Relationships and sexual life
Being the partner or spouse of a chronic pain patient can be difficult, but good communication often goes a long way. It is usually not the practical things that the spouse has to take care of that cause the difficulties, although this can often be a concern for the pain sufferer. The difficulties are much more often related to emotional and communication issues.
It is important to talk about what the sadness or anger is about for both parties so that the feelings are not misinterpreted, and it is important to talk about when it will be okay to ask and when you just want to be left alone. Honest and direct communication is needed as no one in the relationship is a mind reader.
For women with endometriosis, it is the pain in particular that has a negative impact on relationships and sexual life. Many women with endometriosis experience pain during intercourse, which can last for hours or even days after intercourse. For some women, this means changing positions many times in an attempt to find the least painful way to have intercourse. Others have to interrupt intercourse and for some, the result will be that they try to avoid intercourse altogether.
This can have a negative impact on the relationship, making the woman feel inadequate or guilty, which can result in a relationship breakdown. Others continue to have intercourse despite the pain because endometriosis should not be allowed to ruin another relationship or because there is a burning desire to get pregnant. Some of the sexual problems most commonly associated with endometriosis are:
Dyspareunia
Dyspareunia is the medical term for pain in the genitals or lower abdomen in women during intercourse. It is often experienced as a pain deep in the bound of the vagina during intercourse. Often dyspareunia has physical causes, some of which are treatable, others not. Endometriosis located rectovaginal, meaning in the cavity behind the vagina up to the rectum, and infiltrating endometriosis are often the types of endometriosis that cause pain during intercourse, but endometriosis elsewhere in the abdominal cavity is also found to cause dyspareunia.
Vaginismus
Vaginismus is the term for painful and involuntary cramping contractions of the woman's vagina when attempting to insert both the penis or tampons. Vaginismus may be a learned defensive reaction due to a history of pain or discomfort during intercourse, or it may be a psychological reaction. The challenge is that the muscle contractions are automatic and unconscious, but in many cases, this can be treated by gradually unlearning the reaction.
Lack of desire
Pain commonly reduces the desire for sexual activity, as pain is by definition an experience associated with discomfort, whereas sexual life is usually associated with pleasure. Pain and sexual desire seem to be incompatible, and many people who have a pain problem also experience problems or challenges with their sexual life.
The problems can be direct, as described above, in the form of increased pain when being sexually active, or it can be indirect in the form of a decreased or full lack of desire. Sexual life can easily become characterized by negative expectations or performance anxiety, and for some, it can even come to a standstill. It is therefore important that you work to ensure that your sexual life is not unnecessarily limited or stalled by the pain. This can be done by making practical considerations, such as changing positions or finding new ways to be physically close and intimate when the pain is triggered by a particular sexual activity or if specific parts of the body are sore.
It is also important to note that, conversely, sexual stimulation and arousal can temporarily reduce pain under the right circumstances.
You and your partner
For your partner, sexual problems can also arise as a result of the other person's illness or pain. It is common that the desire can gradually decrease or disappear completely, either because you feel that sexuality is associated with something difficult and cumbersome, or because you have experienced that the other person experiences pain during sexual intercourse, which is something most people cannot ignore. If the partner is a man, erectile dysfunction can also occur, which is linked to feelings of insecurity and fear of inflicting pain on the other person.
If you primarily have experienced sexuality and physical intimacy through intercourse and have little or no experience with other sexual acts, you may also feel insecure and paralyzed when it comes to taking the initiative to have sexual intercourse. If at the same time, there is a desire for fertility, there can be a strong focus on ejaculation, which can result in problems with erection and ejaculation for some men because there is great pressure to ejaculate as quickly as possible so as not to cause unnecessary pain to the partner.
In terms of sexuality, it is important to expand the concept and repertoire to include more than just intercourse, where physical closeness, eroticism, and sensuality can come into play through other activities that are not considered inferior to intercourse.
It is important to match expectations and communicate more than you might otherwise do about preferences for touch and stimulation so that both feel confident that sexual intercourse will be enjoyable and pain-free for both partners. For some, it may be helpful to seek support and inspiration from a clinical sexologist or couples’ therapist.
