep in the vagina during penetration and sometimes afterwards (post-coital/post-orgasmic pain).
• Dyschezia: This refers to digestive pain, particularly during defecation. 
• Dysuria: These are urinary pains, such as recurrent cystitis without bacteria. 
• Dysfertility: This refers to difficulties conceiving a child.
• Chronic fatigue (find more information on endometriosis and fatigue)
• Endobelly: Severely bloated abdomen.

So, why is endometriosis so often a barrier to sexual wellbeing? Let's look at dyspareunia. 

Let us first look at the etymological origin of this word. The prefix dys- expresses difficulty (from the ancient Greek δυσ-) and the suffix pareunie (Greek root pareunasthai) means coupling. 

Dyspareunia therefore means difficulty during coupling.

This is a term used in both women and men. In women, two types of dyspareunia are distinguished. 

Superficial dyspareunia

It refers to pain at the vaginal entrance or at the vulvar level (introital pain, vaginismus, vulvodynia, vestibulodynia).

Deep dyspareunia (pain in the vaginal canal and lower abdomen). 

Deep dyspareunia is the 2nd most frequently reported symptom in people with endometriosis and is also the most characteristic (as it affects between 50 and 80% of patients). 

This is a pain felt deep in the vaginal canal at the moment of thrust (during penetration). It can be positional — meaning it is only felt in positions that involve deep penetration (such as doggy style) — but it can also be felt after sexual intercourse.

Causes of dyspareunia: 

Lesions close to the uterus and vagina

This pain is mainly due to the location of endometriosis lesions close to the uterus and vagina (LUS bladder, rectum, torus, ovaries, etc.). The uterosacral ligaments are the most common site of lesions in women with endometriosis. These ligaments, which hold the uterus to the sacrum, are put under strain during vaginal penetration as the uterus moves back and forth with each thrust. 

Uterine contraction 

Adenomyosis (usually defined as endometriosis internal to the uterus) can be responsible for post-coital and post-orgasmic pain. This is because, during arousal and sexual intercourse (with or without penetration), the uterus contracts under the effect of pleasure. This can cause pain in the lower abdomen, similar to period pain. Deep dyspareunia is the most difficult endometriosis symptom to manage, as only 30 to 40% of patients find relief through hormonal treatment. 

Factors that can aggravate the pain:

Factors that can worsen the pain:

Superficial dyspareunia related to endometriosis is only very rarely a symptom in itself. In most cases, it is a consequence of the condition. 

Repeated painful sexual experiences, chronic pain, and stress can sometimes lead to cerebral hypervigilance — meaning the brain develops a defence mechanism to protect the body from a painful act. 

This is actually a sign of good mental health — when you hold your finger above a candle flame, the brain triggers an unconscious reflex contraction so that you pull your finger away.

In the context of repeatedly painful sexual intercourse, the brain activates this same protective mechanism. It will do everything to prevent penetration from occurring: unconscious and involuntary contraction of the pelvic floor, making penetration painful or even impossible, and sometimes recurrent thrush and cystitis. 

There are several solutions to help you better understand your sexuality and manage pain. 

What is important in endometriosis is a multidisciplinary approach to care.

The right supportive care needs to be found for each individual to reduce pain and help manage living with it day to day. It is very much a case-by-case situation. You can also turn to osteopathy, hypnosis, sophrology, naturopathy, and so on… 

Let us never forget that, in life, nothing is ever set in stone — today is today, and tomorrow is another day. A day without pain, a day with a more fulfilling intimate life. Anything is possible. Let us never forget that "knowledge is power". Understanding your condition and how it works allows you to come to terms with it and then take back control. We wish you the strength to take that power!