Sex Hurts!!! Part 3- Fibroids and Endometriosis

Cramps suck!

Having cramps at the time of your period is expected. Most women just pop a couple of ibuprofen and go on with things. But deep cramping pain during sex is different and awful. It can completely disrupt a marriage and cause you to avoid sex altogether. Why are you having deep pain with sex? It can be several things. Endometriosis is a well know cause of pain with and after sex. A few recent literature articles are also pointing towards fibroids being associated with deep sexual pain. So let's dive in and see what info is out there.

Deep dyspareunia

This is the medical term for pain way down inside while having penetrative sex. It's usually a sense of cramping or intense pressure and sometimes my patients will say it feels like "he hits something" that causes the cramps which can last for hours.

Sometimes this is just a uterus that's tipped backwards (retroverted) and he's hitting the top of the uterus with deep thrusting. Usually this just causes cramping during, but not after, sex. This is easy to fix with changing positions; like going doggy-style or side-lying instead of missionary position.

If changing positions doesn't help, it may be fibroids or endometriosis causing the cramping. 

What is a fibroid and how does it cause pain with sex?

Fibroids are benign (non cancer) growths of the muscle tissue of the uterus. They can be in a lot of different places including inside the cavity of the uterus, growing inside the uterus wall, or growing off the edge of the uterus. They most often cause pain and heavy bleeding with your periods, and are a common reason for hysterectomy in the US. Deep pain with sex has recently been associated with an increased likelihood of finding fibroids on ultrasound, and especially with fibroids that are at or near the top of the uterus.

So what do we do about it? If you have deep pain with sex and we can't find a reason other than fibroids, I'd consider either removing the fibroids or doing a hysterectomy. As far as I'm aware, there isn't any literature proof that removing the fibroids or doing a hysterectomy resolves deep pain with sex, but it would stand to reason that it should. Most of my patients that have hysterectomies for fibroids wish they'd done them sooner as their lives in general improve, and especially their sex lives. Here at Nurture Womens Health, I do out-patient hysterectomies using the DaVinci robotic system. You'll go home the day of surgery, and have about a 2 week recovery.

After I finish my "sex hurts" series, I'll do more general blogging on fibroids and pelvic pain, so keep tuned for more info.

What is endometriosis and how does it cause pain with sex?

Endometriosis is when the tissue you shed every month with your period gets up in to your abdomen, attaches to a surface and starts growing there. Science isn't really sure exactly how this happens, but there are a few theories including the most popular one, retrograde menstruation (bleeding during your period out into your abdomen). Endometriosis is a BIG subject that I'll give a lot more love to in blogs to come. But for now, how does it relate to pain with sex?

Pain with sex related to endometriosis is most often caused by a sub-set called deep infiltrating endometriosis. Deep infiltrating endometriosis is when the cells growing in your abdomen invade deep in to the tissues of the pelvis. There are some studies that show any type of endometriosis can cause pain with sex, though.
How is it treated?

This is a really big topic...so I'll keep it simple for now and go in to more detail in later blogs. There's a lot of discussion among the specialists about how to treat endometriosis. My biggest addition to the conversation is that endometriosis is rarely the ONLY cause of someone's pelvic pain. Usually it's accompanied by pelvic floor dysfunction and can be associated with several other things, too. Endometriosis also often involves the bladder and bowel, so it's not as easy as "cut it out" when it comes to treatment. Things that can be done to treat endometriosis include, but are not limited to:


- Hormonal manipulation with birth control
- Leuprolide- an injectable med that makes your body think you're menopausal (imagine the side effects...)
- Orilissa- a new oral medication for endometriosis and fibroids
- Laparoscopic removal of visible implants and scarring
- Hysterectomy, with or without removal of ovaries (this is controversial)

More to come

As I said earlier, fibroids and endometriosis are HUGE topics and have a lot of bearing on pelvic pain in general. This very short synopsis was just about their relation to pain with sex. Please stay tuned to this blog for more information on both of these medical conditions. And as always, if you have been told or think you might have fibroids or endometriosis, please call or go online and make an appointment to see me at Nurture Womens Health.


Resources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503180/
https://www.ncbi.nlm.nih.gov/pubmed/22910685
https://www.ncbi.nlm.nih.gov/pubmed/24165172
https://www.ncbi.nlm.nih.gov/pubmed/18660692/
https://www.ncbi.nlm.nih.gov/pubmed/26246414
https://www.ncbi.nlm.nih.gov/pubmed/24366116
https://www.ncbi.nlm.nih.gov/pubmed/26363387
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302015000600507&lng=en&nrm=iso&tlng=en