Summary:
- Endometriosis is a condition where tissue similar to the uterine lining grows outside it. It can cause deep dyspareunia, a type of pelvic pain that occurs during sexual intercourse.
- Deep dyspareunia can result from endometriosis—but it can also come from other conditions that cause pelvic pain.
- This condition can affect sexual relationships, self-esteem, and mental health. It often requires a multidisciplinary treatment approach.
- Treatments for deep dyspareunia include medication and physiotherapy, with surgery as a last resort. Learning about these conditions and discussing them with a qualified healthcare provider is the best way to determine what the most effective course of treatment will be.
Deep dyspareunia is common in people who have endometriosis, and both conditions can cause pain and discomfort. It’s important to learn more about them and talk to your healthcare provider if you’re affected by either one of them.
Below, you’ll learn more about the link between endometriosis and deep dyspareunia, as well as what to expect with each condition and some advice on how to seek treatment. You can also learn more about endometriosis by exploring our other videos and articles.
What Is Endometriosis?
Endometriosis involves tissues that would normally grow inside the uterus growing outside of it instead. Specifically, this includes glands and stroma that resemble the endometrium – the tissue that normally lines the inside of the uterus.
Why Does Endometriosis Happen?
There are several theories on why and how endometriosis occurs. Here are a few of the most commonly accepted ones:
- Retrograde Menstruation: Cells from the uterus might stick and start to grow after menstrual blood flows backward into the pelvic area.
- Metaplasia Theory: Cells in the lining of the abdomen might change into cells like those in the uterus, which could lead to endometriosis.
- Müllerian Remnants: Some cells left over from when we were developing in the womb might turn into endometrial tissue in places they shouldn’t be.
- Spread Through Blood or Lymphatics: Endometrial tissue might travel through blood vessels or the lymphatic system to other parts of the body and grow there.
- Stem Cells: Special cells from the uterus might move to the pelvic area and cause endometriosis.
Common Symptoms
One of the most common endometriosis symptoms is pain in the pelvic region. But different people with endometriosis can experience this pain in different ways—and some people don’t experience it at all.
If you have endometriosis, you might notice the following:
- Pelvic pain during your period
- Pelvic pain during sexual intercourse
- Pelvic pain when going to the bathroom
- Chronic pain in your pelvic region
- Trouble becoming pregnant
- Bloating
- Nausea
- Fatigue
- Depression
- Anxiety
What Is Deep Dyspareunia?
Dyspareunia is when you experience pain before, during, or after sexual intercourse. It affects both men and women, and can be caused by a wide variety of factors—including inflammation, trauma, hormones, and many others.
There are two kinds of dyspareunia: superficial and deep. Superficial dyspareunia only affects the vulva or entrance of the vagina, whereas deep dyspareunia is felt further inside the vagina or pelvic area.
Why Does Deep Dyspareunia Happen?
Deep dyspareunia can be caused by various factors, including:
- Endometriosis: A condition where uterine tissue grows outside the uterus (explained in more detail above).
- Pelvic congestion syndrome: A condition involving the congestion of certain veins in the pelvis.
- Painful bladder syndrome (also known as interstitial cystitis): A disorder that occurs when the lining of the bladder becomes inflamed.
- Myofascial pain: Pain that arises in the muscles and tissues of the pelvis
- History of pelvic trauma
The Impact of Deep Dyspareunia
While deep vaginal or pelvic pain is the defining characteristic of deep dyspareunia, there are several other ways in which dyspareunia can impact your life. These include:
- Difficulties during sex (including lack of arousal or sexual desire)
- Challenges in sexual relationships
- Increased sensitivity to pain
- Negative body image
- Low self-esteem
- Depression
- Anxiety
The Link Between Endometriosis & Deep Dyspareunia
Approximately fifty percent of people with endometriosis also experience deep dyspareunia. This is called endometriosis-associated deep dyspareunia.
Sometimes the pain associated with this kind of deep dyspareunia comes directly from factors related to endometriosis. But sometimes, it’s due to factors that contribute indirectly—like bladder or pelvic floor dysfunction.
As a result, not everyone with endometriosis and deep dyspareunia sees their pain go away completely once they receive conventional therapy for endometriosis. This can be challenging for some patients to understand, which is why education about endometriosis and deep dyspareunia should go hand-in-hand with treatment.
