The Sex Doctors are In

Understanding Endometriosis

Posted by Madeleine Castellanos, M.D.

Endometriosis is a condition found in women in which pieces of tissue that are similar to the endometrium (inside lining of the uterus) are found in and around the abdominal cavity. These pieces of endometrial tissue respond to the monthly hormones that are secreted so that, when a woman has her menstrual period, these tissues also bleed. Since the body considers blood inside the abdomen an irritant, it tries to wall off the endometrial tissue by forming scar tissue around it. Every monthly cycle brings on more and more scar tissue. This scar tissue builds on itself and can actually adhere different organs together, such as the ovary to the intestine, or the uterus to the bladder.

Scar tissue is what is responsible for the symptoms and the infertility associated with endometriosis. Since scar tissue has no elastic fibers in it, it does not stretch like the other tissues or skin of the body. Because of this, when a woman has any type of movement, the organs and tissues of the abdomen and pelvis accommodate themselves accordingly, but the scar tissue stays firm. It causes tugging and tension of whatever tissues or organs it happens to be stuck to. This results in pain for some women when they are playing sports, or just bending over.

The way that endometriosis usually comes to people's attention is that it causes very painful periods for many women. This is because during a woman's menstrual cycle, the uterus has periodic muscle contractions to expel the old tissue. When there is scar tissue from endometriosis attached to the uterus, these contractions cause pulling and tugging that adds to the pain of cramps. The nature of the pain is also different from the aching of menstrual cramps in that it can be very sharp and stabbing pain, but this varies from woman to woman.

The other way that endometriosis may come to be diagnosed is when a woman experiences pain on deep penetration during sexual intercourse. This definition of 'deep' really refers to deep enough to push on the cervix, which is only 3-4 inches of penetration. Since the scar tissue also may attach to the outside of the vagina, once the vagina starts to be stretched from penetration, any scar tissue located there would once again tug and pull. Women may find that it happens only in certain positions, or certain depths of penetration, depending on how the endometriosis is affecting her. Some women even start to avoid sex or are apprehensive about it because the pain. But with treatment, both painful sex and painful periods can be much improved.

The diagnosis of endometriosis can only be definitively diagnosed by having it directly viewed by laparoscopic surgery. But, it can often be suspected with a high degree of certainty by taking a careful history and good bimanual pelvic exam by the Gynecologist. There are, however, women who never experience any symptoms of endometriosis, but find that they have difficulty conceiving. Because the scar tissue can form cysts around the ovaries and can also stick to the fallopian tubes, it can interfere with their movement and their ability to let an ovum pass into the uterus for fertilization. The result is that a large percentage of women with endometriosis cannot get pregnant naturally or have a higher chance of having an ectopic pregnancy (the fertilized egg implants in the fallopian tube instead of the uterus). Women with endometriosis that have been unable to get pregnant naturally may instead opt for IVF (in vitro fertilization) which bypasses the fallopian tubes entirely. If a woman with endometriosis does get pregnant, however, the nine months of suppressed periods can actually eliminate the endometriosis for many.

Surgery for endometriosis is often very successful in eliminating the pain associated with the scar tissue, and the recovery time is usually quick. Because endometriosis can cause some women to suffer with painful sex, or feel they need to radically adjust their sex life because of the pain, and because it is very commonly contributes to infertility, it is worthwhile to approach your Gynecologist if you have any of the symptoms mentioned above. When diagnosed and treated early, a woman has a better chance of conceiving as well as having less anxiety related to her sexual activity.