Obstetrician-gynecologist Alix Sesques gives her valuable advice to improve the sex life of women with endometriosis.
Why doctor – What is endometriosis?
Alix Sesques – Endometriosis is a complex disease that causes endometrial tissue from the lining of the uterus to migrate to other places in the body where it is not supposed to be. This causes inflammation in the body and chronic pain.
Sexual pain linked to endometriosis
How does this disease impact the sex life of women who suffer from it?
Endometriosis can sometimes cause pain during intercourse because the tissue that comes out of the uterus and bleeds regularly can end up in places near the sexual organs and vagina.
Do all women with endometriosis suffer from this type of problem?
No, but I would say that eight out of ten of my endometriosis patients suffer during sex. It is therefore a common problem that it is important to detect by clearly and systematically asking patients the question.
Is sexual pain related to endometriosis significant?
It really depends from woman to woman, as each patient develops a particular form of endometriosis. This ranges from simple embarrassment to a complete inability to have intercourse.
Sexuality and endometriosis: how to limit pain
Concretely, what do you advise them to improve this situation on a daily basis?
You must avoid painful positions once you have spotted them and identified when they appear (which is often linked to the menstrual cycle, Editor’s note). Generally, I advise my patients to get on top, because this allows them to control the possible onset of pain. I also invite them to focus less on deep penetrations by favoring other types of sexuality.
It is also necessary to overcome problems with lubrication at the entrance to the vagina when they arise by using gel and taking the time to build up arousal before intercourse.
Finally, I encourage the women I see to communicate with their partner about their illness and its sexual consequences, in order to allow them to be attentive and understanding.
And on a more medical level?
The use of surgery or contraception may be effective in some cases.
Sexuality and endometriosis: who to consult?
Who should be consulted?
I think that this is the role of the gynecologist, but faced with the lack of health professionals in this sector, many unfortunately do not have the time and energy to take care of the sexuality of their many patients.
In this case, sexologists, midwives, physiotherapists, osteopaths and general practitioners can also be good recourses if they are sufficiently trained (which is far from always being the case).
And if you ever feel that the caregiver’s feedback is not positive on the subject, I advise consulting someone else, because you should not be left alone with your pain.
Could psychological follow-up be interesting?
Yes, especially in cases of anxiety, vaginismus or phantom pain.
On the other hand, I think that in these cases, we must be careful not to make patients understand that their pain is only “in their heads” and carry out a physical and technical approach to their sexuality with each person in parallel.
How to successfully consult about your sex life?
On the part of the caregiver as well as the patient, we must not hesitate to go into detail, that is to say, to explain or to try to find out how much it hurts, in what positions, at what time, if it leads to when intercourse stops, if there is already contraception, etc.
You must also keep in mind that this type of consultation takes time, and that it can sometimes require several appointments for the patient to feel comfortable enough and to express themselves.
Learn more about endometriosis and sexuality
Can sexual pain really go away once it is properly taken care of?
Not always, especially in the case of the presence of a nodule deep in the vagina. In this specific case, contraception is ineffective and surgery can result in a scar which remains painful (without necessarily preventing recurrence).
Are women with endometriosis given enough support regarding their sexuality?
No way. I am regularly appalled by the number of patients who arrive in my office totally resigned to the fact that their sexuality has always been a problem.
However, sometimes it doesn’t take much to improve their situation.
What do you think should be done to improve their condition?
As the subject is still taboo, in my opinion French women should be more informed about endometriosis and sexuality, so that they understand that it is an important part of their overall quality of life that can be taken care of . In this sense, perhaps it would be interesting to integrate the sexual dimension into current scales for evaluating the well-being of patients.
It would also be necessary to develop a network of professionals specialized in this type of problem throughout the territory, which is not yet the case today.