Aug 2021

Dyspareunia and Endometriosis

  • By: Samantha Denäe

Dyspareunia and Endometriosis often go hand in hand as it is one of the major symptoms when being diagnosed. By definition, dyspareunia is difficult or painful sexual intercourse and as one of the tale tell signs of Endometriosis, it’s crucial to tell your doctor if you’re experiencing pain during sex. When misplaced Endo tissue is growing, it causes inflammation and scarring. 

Behind the uterus is the cul-de-sac, or Pouch of Douglas, which is normally lined by the smooth peritoneum, the skin-like sheet of tissue that covers the uterus and vagina anteriorly (in front), and the rectum posteriorly (in back). This keeps the rectum, vagina, and uterus free and clear of each other. Endo will frequently stick the vagina to the rectum, causing pain during sex. It comes from the inflammation and fibrosis fusing the front wall of the rectum to the back wall of the vagina. Typically, mobility and expansion of the upper posterior vagina behind the cervix occurs during sex, but not when Endo is present. Penetration can cause the endometriotic lesions and nodules to pull and/or stretch the inflamed tissue, causing pain.

Although everybody’s body is different, about two-thirds of women with Endometriosis experience painful sex or sexual issues. Some women experience no dyspareunia, while others experience it at only certain times of the month, like around the time of their period, during and/or after sex, lasting anywhere between hours to days after a sexual encounter, or pain during sex at all times. A cramping sensation is what is typically felt after sex. 

The discomfort levels are also described differently, ranging from mild to sharp pain, stabbing pain, jabbing, or a deep abdominal ache. This also depends on vaginal penetration and how deep the penetration is. Because Endo has the ability to grow in different places in the body, it will determine your pain. Whether it’s growing around your uterus, fallopian tubes, or behind the vagina in the lower uterus, it can cause painful sex. Additionally, Endometriosis can be found from the vagina to the rectum. 

Endo growth on your ovaries may cause little to no pain during sex, but if Endo is in many places, like the kidneys, colon, bladder, etc. sex could be painful no matter what. The pain can also become more intense in certain positions, depending on exactly where the Endo is located and how advanced it is. Another cause of dyspareunia could be vaginal dryness, which when having Endo, can be the result from hormonal treatments or from having an Oopherectomy, the removal of the ovaries.

Communication is key between you and your partner as well as you and your physician. Be open and honest about your experience. Although it’s tough, there are ways to try to allievate the pain felt during sex.

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