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Why do some women have pain during sex?

Endometriosis is no joke, affecting millions of women.
Endometriosis can be extremely painful and cause fertility issues. Photo supplied.

Why do some women shy away from sex? It might be fatigue after a long day where everything, everything, has gone wrong. But before men jump to conclusions, they should know about a disease called endometriosis. This problem causes severe pain during sex. It occurs in about 10 percent of women and has a profound effect of their lives. And, about 30 percent will have trouble becoming pregnant.

Some women with endometriosis may be fortunate. In spite of extensive disease, they are completely free of symptoms. Others, with minimal amounts of endometriosis bitterly complain of a variety of symptoms.

What is endometriosis? At the end of a menstrual cycle women experience vaginal bleeding. The inside of the uterus, called the endometrium, starts to break down, resulting in a normal menstrual period.

Doctors cannot completely explain why some women also have misplaced endometrial lining in the abdominal cavity. This also bleeds. But since this blood is trapped, with nowhere to escape, it triggers pelvic symptoms.

Endometritis is the unfortunate result, an inflammatory reaction throughout the pelvic cavity. Depending on the location of the abnormal endometrium, the pain can be intense. The uterus, ovaries, and fallopian tubes can be affected, as can the urinary bladder or the ureter, a small tube that carries urine from the kidney to the bladder. All too often the endometriosis is scattered throughout other parts of the pelvic cavity.

However, the prime location for this disease is at the end of the vagina where the uterosacral ligaments provide support for the vaginal tissues. It is a very sensitive area after endometriosis triggers inflammation of these ligaments. They become thickened, scarred and terribly tender. Often the disease causes the formation of large abdominal cysts full of blood.

It’s then small wonder that patients complain of a diversity of symptoms. In addition to painful sex, they suffer from generalized chronic abdominal pain, low backache, and fatigue. Abnormal bleeding is common too.

What causes more anxiety is that about 30 percent of these women have trouble becoming pregnant.

The actress Susan Sarandon, who suffered with this condition and advocates for the Endometriosis Foundation of America, said, “Endometriosis was definitely another character in any relationship that I had.” The comedian Whoopi Goldberg has also spoken about the need for more attention. “There is nothing dirty about it. No religious group is going to be pissed if you discuss this. Because if you don’t discuss it, many more women are going to find themselves unable to have children or find themselves close to dying because [the disease has] led to something else.”

Medical treatment is always tried first. Birth control can provide relief by stopping periods.

Surgery is usually done if doctors believe endometriosis is widespread throughout the abdomen. Doctors then resort to abdominal laparoscopy. What they see is often endometrial lesions involving many areas of the pelvic cavity along with extensive involvement of the uterosacral ligaments.

Looking at these lesions though the laparoscope allows doctors to destroy them with an electric current. And if ovarian cysts are present these can also be removed, conserving normal tissue for future pregnancies.

What about menopause? The pain may improve once periods stop and there is a lack of the female hormone estrogen.

There is always hope that laparoscopic surgery and destruction of endometrial lesions will result in a wanted pregnancy. However, the constant waiting can be terribly frustrating for those desiring pregnancy.

An Italian proverb reassures. “Hope is the last thing ever lost.” Or, as another wise sage remarked, “Don’t forget to wind the clock, as tomorrow is another day.”

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