Niva Herzig PT of Core Dynamics Physical Therapy joins The Endometriosis Summit blog as a kick off to two part series in Sex and Relationships. Niva will join Endo Summit 2020 on March 1 as we explore Sex and Relationships in an interactive activity at our Town Meeting. Niva writes:
Abdominal Pain. Vaginal Pain. Rectal Pain. Low Back Pain. Hip Pain. What if you have one or all of these for a week per month? What if you had them for 2 or 3 weeks? What if you had to miss work or school because these symptoms were at such severity? How would you feel if you had to repeat surgeries because the gold standard of care was not readily available? This is exactly what people with endometriosis experience.
As humans, most of us crave some sort of relationship which includes intimacy (physical and emotional). Dealing with chronic pelvic pain often challenges intimacy needs. Some avoid having relationships that may lead to intimacy or sexual intercourse. They avoid dating or engaging with people who they may be attracted to. In fact, many reduce social interactions or report losing friends and partners due to chronic pain. Many do not know how to start the conversation regarding their history with painful sex to a possible (new) partner.
People with endometriosis who are in relationships often report avoiding close contact with their partners. They fear it may lead to sexual intercourse which is known to be or has been experienced as painful (dyspareunia). This leads to fear avoidance by either partner: fearing sexual intercourse or partners fear hurting them -a perfect storm to make matters worse. Sexual intercourse becomes completely avoided. Beyond pain, there may be fatigue, mood, depression, guilt, anxiety and low self-esteem which may interfere with desire. People with endometriosis often must decide whether to avoid sex or to endure pain.
What about the those undergoing surgeries? Many have had hysterectomies at a young age not realizing that hysterectomy does not treat endometriosis, only adenomyosis. Many have endured multiple surgeries without realizing the impact that excision of endometriosis could have on their quality of their life. Many experience fertility challenges. They grieve their absent fertility. They grieve the perception of "normal" for the human body. They grieve from the damage fertility drugs and/or inadequate hormonal treatments has done to their bodies. In return, many feel less desirable and may shy away from intimate relationships. Trauma abounds in life with endometriosis. Multiple surgeries are traumatizing especially when they start at a young age. Medical gaslighting, symptom minimization all by supposedly trusted medical practitioners, unfortunately, leaves a lasting impact. Many fear being touched and many have trust issues with those in intimate experiences. This adds to the emotional pain that may disturb a relationship.
How can people with endometriosis empower themselves in a relationship?
1. Communication with a partner is highly recommended. Perhaps the couple attend therapy with a sex therapist or relationship therapist.
2. Physical Therapy can make a huge difference in sexual pain. Physical therapy will address pain (reducing, managing and awareness), myofascial and visceral restrictions, movement impairment and biomechanics, exercise programs, etc.
3. Explore excision. Excision of the disease at its root removes the disease from the ligaments and areas of the body that may contribute to deep pain from sex. Additionally, specialized treatment by a qualified excision specialist will improve fertility, decrease the inflammatory response in the pelvis, and lessen daily pain and dysfunction. An excision specialist will need to be sought out because most OBGYNs only perform ablation or burning of endometriosis.
People can lead a fuller life with endometriosis. Earlier diagnosis, proper treatment that includes multidisciplinary care of excision combined with physical therapy and a functional approach will lessen the burden of the disease on everyone's life. Sex and intimacy are a fulfilling part of life. Good care will restore intimacy to your life.
An integrative approach to care is my recommendation for battling painful sex. Combining medical with psychological and physical therapies as well as acupuncture are great ways to start. Adding nutritional counseling, health coaching and exercise will make it more successful.
At Endo Summit 2020 we will explore all things Sex and Relationship related. We will also explore why your voice may be the most important thing in endometriosis care. Stand up and be heard. Tickets are on sale www.theendometriosissummit.com