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physical therapy can help endometriosis
Endometriosis & Painful Sex | Image Courtesy of Anthony Tran via Unsplash

Did You Know Physical Therapy Can Help Endometriosis?

What is the link between endometriosis and painful sex?

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.

Sexual Function

One such domain of quality of life that is often affected is sexual function. The DSM-V1 defines sexual dysfunction as a clinically siginifcant 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?endo sexual function jannes jacobs article 600p

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 for my painful sex or other 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 and 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 it 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?

Now that you know that physical therapy can help endometriosis, 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.

Notes: 

1. DSM-V is a book published and maintained by the American Psychiatric Association, titled The Diagnostic and Statistical Manual of Mental Disorders.  It categorizes and defines clinically significant disturbances in psychological, biological or developmental processes underlying mental processes. 

 

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 Fritzette H.

I went to Heather after the birth of my third child. It was lucky, really, that I was referred to her, because my doctor had referred me to a surgeon for a possible hysterectomy or pelvic wall rebuild. Thankfully, I went to Heather before undergoing either surgery, she was able to fix the problem. She has studied extensively in women's health--even written a book about it--and was able to diagnose my problem, suggest a course of treatment (6 weeks), and then follow through with said treatment. By the end, as she said, I was as good as gold. Boy, was it worth it! Though uncomfortable to talk about, much less write about, it is worth getting the word out there. If you have painful intercourse, especially after birth or other trauma, the treatment may be as simple as Physical Therapy (with Heather, of course). I highly recommend her.

-- Fritzette H., 3/24/16 via Yelp!

Testimonial by J.B.

My husband and I were having problems with painful intercourse. My therapist recommended that I go and get a pelvic floor evaluation from a physical therapist. Having never been treated by a physical therapist, I wondered how this really was going to help me. My husband who is a physician was very supportive and agreed that a PT evaluation would be a great idea. So i made the appointment and was blown away by what I learned. I had no idea that pelvic floor muscles could get tight and have trigger points just like any other muscle in the body. I'm a massage therapist and very familiar with tight muscles, and this new thought really amazed me. Heather's program to help relax and strengthen these muscles made such a difference. I can say that I am 100% pain free during intercourse now. Yippee! Going to the PT appointments and doing the at-home exercises was definitely a discipline, but it's 100% worth it! The rewards are amazing.

-- J.B.

Testimonial by Fritzette H.

I went to Heather after the birth of my third child. It was lucky, really, that I was referred to her, because my doctor had referred me to a surgeon for a possible hysterectomy or pelvic wall rebuild. Thankfully, I went to Heather before undergoing either surgery, she was able to fix the problem. She has studied extensively in women's health--even written a book about it--and was able to diagnose my problem, suggest a course of treatment (6 weeks), and then follow through with said treatment. By the end, as she said, I was as good as gold. Boy, was it worth it! Though uncomfortable to talk about, much less write about, it is worth getting the word out there. If you have painful intercourse, especially after birth or other trauma, the treatment may be as simple as Physical Therapy (with Heather, of course). I highly recommend her.

-- Fritzette H., 3/24/16 via Yelp!

Testimonial by A.M.

Months after giving birth, it was difficult for me to go from a sitting or lying position up to a full standing position without feeling that I had to remain hunched over until a bit of time had passed to get fully upright. However, after taking Heather’s course, I learned exercises to get my body back to normal. She also showed me correct ways to lift and carry my son as well as put him in/take him out of the carseat and stroller. This class was really beneficial and Heather is a wonderful teacher who made me feel very comfortable.

-- A.M.

Testimonial by S.H., age 24

I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be.

It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally over. I really feel that Fusion Wellness is a team of people you can call family and are there to root for you and cheer you on until you reach your goals. There is nothing better than knowing I accomplished this with you guys by my side and as calmly and patiently as I needed. Thank you from the bottom of my heart for always being there and helping me reach my goals.

S.H., age 24

Testimonial by R.S.

I wanted to thank you so much for helping me get through something I thought I may never be able to. We have achieved pain-free intercourse and this has really solidified our marriage. We are so grateful to you for all the work you do! Thank you!!

-- R.S.

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