Medical App & Medical Advice with Hello Doctor

What exactly is Endometriosis?

Do you find yourself curled up in bed with severe period pain, popping painkillers nearly every month? Something could be wrong! Endometriosis is one of the causes of severe period pain … but what exactly is it?

What is endometriosis?

  • The endometrium is the tissue that lines the inner cavity of the uterus (womb)
  • Endometrial cells are shed every month during menstruation
  • Endometriosis occurs when the endometrium grows outside of the uterine cavity
  • It is a painful condition as these endometrial growths bleed in the same manner as the endometrial lining inside the uterus does every month during menstruation
  • Endometriosis is a non-cancerous (benign) condition

Where in the body can endometriosis occur?

  • Common sites: ovaries, fallopian tubes, the surface that lines the pelvis, the outer surface of the uterus, the outer surface of the intestines
  • Less common sites: bladder, vagina, cervix
  • Rare sites: previous surgical scars, on the liver, in or around the lungs or brain

How would I know if I could have endometriosis?

  • Severe pain during menstruation or ovulation
  • Lower back pain or pelvic pain
  • Deep pain during sexual intercourse
  • Infertility
  • Painful bowel movements and/or pain when urinating during menstruation
  • Diarrhoea, constipation, bloating or nausea during menstruation

Are some women more at risk of endometriosis than others?

  • Endometriosis is a condition affecting women in their reproductive years
  • It is rare in postmenopausal women
  • 1 in 10 women aged 25-34 years old are affected

Other risk factors

  • Never having given birth
  • Delaying falling pregnant to an older age
  • Early age at onset of menstruation
  • Late menopause
  • Genetic factors: if your mom or aunt has endometriosis
  • Tall, thin women with a low body mass index/BMI

What causes endometriosis?

  • The cause is mostly unknown
  • Retrograde menstruation: this occurs when menstrual blood flows back through the fallopian tubes and into the pelvic cavity (instead of out of the body)
  • Direct transfer of endometrial tissue during surgery to other sites (i.e. surgical scars)
  • An altered immune system response
  • Coelomic metaplasia

How is endometriosis diagnosed?

  • Symptoms experienced by a patient may suggest the diagnosis.
  • Pelvic examination: may reveal scars behind the uterus, large cysts, however smaller areas of endometriosis may be harder to detect.
  • Ultrasound scan (sonar): may reveal ovarian cysts from endometriosis.
  • If a trial with medication (i.e. hormonal birth control or GnRH agonist) leads to an improvement in pain, endometriosis may be considered as a possible cause.
  • Laparoscopic surgery: this surgery allows the gynaecologist to look inside the pelvic area for endometriosis tissue/implants.
  • A tissue sample may need to be taken during a laparoscopy to confirm the diagnosis.

How is endometriosis treated?

No cure is available, but treatment is available to control and reduce symptoms

a. Medication

  • if not planning a pregnancy: hormonal birth control (extended or continuous cycle to either prevent menstruation or reduce the number of times per year of menstruation)
  • if planning a pregnancy: GnRH agonists
  • new agents: Visanne (made from a progesterone substance known as dienogest)

b. Surgery

  • considered when symptoms are severe, hormonal treatment fails or if there are fertility problems

c. Anti-inflammatory medication for pain relief

  • Pain-relief is available as over-the-counter medication from your local pharmacy. These shouldn’t be taken chronically, though, as it can cause dangerous side-effects

If you’re struggling with endometriosis, or just need some advice, why not chat to one of our doctors? They’d be happy to help.

Hope for those struggling with pain during sex

You used to enjoy sex, but now it hurts like hell. Here are the possible reasons why, and how you can deal with it.

Women:

Vaginal dryness

This is most commonly caused by too little arousal before sex. When a woman becomes sexually aroused, her vaginal glands secrete a fluid that acts as a lubricant. If this process is disrupted, not enough lubrication can make sex uncomfortable and painful. This issue can also stem from a drop in oestrogen levels after menopause, childbirth or during breastfeeding.

Certain medications can also constrain arousal, and decrease lubrication. These include antidepressants, high blood pressure medications, and antihistamines.

What to do: Use a water-soluble lubricant. If you think your medication may be at the root of the problem, talk to your doctor about changing your prescription.    

Vaginismus

Vaginismus is a condition in which the muscles of the vaginal wall tighten involuntary, making sex painful, if not impossible. This can happen as your partner attempts penetration or when you’re touched near your vaginal area. There’s no direct cause for vaginismus, but the condition may be linked to past sexual abuse or trauma, painful sex, and emotional factors.

What to do: Practise Kegel exercises. Kegels can help you learn to control and relax your pelvic floor muscles, which control your vagina. This can strengthen your pelvic muscle and enhance sexual pleasure. To find the right muscles, try and stop yourself from weeing midstream. The muscles you use are the same muscles you use when doing Kegels. Squeeze your pelvic muscles as if you’re trying to close the vaginal opening. Hold the contraction for 10 seconds and then relax. Wait a few seconds and repeat. Do this up to 10 times, three times a day.

Men:

Prostatitis

Prostatitis is the inflammation of the prostate gland. This condition makes it difficult to urinate and have sex. Erections and ejaculations are especially painful for men with prostatitis. Prostatitis is caused by an infection with bacteria. Risky sexual behaviours, unhealthy food, allergies, immune disorders, and complications from past surgeries or injuries can all contribute to its development.

What to do: Soak in a warm bath to relax your prostate gland and ease the pain. Give alcohol, caffeine and spicy foods a miss as these can irritate your bladder and make the symptoms worse. If infection is the cause of the pain, see your doctor. He can prescribe antibiotics and other medications to resolve the problem.

Women & Men:

Urinary tract infection (UTI)

A UTI is a bacterial infection in any part of your urinary system: your kidneys, bladder, ureters, and urethra. It’s common in both men and women, and can cause a burning sensation when urinating, itching in the genital area, and make sex unpleasant.

UTIs are usually caused by Escherichia coli (E. coli), a type of bacteria found in the gastrointestinal tract. Poor personal hygiene, having multiple sexual partners, pregnancy, a suppressed immune system, and heavy use of antibiotics can increase your risk for UTIs.

What to do: As UTIs are normally caused by bacteria; they’re most commonly treated with antibiotics, so see your doctor if you notice symptoms. Complete the full course of treatment to make sure the infection clears up fully. Drink lots of water and urinate frequently to flush out the bacteria. It’s best not to have sex while you’re recovering, but if you decide to get frisky, use a condom so as not to spread the infection. Urinate shortly after sex and keep your genitals clean.

Stress

Your pelvic floor muscles tense up in response to stress. This can contribute to pain during sex.

What to do: Stop carrying tension with you to bed. De-stress before you get busy. Enjoy a relaxing bath, ask your partner to give you a massage, or try meditation. This will help your mind and body prepare for sex. 

Good to know

  • Change positions. Sex isn’t a one-size-fits-all. Switch things up until you get yourself into a position and depth that feels good to you.
  • Don’t rush it. Foreplay can help stimulate natural lubrication. The longer you take, the better lubricated you’ll be, and the less pain you’ll feel.
  • Speak up. Don’t be afraid to tell your partner what feels good and what doesn’t. Communication is crucial for great, pain-free sex.

Don’t suffer in silence! Speak to one of our doctors about it, and bring the pleasure back into your bedroom.

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