About Last Night: I’m worried that my illness is going to kill our relationship 24-09-17

October 2, 2017

Q: I’m 32, and have been going out with Paul for five years. He’s my best friend, and we love each other, but our sex life is almost non-existent. I have endometriosis, and am often in pain, especially during sex. As a result I fear experiencing pain, Paul fears hurting me, and the whole thing’s tense and unsexy. I’m worried that this is going to kill our relationship, although Paul’s been very understanding.

A: Painful sex is never OK, and it is no good trying to “soldier on” to please a partner. Repeated painful encounters will act like aversion therapy, making sexual pleasure less and less likely.

Dr Elizabeth Farrell, the gynaecologist at Jean Hailes for Women’s Health, says there are many causes of sexual pain and the causes need to be determined. “Pelvic floor tightness or spasm can be a cause of severe entry and vaginal pain, which can be a response to deeper pain,” she says. “Sometimes pain occurs when a woman tightens her pelvic floor as a response and then unknowingly the tightness persists, causing more and more pain.”

The endometrium is the layer of tissue that lines the womb, or uterus. If conception does not occur after ovulation, this lining is shed, resulting in a woman’s menstrual period. The hormone, oestrogen, choreographs this cycle.
Endometriosis is a complex condition. Somehow, endometrial tissue escapes from the uterus, and starts to grow elsewhere in the body cavity. Where it occurs determines what, if any, symptoms the woman has.

Because this tissue responds to oestrogen, it changes throughout the cycle and discomfort can be worse around menstruation. This rogue tissue can have a range of other health impacts. Being of a sticky composition, it can cause parts, such as the bladder and the bowel, to adhere. Depending on where it appears it can also affect fertility. Every case is different, and there is no one-size-fits-all treatment. Ongoing monitoring is required.

Dr Farrell advises: “With her history of endometriosis this young woman needs to be seen by her GP to assess her pain. A referral for pelvic floor physiotherapy may be appropriate. It is important to exclude a recurrence of the endometriosis or whether there is a pain management problem so she may need to be seen by a gynaecologist with expertise in endometriosis. A sympathetic assessment of the sexual pain and a subsequent plan to help her symptoms is necessary.”

More information can be found on the Jean Hailes website: jeanhailes.org.au/health-a-z/endometriosis.

Endometriosis is one of the few conditions that improves with age. Some women get symptomatic relief from the oestrogen-controlling effects of the contraceptive pill. Oestrogen falls at menopause, and the hormone cycle ceases, as do the symptoms.

However, at 32, this prospect is hardly cheering. Medical practitioners are trained to treat physical symptoms, but human sexuality is much more than a physical function. Desire, intimacy, emotional bonding, individual self-esteem and wellbeing, all of this is complex. Many doctors do not feel equipped to deal with the effects of an illness on the person’s sexual relationships. So, alongside your medical treatment, you need support and guidance in achieving a successful sex life.

Dr Anita Elias, the head of Monash Health’s Sexual Medicine and Therapy Clinic, and of the Sexual Counselling Clinic at the Royal Women’s Hospital’s Malvern Psychotherapy Centre, says the first step would be to have a thorough assessment by a doctor with experience in managing sexual difficulties.

Free treatment is available at both of the clinics mentioned.

Only you can be treated for endometriosis, but Paul needs to be part of the rebuilding of your sex life. It is easy for the supporting partner to feel sidelined. Both of you would benefit from joining a support group. It helps to know you are not alone, to share stories and ideas, and to find meaningful support. Find your nearest group at www.endometriosisaustralia.org.

Meanwhile, you and Paul need to broaden your definition of sex. Many people who cannot have penetrative intercourse enjoy rich and erotic sex lives. Explore caressing, oral sex, and “outercourse”. Investigate Tantra, erotic massage, kink, and role play.

Email your questions to abtlastnight@gmail.com

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