Is Endometriosis Pain Harming Your Relationship? How to Relieve Your Discomfort and Resume Physical Intimacy

When you have endometriosis pain, sex can become unbearable. But neither you nor your relationship has to suffer. To mark Endometriosis Month, here are 10 expert tips to help you end the discomfort, communicate with your partner and resume physical intimacy... You’ve planned a romantic evening with your mate, and everything is going well – but you can’t seem to relax, because one wrong move might put you in pain so severe that it lingers for days. This is a familiar scenario for some of the 5.5 million American women who have endometriosis. With this condition, tissue similar to the lining of the uterus grows in other parts of the pelvis and abdomen. It can occur on or under the ovaries, behind the uterus, on the tissues that hold the uterus in place, or on the bowels or bladder. Some women with endometriosis feel no pain during intercourse (called dyspareunia). But for others, endometriosis pain can make physical intimacy unbearable and even break up marriages. That’s because their endometriosis is in the “cul-de-sac” – what doctors call the small space behind the cervix and lower uterus. “When endometriosis gets into that space, it widens it,” explains Deborah Coady, M.D., clinical assistant professor of obstetrics and gynecology at NYU Langone Medical Center in New York City and co-author of Healing Painful Sex (Seal Press). “It causes nerve endings to grow and inflames the tissues, and the connective tissue around the area becomes stiff,” she says. “If that area is hit during intercourse, endometriosis pain can be excruciating.” And it can last for days, because “the nerves become so irritated that they keep firing and sending impulses to the brain,” Coady says. There can be other sources of pain, she adds. Endometriosis also can cause fluids to leak from tissues, which then spread and cause inflammation in the pelvic area. “The vagina is supposed to be an elastic organ,” she says. “When endometriosis causes stiffness and pulls on other structures in the pelvis, it can make you uncomfortable.” But women with endometriosis pain don’t have to settle for a sexless life. Here are 10 expert tips that can help keep your relationship healthy. 1. Get proper medical treatment. Often, doctors start treatment with medications, such as painkillers or hormones, and then move on to laser surgery, which removes growth on tissue surfaces. For women with deep, penetrating endometriosis – the type that most frequently causes pain during sex – doctors may have to cut out endometrial tissue. “Surgical excision is the only therapy that provides relief,” says Jessica Brown, M.D., who, like Coady, is a clinical assistant professor of obstetrics and gynecology at NYU Langone Medical Center in New York City. Because endometriosis affects other organs – such as the rectum and bladder – this is best performed by a surgeon who has experience operating on the rectal area, Coady says. To find an experienced surgeon, ask your ob-gyn for referrals or call the closest large medical center or medical school, Coady suggests. If your doctor can’t help with endometriosis pain, ask for a referral to someone who can. Keep looking for a doctor who can give you the treatment and advice you need to feel better, advises Marta Meana, Ph.D., professor of psychology at the University of Nevada, Las Vegas, and president of the Society for Sex Therapy and Research, an Illinois-based professional association. 2. Don’t put your relationship on hold. Finding effective treatment for endometriosis pain can take time. But “you still have your life to live, and can’t put it on hold until the problem is resolved,” Meana says. Many couples stop showing any signs of physical affection, she says. “They stop giving each other a peck on the cheek at the end of the day, or cuddling while they watch TV,” she says. “They’re afraid that their partner will think they want to have sex.” So ask yourself this question, she advises: “Is my sexual life important enough for me to work on while I’m looking for treatment?” If your answer is “yes,” you need to commit to making the necessary changes to make your relationship work, she says. “I’ve seen hundreds of women who have started – and maintained – relationships with these conditions,” Meana says. “I know this is tough, but I think when people are in love, they do what they have to in order to make it work out.” 3. Talk it over. Sex may be a difficult subject to discuss, but communication is key. “You’re not doing yourself or your partner any favors by pretending things are OK when they’re not,” Meana says. “He can see you wince” when you’re experiencing endometriosis pain. If you don’t explain the source of your discomfort, your partner may start to think that you’re not attracted to him or that he’s doing something wrong, she says. Honest communication about the activities that are painful, and why they hurt, is the best way to avoid misunderstandings about physical intimacy, she explains. “Once you’ve had this conversation, you’ll be able to continue having that physically affectionate relationship,” she says. Also, be considerate of his feelings. Start by telling him what you like about your time together, Meana advises. Then explain that, while certain activities are painful now, you’re working on getting treatment so you can resume them in the future. 