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Endometriosis and Sexual Function | Image Courtesy of Anthony Tran via Unsplash
Endometriosis and Sexual Function | Image Courtesy of Anthony Tran via Unsplash

Endometriosis and Sexual Function Require a Specialized Approach

Endometriosis is a global disease affecting 5-15% of women during their reproductive years. It is characterized by the presence of endometrial-like tissue outside of the uterus which can trigger a local inflammatory response and can have a significant impact on patients’ quality of life.

One such domain of quality of life that is often affected is the correlation between endometriosis and sexual function. The DSM-V defines sexual dysfunction as a clinically significant disturbance in a person’s ability to respond sexually or to experience pleasure and includes pelvic pain, penetration disorders, lack of sexual interest, and/or arousal and orgasm disorders. Unfortunately, it is common, as approximately 40% of women with endometriosis and chronic pelvic pain suffer from sexual dysfunction. 

Why does painful sex occur with endometriosis?

It is thought that women with endometriosis experience dyspareunia (pain with sex) due to endometrial lesions on specific areas, such as the uterosacral ligaments, pouch of Douglas, posterior vaginal fornix and anterior rectal wall. In addition, we know that endometriosis can affect women’s menses, bladder and bowel function, and pelvic pain regardless of where they are in their cycle. All of the above can affect sexual function. There is also a high rate of depression among those with endometriosis and there is a known link between depression and decreased sexual functioning. 

In addition, there are psychological factors in play. Pluchino, et al. (2016), states,

the association between coital pain and sexual dysfunction is the result of repeated experiences of sex associated with pain and fear of pain. The fearful reaction in turn negatively affects desire, arousal, reward, lubrication, loss of genital congestion and heightened pelvic floor tone in a circular model.”

Emotional elaboration (anxious, frustrated, guilty, etc.) and cognitive elaboration (hypervigilance, catastrophizing) can also lead to poor pain perception and decreased pain tolerance. 

Infertility can also affect our feelings towards sex. For example, decreased sexual self-esteem, feelings of failure of not being able to conceive, as well as experiencing external pressures can definitely contribute to overall poorer attitudes towards sex. Fertility status, length of infertility, and IVF are associated with overall decreased sexual functioning as seen on scores on an outcome measure that specifically measures these (Female Sexual Functioning Index, or FSFI). 

Are there other options besides surgery for endometriosis to improve my sexual function?

The best way to treat endometriosis is surgical excision. There are a number of studies that show improvement in sexual functioning after surgical excision. One study showed an improvement in arousal, desire, and pain six months after surgical excision of those with deep endometrial lesions. A different study showed that six months after surgical excision of deep endometrial lesions, patients reported a significant increase in satisfaction and desire at a level similar to those reported by healthy controls! However, depending on how long one has been symptomatic, it can be more difficult to achieve a pain-free sexual lifestyle even after surgery. A systematic study summarizes a key message that although surgery can improve many symptoms, it does not necessarily resolve sexual dysfunction. The authors recommend a multidisciplinary approach with “the aim of improving global sexual functioning, and not just reducing pain at intercourse,” including addressing physical/anatomical, psychosocial, and emotional factors. 

What will Physical Therapy do to reduce endometriosis pain during sex and improve sexual dysfunction?

Pelvic floor physical therapists can help create a healthy, optimal pelvic floor. More often than not, those with symptomatic endometriosis or suspected to have endometriosis demonstrate a hypertonic (or overactive) pelvic floor. Hypertonic muscles are short, weak muscles and can develop trigger points in the muscles. The hypertonicity and trigger points can lead to pain with sex, bladder dysfunction (with symptoms of urgency, increased frequency, incomplete emptying), and bowel dysfunction (constipation, pain with defecation, and more). In addition, pelvic floor physical therapists can help address common digestive symptoms such as bloating and abdominal pain by working on visceral (abdominal fascial and organ) mobility. Visceral mobilization techniques help keep organs moving fluidly as they can sometimes be tethered by endometrial lesions.

