What to do when sex hurts with endometriosis

Laila had just separated from her husband of three years when she came to the Sexology Clinic. She had mixed feelings of relief and loss; relief because she did not have to have sex again and loss because she valued family life and would have wanted to have a husband and children.

“More importantly for me now is to look into the future,” she said, “I believe I can find other important things to do in life than having a husband and children, but I just need your insights.”

Laila was 32 years old. She was a successful young lawyer in town and married to a businessman. Their marriage started off with a grand wedding and a lavish honeymoon. She had kept off sex during courtship for religious reasons and Andrew, her husband, was happy with this.

“At that point he said that he finally had a woman of his dreams because of my sexual conservatism,” Laila explained.

The story however changed from the day of their honeymoon. Laila always had bad periods pains and experienced heavy bleeding. She was used to taking a cocktail of tablets to ease the pain. She had also been put on contraceptive pills, to help with hormonal balancing. Many doctors told her that the pain would ease up with the delivery of her first-born child.

“One thing I did not expect is that sex would also turn out to be agonisingly painful and that conception would be a problem,” Laila said.

“As fate would have it, three years down the line even with my endurance of the pain, there was no conception and that turned out to be the deal breaker in my marriage,” Laila lamented, “my husband and his family said I should leave because I could not give them a child.”

I did a full examination on Laila and recommended for some tests. We discovered that she had endometriosis. 

This is a disease that is common in women; it is a situation in which monthly periods do not just flow out of a woman, they also flow into the tummy because the tissues that bleed are misplaced in other organs of the pelvis. When the monthly periods happen, therefore, the bleeding tissues inside the pelvis become open painful wounds and when they heal scars form and hold and distort organs, matting them together and interfering with normal function.

In addition to prolonged pain, therefore, endometriosis causes painful sex. Further, conception can be difficult because the ovaries and tubes get wounded. 

The experience of endometriosis can aggravate anxiety and even lead to depression. Relationship problems are prevalent, not just because the woman avoids sex but also because she has difficulty conceiving which for most families is a key issue in marriage.

“Sometimes I wonder why I have to go through this, why me?” Laila said, amidst tears, “I have never seen any other woman having this problem.”

Well, endometriosis is quite common. It is estimated that 5 to 10 percent of women could have the problem. Out of all women with chronic and recurrent pelvic pain, 50 to 80 percent have endometriosis. The problem is that most of the affected women have not had their diagnosis and many get treated for non-existent urinary tract and other pelvic infections.

Just like with any other chronic illness, women can live with endometriosis and get the best out of life. Sex happens in women with endometriosis, but the couple must be trained on how to make it pleasurable rather than painful. When intercourse happens, couples should adapt to positions that do not cause pain. Sex therapy is important to deal with the mental distress and sex aversion which come with endometriosis.

It is also important to note that there are several treatment modalities directed at the disease. The pain and heavy periods can be managed and many women with endometriosis have also had children. Endometriosis should not lead to divorce and isolation; it can be managed.