Seeking Professional Help
Treating dyspareunia usually involves an approach that encompasses the physical, emotional, and behavioral challenges associated with this condition. You might work with any or all of the following professionals:
- Gynecologists
- Pain management experts
- Physical therapists
- Sexual therapists
- Mental health professionals who specialize in chronic pain
Potential Treatments & Therapies
There are numerous different potential treatments for dyspareunia, which could include:
- NSAIDs (non-steroidal anti-inflammatory drugs)
- Hormonal therapies
- Physical therapy
- Muscle relaxants
- Antidepressants
- Botox injections
- Cognitive behavioral therapy
- Other brain-based therapies
- Surgery
The specific type of treatment your healthcare provider recommends for you will be based on the specific factors contributing to your pain. Surgery is generally considered a last-resort treatment for deep dyspareunia, although it can be effective for treating deep dyspareunia caused by endometriosis.
Learn More about Deep Dyspareunia & Endometriosis
To help you learn more about these conditions and the relationship between them, we created three brief, 3D-animated educational videos in collaboration with people from our Patient Research Advisory Board who have endometriosis. This approach ensures that the videos are relevant and clear.
These videos specifically discuss the role that endometriosis lesions and central sensitization may play in deep dyspareunia. Watch them and use what you learn to understand your condition better so that you can make more informed decisions about addressing it with your healthcare provider.
Presented By
Affiliations
BC Women’s Center for Pelvic Pain and Endometriosis, Women’s Health Research Institute, University of British Columbia
See Also
Watch on YouTube
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What is Endometriosis and Deep Dyspareunia?
Endometriosis is a chronic medical condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterine cavity and is one of the leading causes of deep dyspareunia. The misplaced endometrial tissue can contribute to pelvic inflammation and adhesions, resulting in deep-seated pain during intercourse.
- Addressing the underlying endometriosis often alleviates symptoms of deep dyspareunia.
- Multi-disciplinary approach involving gynecologists, pain specialists, and possibly mental health professionals.
What are the risks of Endometriosis and Deep Dyspareunia?
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Compounded Emotional Strain: Having both endometriosis and deep dyspareunia can result in compounded emotional and psychological stress.
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Complex Treatment Pathways: The simultaneous occurrence of both conditions may complicate treatment, requiring a multi-disciplinary approach that can be logistically challenging and costly.
Consulting healthcare providers for proper diagnosis and treatment planning is critical in managing the risks associated with endometriosis and deep dyspareunia.
Video Transcript: Endometriosis and Deep Dyspareunia: Animated Educational Videos for Patients
Welcome to the second video in our series about endometriosis. We will discuss how endometriosis, a condition that affects about one million females in Canada, is one of the major causes of pain with deep vaginal penetration, also called deep dyspareunia.
Deep dyspareunia affects approximately 50% of people with endometriosis. Endometriosis often grows in the posterior cul-de-sac, also called the pouch of Douglas, the space between the uterus and the bowel. It has been linked to higher levels of estrogen and an increase in nerve cells.
An increase in estrogen can lead to inflammation, while the increase in nerve cells often causes pain. Together, the inflammation and increase in nerve cells may cause tenderness of the pelvic area. When having penetrative sex, this tender area can be hit and can cause deep dyspareunia.
Watch the next video in our series to learn more about painful sex caused by central sensitization.
Contact your healthcare provider if you have concerns about endometriosis or painful sex.
Welcome to the third video in our series about endometriosis. In our previous videos, we discussed what endometriosis is, how it occurs and the symptoms people with it experience, as well as how endometriosis can cause pain during deep vaginal penetration, also called deep dyspareunia. In this video, we will focus on deep dyspareunia, a common symptom in people with endometriosis.
In this example, direct contact with tissues affected by endometriosis is the immediate cause of deep dyspareunia. However, endometriosis can also be an indirect cause of painful sex. Other things related to endometriosis may also cause painful sex, one of which is central sensitization.
Central sensitization is caused by changes to the central nervous system, which includes the brain and spinal cord. Brain and spinal cord cells become highly sensitized or excited, which causes them to amplify the normal signals we receive from our senses. Even a light touch may be felt as pain.
Central sensitization can occur in different people, including those with endometriosis. This pain is real. It is not in your head. In this circumstance, the pain is not caused by direct contact with endometriosis. Endometriosis is the trigger that leads to central sensitization, which in turn, results in pain in other areas like the bladder or pelvic floor muscles. So, imagine the fires of sensitization are out of control. The goal is to extinguish the fire and reduce the pain.
In order to determine which treatment will be most beneficial, it is important to identify the specific cause of painful sex in people with endometriosis. Endometriosis medications or surgery may not help pain due to central sensitization. For example, some people may still experience deep dyspareunia even after the removal of their endometriosis. Central sensitization is complex. Other treatments such as physiotherapy, psychological therapy, cognitive behavioural therapy and mindfulness, or medications may help.
Contact your healthcare provider if you have concerns about endometriosis or painful sex.