Specialized physical therapists would:

  • address trigger points and hypertonicity of the pelvic floor muscles
  • educate on bladder/bowel strategies to optimize function
  • teach how to use tools to improve sexual function (medical dilators, pelvic wands)
  • implement visceral mobilization of abdominal organs
  • apply autonomic nervous system downtraining techniques
  • address other musculoskeletal drivers head to toe (jaw, neck/shoulder, hips, low back, etc.) 
  • present an individualized and appropriate exercise/stretch program for you

Don’t know where to start?

Start with a pelvic floor physical therapist to get a full examination (orthopedic and pelvic floor) and help with guidance throughout your journey to the appropriate practitioners and treatments. Contact us for questions, concerns or to make an appointment.

 

References:

Barbara G, Facchin F, Meschia M et al. What love hurts. A systematic review on the effects of surgical and pharmacological treatments for endometriosis on female sexual functioning Nordic Federation of Socieities of Obstetrics and Gynecology 2017;96:668-687. 

Dior UP, Reddington C, Cheng C, et al. Sexual Function of Women With Deep Endometriosis Before and After Surgery: A Prospective Study. J Sex Med 2021; 000:1-10.

Donato ND, Montanari G, Benfeati A, et al. Sexual function in women undergoing surgery for deep infiltrating endometriosis: a comparison with healthy women. J Fam Plann Reprod Health Care 2015;41:278-283. 

Pluchino N, Wenger Jean-Marie, Petignat P, et al. Sexual function in endometriosis patients and their partners: effect of the disease and consequences of treatment. Human Reprod Update 2016;6:762-774. 

What Our Patients Have to Say

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Testimonial by S.S., age 54

Heather is the best! I saw her today for terrible hip/groin pain. I was so impressed with the safety measures in place and felt completely safe . Thanks for the healing hands.

S.S., age 54

Testimonial by A.W., age 32

I wanted to let you know that my pelvic floor held strong and gave me no trouble whatsoever in my trail race this morning (12 miles)! In a way, I felt like I ran better than ever because my core feels so rock solid from all the exercises you have me doing. That was especially valuable on the technical downhill - I just flew down the trail because I had confidence in my balance and form. Thank you for helping me get back to doing what I love.

-- A.W., age 32
(completed Post-partum Renewal Program using the InTone biofeedback/stim unit)

Testimonial by Mary L.

I started seeing Heather to treat my Interstitial Cystitis in November 2016. At this time, I was extremely miserable, in constant pain, and felt as though no one was listening or understood what was going on with my body. I have just finished my last appointment and I can honestly say that my life has completely changed for the better because of Heather and her team of PTs! I live almost completely pain free, and when I do have flare ups, I am able to treat them at home on my own. I am so grateful that this office was recommended to me a honestly cannot recommend them enough!

Read more: Testimonial by Mary L.

Testimonial by S.S., age 54

Heather is the best! I saw her today for terrible hip/groin pain. I was so impressed with the safety measures in place and felt completely safe . Thanks for the healing hands.

S.S., age 54

Testimonial by Alexandra B.

Heather is without exaggerating AMAZING! After years of trouble with a certain part of my body, in no time, she made everything change back to equilibrium and to what would be considered normal. She explains everything in detail and therefore gives you a better understanding of why things are the way they are, and how you can work towards turning things around. I would highly recommend Heather for any type of Physical Therapy. She has created her own "Method/Therapy" through years of studying (with some of the greatest practitioners), practice and breaking down the issues of her past patients, enabling her to fine tune her own system. I'm so thankful to have found her, and I'm especially grateful for the quick recovery I've achieved, after years of distress. If you cannot afford her, I recommend you purchase her book. Although it may not be Heather in person, it can still help you to get on the right path to recovery!

-- Alexandra B., 5/20/2015 via Yelp!

Testimonial by A.B.

Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
-- A.B.

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