Why did Ana start to hurt having sex?

Ana had never experienced excruciating pain in her life, not even during the crucial days of menstruation. So the pain you felt when having sexual contact with your partner was unexpected. But Ana is not the only woman who experiences stabbing pain during intercourse, nor is she one in a million.

There are several causes for which this can occur, but one of the most important is endometriosis. Women with endometriosis feel intense pain with any type of vaginal penetration. The severity of pain varies from woman to woman, and some women even experience pain during menstruation, making them more vulnerable to painful intercourse (dyspareunia).

How does endometriosis occur?

The endometrium is the inner lining of the uterus. It changes according to needs, and prepares itself each month to welcome the embryo during the menstrual cycle. Estrogen and progesterone are the two hormones involved in the growth of the endometrium . If pregnancy does not occur, the endometrium breaks down, causing the inner lining of the uterus to shed, expelling blood, which leads to menstruation.

The thickening and thinning of the endometrium is normal , but it becomes a problem when the same lining begins to grow somewhere outside the uterus, that is, when the endometrium grows somewhere other than the uterus. Just like what happens inside the uterus, the endometrium outside can also swell and bleed, causing serious problems, such as dyspareunia, among others.

It should be noted that just as the inside of the uterus is naturally covered by endometrium, what surrounds the uterus on the outside is a different type of tissue called the peritoneum. Under normal conditions, the peritoneum covers not only the outside of the uterus, but also the vagina and rectum, allowing these organs to remain separate. But when we are facing a case of endometriosis, instead of being separated by the peritoneum, the vagina can stick to different abdominal structures, depending on where the endometriosis “plaques” are found, causing deep pain during sexual intercourse.

How to avoid dyspareunia?

Endometriosis is one of the main reasons why intercourse can be painful. Causing pain, vaginal penetration during sex can make this pain unbearable. There are several factors that can contribute to the pain being greater or lesser , among them are certain sexual positions, or the type of communication within the couple.

There are several recommendations to reduce the chances of having painful intercourse, among which the following stand out: good communication with your partner, so that he or she knows what is causing you pain and what is pleasurable for you; use lubricants to reduce friction or resistance; choose the most suitable position, depth and intensity for the pleasure of both; And be prepared to have postcoital bleeding, as it is quite common in people with endometriosis. Also, in case you experience pain during ovulation, don’t worry. This is common because ovulation is when the endometrial tissue swells the most, so try to avoid this period when having sexual intercourse, and practice it before or after ovulation.

It should be noted that sex does not always mean intercourse, you can also practice very pleasant sex without the need for penetration, through kisses, rubbing, massages, oral sex, or any alternative that makes both of you enjoy without pain.

treatment is possible

Endometriosis can be treated in two ways: using medication or through surgery.

When it comes to medications , pain relievers are going to be your best friend for relieving sexual pain, and if you take them an hour before sex (which is how long it takes for many of them to kick in), the better. what better There are also some hormonal supplements or contraceptive treatments that can relieve pain and slow the progression of endometriosis, as well as reduce the activity of the ovaries. Therefore, it is best to consult with your trusted gynecologist, so that he can recommend the most appropriate treatment for your case.

If we resort to surgery because our case is more serious, there are mainly two types: conservative surgery , which is performed to remove only the endometrial tissues that are outside the uterus through a small incision in the abdomen, but this is a temporary measure, as they may reappear over time; and as a last resort what is commonly known as “emptying”, hysterectomy , a surgery that consists of removing the uterus, and depending on the case also the ovaries, the fallopian tubes or the cervix, in order to stop the production of estrogens in addition to radically eliminating the problem of endometriosis, since you no longer have areas where it can be produced. It is important to know that after hysterectomy, the woman loses the ability to conceive, so this option is not generally used except in extreme cases where there is no other solution or when a woman no longer wishes to become pregnant again and wants a definitive treatment for your problem.

Avoiding sex is not the solution

Painful sex does not mean giving up sexual relations, it means adapting to the demands of your body. If you experience sexual pain in a certain position, try another or alternatives like kissing, massaging, sucking, etc. And if sex hurts on certain days, try to avoid penetration. Instead, opt for other acts and don’t think that avoiding sex is the solution.

If you have any questions or problems, do not hesitate to consult your gynaecologist, who is the one who can best explain and guide you about your case.

References:

Berkley, K. J., Rapkin, A. J., & Papka, R. E. (2005, 10 de Junio). The Pains of Endometriosis. Science, 308(5728), 1587–1589. https://doi.org/10.1126/science.1111445

‌Glasser, S.R., Aplin, J.D., Giudice, L.C., & Tabibzadeh, S. (2002). The Endometrium (1st ed.). CRC Press. https://doi.org/10.3109/9780203219034

Hummelshoj, L., De Graaff, A., Dunselman, G., & Vercellini, P. (2013, 16 de octubre). Let’s talk about sex and endometriosis. Journal of Family Planning and Reproductive Health Care, 40(1), 8–10. https://doi.org/10.1136/jfprhc-2012-100530

Liu, J. H. (2020, July 13). Endometriosis. Manuales MSD. https://www.msdmanuals.com/es/hogar/salud-femenina/endometriosis/endometriosis?query=endometriosis

Vectorjuice (s.f.). Endometriosis abstract concept vector illustration. endometrium dysfunctionality, gynecological clinic, endometriosis diagnostic and treatment, female reproductive function abstract metaphor. Free Vector [Imagen]. https://www.freepik.com/vectorjuice

Wahl, K. J. et al. (2020, Julio). Deep Dyspareunia, Superficial Dyspareunia, and Infertility Concerns Among Women With Endometriosis: A Cross-Sectional Study. Sexual Medicine, 8(2), 274–281. https://doi.org/10.1016/j.esxm.2020.01.002