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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 Carolina J.

I had tried Pelvic Floor Physical Therapy before (with another PT) and I had a really bad (painful) experience. A friend of mine and fellow patient, told me about Heather, Laureen and Femina PT (née Fusion Wellness & Physical Therapy) and I decided to try again. I am so happy I did! Femina PT have, literally, changed my life. I was able to do again things I couldn't do for over 10 years!! Their bedside manners are impeccable, their knowledge and understanding make me feel comfortable to recommend this place to anyone in pain. Specially if you have Endometriosis. 100% recommended!!

-- Carolina J., 12/28/16 via Yelp!

Testimonial by M.M.

My husband and I were married for 5 years and unable to have intercourse, but I never knew why. After numerous awful experiences at doctor’s offices (where many doctors told me I “just needed to relax”), a surgery that didn’t fix the problem, and a year of owning dilators that didn’t get me anywhere, someone finally referred me to Heather for Physical Therapy. I finally had answers and information from someone who knew exactly what I was dealing with!

Read more: Testimonial by M.M.

Testimonial by M.N., age 28

A personal journey and testimonial from one of my patients:

I was diagnosed with vaginismus 4 years ago. I never heard of such medical condition until after I got married. At first my husband and I didn't know what to do, we didn't know what the issues were or how to overcome it. Being born and raised in Armenia and being Christian I wasn't that open about talking to sex with others and so it wasn't easy to seek help. But eventually I went to an Ob-Gyn and luckily she knew about the medical condition (not many doctors know). She referred me to a physical therapist and I couldn't believe it and thought it's something I can handle myself. I ordered a kit from vaginismus.com and started practicing with dilators. There was some small progress but wasn't much helpful.

Read more: Testimonial by M.N., age 28

Testimonial by Rosanna R., age 35

Heather has affected my life in the MOST POSITIVE way and I am forever grateful. My husband refers to her as the "sex doctor" so you can only imagine how happy he is with my therapy outcome.

After the birth of my son I suffered from "Vaginismus", however, at the time I just thought I was broken. My "broken vagina" affected me physically but it was an emotional struggle as well. Many women in my life also suffered with pain from sex after their babies were born so I knew I wasn't alone. They told me they "just got used to it" but I couldn't see myself living that way.

Sex wasn't just painful, it was literally impossible - IT DIDNT FIT!

Read more: Testimonial by Rosanna R.,...

Testimonial by Carolina J.

I had tried Pelvic Floor Physical Therapy before (with another PT) and I had a really bad (painful) experience. A friend of mine and fellow patient, told me about Heather, Laureen and Femina PT (née Fusion Wellness & Physical Therapy) and I decided to try again. I am so happy I did! Femina PT have, literally, changed my life. I was able to do again things I couldn't do for over 10 years!! Their bedside manners are impeccable, their knowledge and understanding make me feel comfortable to recommend this place to anyone in pain. Specially if you have Endometriosis. 100% recommended!!

-- Carolina J., 12/28/16 via Yelp!

Testimonial by M.M.

My husband and I were married for 5 years and unable to have intercourse, but I never knew why. After numerous awful experiences at doctor’s offices (where many doctors told me I “just needed to relax”), a surgery that didn’t fix the problem, and a year of owning dilators that didn’t get me anywhere, someone finally referred me to Heather for Physical Therapy. I finally had answers and information from someone who knew exactly what I was dealing with!

Read more: Testimonial by M.M.

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