Endometriosis and Deep Dyspareunia: Animated Educational Videos for Patients

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Video Description

Approximately fifty percent of people with endometriosis experience deep dyspareunia (pelvic pain with deep vaginal penetration).

The etiology of deep dyspareunia in endometriosis is multifactorial and may include both peripheral and central contributors. A subset of people with endometriosis and deep dyspareunia may not have complete alleviation of pain after conventional endometriosis therapies, possibly due to central contributors to the pain, and this may be challenging for patients to understand.

To address this gap, three brief, 3D animated educational videos were created in collaboration with people with endometriosis from our Patient Research Advisory Board, to ensure the videos are relevant and understandable to patients. These videos discuss the role that endometriosis lesions and central sensitization may play in deep dyspareunia.

These videos provide patients with freely accessible materials to support informed decision making and understanding of their conditions.

Presented By


BC Women’s Center for Pelvic Pain and Endometriosis, Women’s Health Research Institute, University of British Columbia


University of Toronto, University of British Columbia

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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?

  • Compounded Emotional Strain: Having both endometriosis and deep dyspareunia can result in compounded emotional and psychological stress.

  • 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.