Endometriosis affects about 10 to 15 percent of reproductive-age women, and many with the disease also experience severe pain during sex. Uncomfortable sexual penetration can greatly reduce the quality of life for your endometriosis patients, and they may be suffering in silence. Helping them understand the connection between dyspareunia and endometriosis to get them to talk about symptoms allows you to provide endometriosis treatment earlier.
Dyspareunia, Endometriosis and Quality of Life
A report in Obstetrics & Gynecology found that anywhere from 8 to 22 percent of women experience dyspareunia during their lifetimes; however, women with endometriosis may feel severe pain from deep dyspareunia more often. About half of women with endometriosis experience this deeper pain, according to Sexual Medicine Reviews. This pain may be directly caused by endometriosis or by another condition.
Many factors can lead to pain during sex, including vaginal dryness, bladder pain syndrome and other comorbid conditions. Some cases of painful intercourse may be directly related to endometriosis, but it is not always easy to tell which issue came first. The Sexual Medicine Reviews article proposes four types of dyspareunia to help classify women with endometriosis:
- Type I: caused by endometriosis.
- Type II: related to a comorbid condition.
- Type III: related to a primary genito-pelvic pain penetration disorder.
- Type IV: a combination of types I-III.
The associated discomfort can lead to a pain cycle in which the woman is afraid of being hurt during intercourse, resulting in reduced libido, lack of lubrication and even muscle spasms that prevent her from finding relief. Research in Sexual Medicine found that women with severe deep dyspareunia and endometriosis experience lower sexual quality of life. Even patients with superficial pain during sex had lower sexual quality of life scores. Endometriosis patients also had higher depression levels and more pain catastrophizing.
Begin the Conversation
The first step in treating patients is getting them to talk about their symptoms. Women can experience endometriosis pain during sex or during masturbation — both of which can be uncomfortable for some patients to discuss — and they may be suffering quietly.
Open up the conversation by asking about sexual health. Directly ask patients with endometriosis if they experience any pain with penetration. Then look for signs of depression or other psychological issues that may be affecting them and should be addressed during treatment.
Treatment Options for Endometriosis and Dyspareunia
First, determine which type of dyspareunia your patient has. Responding to pain during intercourse with endometriosis diagnosis and treatment may not offer relief if other factors are at play, even psychological ones. If the pain stems from endometriosis, the standard treatment is surgery for endometriosis followed by oral contraceptives, according to a review in Obstetrics & Gynecology.
Further, Contemporary OB/GYN reports that laparoscopic endometriosis surgery can relieve deep dyspareunia and improve the sex lives of women with severe endometriosis. The authors also note that discovering and diagnosing endometriosis early is critical to adequate treatment and symptom management. Far too often, women suffer for years — thinking their painful periods or heavy bleeding are normal — before getting an accurate diagnosis. In addition to trying to draw out all the symptoms your patients are experiencing during a consultation, a pelvic exam and 3D ultrasound can streamline the diagnostic process.
Encourage an open environment where your patients feel comfortable talking about issues with their sex lives. Listening about their symptoms and digging deeper can help you recognize the link between painful intercourse and endometriosis and offer them treatment in a more timely way.
