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During a recent conversation with Dr. Charlotte Owens, she shared with us that one major sign that a person has endometriosis, though a similar symptom of fibroids, is pain during sex. What is supposed to be a pleasurable time for both parties engaged in intercourse can, for a woman with the disorder, be an incredibly uncomfortable one. And while we understood that to be a trait of such an ailment, we also wanted to know what causes that pain. The simple answer is, it’s complicated.

“I wish we knew exactly what causes the pain with intercourse,” says Mary Jane Minkin, MD/OBGYN from the Yale School of Medicine. “I think the easiest way is to think about what endometriosis represents. Imagine the tissue that lines the uterus, the endometrium. Imagine it backing up, and instead of flowing out through the cervix, ie, a normal period, imagine it flowing backwards out the fallopian tubes and spilling all over the pelvis to the outside of the fallopian tubes, the ovaries, the bowel, the bladder. It plants itself there, bleeding internally like a period, but in the body cavity. I think that makes it easiest to think of what endometriosis can do.”

As Dr. Minkin explained it, that tissue buildup in the body can lead to adhesions, or organs sticking to one another. A common example of that is the bowel sticking to the uterus.

“When you have sex, the penis poking at the cervix and pushing up the uterus with the bowel stuck to it, that’s easy to imagine how that can be painful,” she says.

Sounds as painful as it feels for about one in 10 individuals of reproductive age who have endometriosis. But there are ways to still enjoy sex without allowing that backup of tissue to ruin the fun. A few ways, according to Dr. Minkin, include trying new positions (including moves that allow the woman to control the level of penetration) and staying lubricated.

“There are certainly some positions that are more comfortable with sex than others, and exploring is a good thing to do,” she says.
She adds, “No matter what the cause of pelvic pain, you want to make sure that there is adequate lubrication for intercourse. If dryness is an ongoing problem, using a moisturizer like Replens on a regular basis two to three times weekly is quite helpful. And using a lubricant like Replens Silky Smooth for intercourse will give added comfort.”
But pain during sex, which has a medical term of dyspareunia, isn’t something that one should just grin and bear for the long term. Dr. Minkin recommends seeing your gynecologist to find treatment options to make things easier both while engaging in intercourse and also just getting through the day-to-day endometriosis pains.
“If a woman is experiencing pain with intercourse, she should check in with her GYN health provider. There are a lot of remedies available to help treat endometriosis, both medical and surgical (with minimally invasive surgery),” Dr. Minkin says. “And these interventions can help with other issues not associated with sex (like painful and heavy periods, for example). So do check in with your health care provider.”
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