Endometriosis and sexuality
July 9, 1999
Web posted at: 11:43 AM EDT (1543 GMT)
By Sandor Gardos, Ph.D.
(WebMD) -- It is estimated that up to 10 million American women suffer from a chronic, painful condition known as endometriosis. This illness occurs when pieces of the normal lining of the uterus (the endometrium) "migrate" to other areas of the body -- most commonly, the pelvic region. Because the endometrium normally sheds during a woman's monthly menstrual cycle, internal bleeding, inflammation and pain usually result if this tissue locates itself in a part of the body that has no way of draining it.
Although pain during or following intercourse is one of the most common reasons for women with this condition to see a doctor, the issue of how endometriosis affects sexuality is almost never discussed. This is especially troubling since almost all of the available treatments will also affect a woman's sexual functioning in one way or another.
A mysterious malady
No one is entirely sure what causes endometriosis, but it is clear that this condition can only occur after a woman begins menstruating. The "retrograde theory," first proposed in 1921 by Dr. John Sampson, suggests that endometrial tissue sometimes backs up through the fallopian tubes, becomes lodged in other parts of the body, and continues to grow. How endometrium would get into some of the other locations where it has been found, such as the arms and even the brain, is unclear.
How do I know if I have endometriosis?
You should see your gynecologist if you are experiencing painful periods, intercourse or urination; lower-back or pelvic soreness; or unusually intense periods. Unfortunately, endometriosis can be difficult to diagnose. Since the only way to confirm the presence of stray endometrium is via laparoscopy, most doctors will do what is known as an exclusionary diagnosis, first ruling out all other possible causes for a woman's symptoms.
How might endometriosis affect my sex life?
Endometriosis is one of the leading causes of dyspareunia (painful intercourse) in women. In fact, until it was better understood, many women went through years of psychotherapy to treat what was, in fact, a medical condition. Of course, this is not to say that painful intercourse is always caused by endometriosis, or that dyspareunia is always medical in origin, but it is vital that any woman experiencing pain during or after intercourse see her gynecologist.
What are the treatments and how might they affect my sex life?
Although there is currently no cure for endometriosis, there are a number of treatments that focus on reducing symptoms, slowing growths and preventing or delaying reoccurrences. Treatments fall into a number of categories, all of which, unfortunately, can have an effect on a woman's sexuality.
One of the first treatments usually tried is the birth control pill. Since the pill regulates a woman's menstrual cycle, it can minimize some of the symptoms of endometriosis. Although most women can take the pill without incident, a few do report changes in libido.
In more extreme cases, various drugs that suppress the growth of the endometrium may be used. Unfortunately, these drugs work by suppressing estrogen levels, thus causing a form of induced menopause, along with all the associated symptoms. In particular, many women experience loss of sexual desire, as well as vaginal dryness. Luckily, supplementing these drugs with androgens, as well as using extra lubrication, can be very helpful. Lamentably, some of these drugs also have masculinizing effects (facial-hair growth, deepening of the voice, etc.). Not only do many women find these effects highly disturbing, but they also contraindicate the use of an androgen supplement.
In the most advanced cases, surgery -- including hysterectomy -- may be necessary. Many women go through serious changes following hysterectomy -- both due to the sudden hormonal changes, as well as to feelings they may have that they are no longer "entirely a woman." Some women also report a change in the way their orgasms feel given that, following complete hysterectomy, they no longer experience uterine contractions. One technique that can be very helpful if hysterectomy is required is what is known as "supracervical hysterectomy," where the cervix is left intact. This not only helps maintain the vaginal muscle tone but may also help to preserve full sexual sensation. If a full hysterectomy is performed (including the removal of the ovaries), most women notice a decrease in sexual desire, since (even in postmenopausal women) the ovaries continue to produce small amounts of testosterone, which is the hormone responsible for libido in both men and women. Again, supplementing via synthetic androgens may be helpful.
Finally, almost all treatments are supplemented with some form of pain reliever to help women cope with the discomfort. Nonsteroidal anti-inflammatory pain relievers like Advil and Motrin do not normally have any of the sexual side effects that most of the stronger narcotics do. If a woman is experiencing so much pain that drugs such as Demerol or Codeine are required, she may experience drowsiness, vaginal dryness and difficulty with arousal and orgasm -- obviously, a very bad combination. On the other hand, if a woman is experiencing so much pain that it makes intercourse impossible, taking a pain reliever an hour or so before sexual activity can be a life-saver.
Although some of these treatments may seem to be worse than the disease, the reality is that endometriosis rarely goes away on its own. Left untreated, it can cause infertility and debilitating pain. The best advice for women who are experiencing any of the listed symptoms is to see their doctor as soon as possible. Finally, don't be afraid to mention sexual side effects as they occur, or even to ask for a referral to a qualified sex therapist if needed. Endometriosis need not mean the end of a healthy sex life if it is treated properly and promptly.
Copyright 1999 by WebMD, Inc. All rights reserved.
RELATEDS AT :
Endometriosis (Health Topics A-Z)
Endometriosis (Self Care Advisor)
Endometriosis and Hysterectomy
The Endometriosis Association
The Endometriosis Research Center
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