4. If something hurts, stop doing it. “If penetration is excruciatingly difficult, don’t do it,” Meana says. “If you try to ‘grin and bear it,’ you’ll develop an aversion to sex.” Fear of endometriosis pain can ruin a couple’s sex life if you don’t deal with it, she says. “If you’re having difficulty having sex, you’re probably also going to have difficulty in your relationship and with how you feel about yourself,” she says. “This can impact a central area of your quality of life.” 5. Try new things. While you’re seeking the best treatment, expand your sexual repertoire. “There are a lot of things we can do that feel fantastic,” Meana says. “Intercourse is only one of them.” It’s better for you and your spouse to experiment with pleasurable ways to be together than to stop physical intimacy altogether, she says. “A lot of couples will stop having sex,” she says. “I always ask them, ‘Didn’t you love just kissing and touching each other? Why would you stop that?’” For example, take activities you once regarded as foreplay and make them a more central part of your sex life, she suggests. For some couples, such experimentation can lead to increased feelings of intimacy, Meana says. 6. Wait until you’re ready. For women with endometriosis, being very aroused before intercourse is important, Meana says. That’s because the physiological changes caused by arousal lift the end of the vaginal canal – the area where your discomfort is located. This alone may be enough to prevent endometriosis pain during physical intimacy, she says. 7. Change positions. Some positions may hurt more than others, so you may need to experiment to find one that’s best for you. Choose a position that’s less painful and that also gives you some control. For example, if you’re on top, you can guide the depth of penetration or stop if it hurts. 8. Let your body do the talking. In sexual relationships, not all conversation is verbal. “It’s amazing how well our bodies can communicate just by moving,” Meana says. So use movements to show your partner what works and feels good during physical intimacy, she suggests. “The other body will get the message,” she says. 9. Keep working at it – even after surgery for endometriosis pain. Surgery can remove the endometrial tissue, but some pain may still exist, because endometriosis might have triggered muscle spasms and residual nerve pain. In addition, surgery leaves behind scar tissue, which can continue to make sexual intercourse painful or uncomfortable. Also, you may have some lingering fear of resuming intercourse. “If everything that has always come near your pelvis has hurt, you first need to make a positive association with your pelvis,” says Sallie Sarrel, DPT, ATC, a physical therapist who lectures on gynopathology at the University of Medicine and Dentistry of New Jersey. Sarrel has had excision surgery for endometriosis. The best way to deal with these issues is to work with a physical therapist specializing in treating pelvic-floor dysfunction. A list of practitioners is available at the Herman & Wallace Pelvic Rehabilitation Institute or the Section on Women’s Health of the American Physical Therapy Association. The therapist can work to lengthen tissues and fascia (connective tissue between muscles) to increase mobility around scar tissue, Sarrel says. This will relieve tightness caused by the scar tissue and spasms in your pelvic area. Treatments may include massage, myofascial release, and working on trigger points in your abdomen and pelvis. The therapist can also teach you stretches and strengthening exercises to do at home. All these techniques will work on your pelvic floor, which “consists of the muscles and connective tissues that extend from the pubic bone in front to the tail bone in back,” says Amy Stein, MPT, a physical therapist at Beyond Basics Physical Therapy in New York City and author of Heal Pelvic Pain (McGraw-Hill). “It helps support the abdominal organs, the bladder and the bowel, and it’s part of your core,” she explains. “It affects sexual function and continence.” Any exercise program that strengthens your core – such as Pilates – also can help you resume physical intimacy. Ask your physical therapist how to best start a Pilates or other strengthening program. 10. If you need more help, find it. If you still need guidance on working things out in the bedroom, consider couples or sex counseling. Listings of counselors in your area are available at the Society for Sex Therapy and Research or the American Association of Sex Counselors, Educators and Therapists. For more information and expert advice, visit our Women's Health Center. Do You Have Endometriosis? Has your period always been troublesome? Can’t figure out your female problems? You may have endometriosis, a common gynecological condition in women that occurs during their reproductive years. Understanding the symptoms and how they affect you could take you one step closer to the answers and treatments you may need.