If your spouse or partner has abdominal cramping around or beyond the time of her period, try to realise that she is in no way just being oversensitive or fussier than other women.
Having a partner who suffers from severe abdominal pain on several days every month often affects intimacy and life together as husband and wife in general. It is not an easy situation to deal with, but effective relief is often available.
Some women experience unbearable pains with any form of intercourse, but others experience it only with deep penetration. They feel pain only at certain times of the month, such as around the time of the period, while others feel it throughout the month. This is the challenge with women with endometriosis.
Pain during or after sexual intercourse, is a common symptom if you have endometriosis – a disorder that affects women in their reproductive years and a significant factor in treatment of female infertility.
Endometriosis is a medical condition where the kind of tissue that usually lines the womb also grows in other parts of the body. These growths are called endometrial implants, and may be small or larger in size. Like the lining of the womb, they build up and are shed every month. But, unlike period (menstrual) blood, the tissue that is shed in the abdomen cannot leave the body, so inflammations and scars often develop.
Blood and tissue shed from the endometrial growth has no way of leaving the body, hence resulting in internal bleeding, inflammation that may result in pain, adhesions, bowel and reproductive problems.
The endometrial implants may grow on the ovaries and Fallopian tubes, which can lead to fertility problems. Sometimes you first find out that you have endometriosis only when you consult a doctor who refers you to a fertility specialist because you have not been able to get pregnant despite trying for a long time.
Endometriosis also causes damage and blockage to the fallopian tube by impeding the journey of the eggs down the fallopian tube to the uterus, hence leading to infertility.
Up to 50 per cent of women with endometriosis complain of painful intercourse, often leading them to avoid sex. The reason is because deep penetration can put pressure on areas where endometriosis occurs, such as the ligaments attaching the uterus to the pelvis or the lining of the pelvis.
This kind of painful intercourse is sharp, stabbing, jabbing or a deep ache. It ranges in intensity from mild to excruciating. It may be felt for up to 24–48 hours after intercourse, or both.
Endometriosis can be one of the reasons for infertility in otherwise healthy couples but the exact prevalence in Nigeria is not known, since many women may have the condition and have no symptoms, but most are diagnosed around the age of 25-35 years, and it has been reported in girls as young as 11 years of age.
It is rare in postmenopausal women, but runs in families and delaying pregnancy until an older age is also believed to increase the risk of its development.
Now, dealing with painful intercourse can be a difficult and emotional task. It needs open and honest communication between you and your partner. It also needs both of you to be patient and understanding towards each other.
In particular, you need to develop an awareness of each other’s predicament and feelings. Without these efforts, dealing with the problem can degenerate.
Severe abdominal pain and cramping can force most women to make changes in everyday life. As a woman with endometriosis you need to explain to your partner the nature of your pain, and how it affects you, physically and emotionally. You also need to talk about your need to love and be loved; your fear of intercourse and fear of intimacy that may lead to intercourse; your guilt about not being able to have intercourse, and your fear that your unwillingness to have intercourse will be interpreted as a sign of rejection.
If you experience pain during or after sex, you may try to avoid sex altogether or simply get on with it despite the pain because you would like to get pregnant, or are afraid that your partner might feel rejected or even leave you if you constantly refuse to have sex.
If painful sex is a problem, trying out different positions or techniques might improve things. It is better to be open and honest so you and your partner can learn which situations create pain. That way you can learn which situations to avoid, so you can both have pleasurable and satisfying intimacy together.
Not being able to get pregnant often adds to the burden but once you have discussed and resolved some of these issues, you will have the foundations for moving on and finding ways of resolving the problem.
You may need to see a sex therapist. Similarly, it may be appropriate to try experimenting with the timing of intercourse. You may find that intercourse is pleasurable at certain times of the month, such as in the week after ovulating or in the two week period after having a period. If you can identify the times when intercourse is pain-free, make that time of the month a special time to enjoy intimacy together.
If you experience pain during intercourse, it is important to tell your partner immediately. Trying to conceal the pain will usually result in you unconsciously withdrawing which may be perceived as rejection.
Treatment can help relieve the symptoms of endometriosis. The diagnosis treatment and prevention of endometriosis is a challenge, especially in terms of the availability of equipment and training of doctors to recognise it.
Endometriosis is often misdiagnosed leading to delays in treatment, sometimes for several years. The surest way to diagnose endometriosis is by laparoscopy, an operation performed under general anaesthetic, where a small instrument called a laparoscope (a tube like telescope with light in it), is inserted into the abdomen through a cut in the belly button. The goals of endometriosis treatment include pain relief and/or enhancement of fertility.
Ajayi is the MD of Nordica Fertility Centre
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