Endometriosis Pain After Orgasm: Understanding and Managing Post-Sex Discomfort

Introduction

Endometriosis is a chronic condition which is manifested by tissue similar to the internal uterine lining grows outside the uterus, often causing severe pelvic pain.  This is due to direct nerve stimulation, inflammation and central nervous system sensitization and hyperactivity.  One significant, yet often overlooked, aspect of endometriosis pain is the discomfort experienced after orgasm. So here are the causes, treatments, and management tips for dealing with pain after sexual intercourse in patients with endometriosis.

Causes of Pain After Orgasm

Pain after orgasm in endometriosis patients can be attributed to a number of factors:

1. Pelvic Floor Spasms: The pelvic floor muscular contractions which normally occur during orgasm can exacerbate pain due to the hypersensitivity of the pelvic region affected by endometriosis (Falcone & Flyckt, 2018).
2. Adhesions and Scar Tissue: Endometriosis causes scarring and adhesions, which can cause organs to stick together (e.g. rectum to the upper vagina and cervix), leading to pain during and after deep penetration.
3. Inflammation: Endometriosis lesions release inflammatory substances, which exacerbate molecular neuro-signaling, which can increase pain post-sex.
4. Uterine Contractions: During orgasm, uterine contractions can trigger pain, especially if there are endometriosis lesions on or around the uterus.
5. Tilted Uterus: A retroverted or tilted uterus, common in endometriosis, can also contribute to pain during and after intercourse.

Symptoms to Watch For

• Abdominal Pain: Often sharp or cramping, exacerbated by deep penetration.
• Pain with Deep Penetration: Aggravated by certain sexual positions.
• Vaginal Dryness: Can cause friction and pain but may not be related to end

Treatment and Management Options

Pain Relief and Medication

1. Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Medications like ibuprofen can reduce inflammation and provide pain relief before and after intercourse.
2. Hormonal Treatments: Birth control pills or GnRH agonists help manage estrogen levels, potentially slowing the growth of endometriosis tissue and associated pain. However, these can produce other symptoms, some of which can be long-lasting and affect health.  These should be decided upon under expert guidance. 

Surgical Therapy

If endometriosis is suspected or if you already have this diagnosis, a cornerstone of therapy is surgical excision of endo and endo-related scarring or fibrosis, and clearing of adhesions which cause organs like the uterus and rectum to be stuck together. Surgically excising diseased tissue and scar removes the inflammatory stimulus which leads to pain.  This surgery also restores normal anatomy and relationships between the uterus, the vagina, the rectum and bladder.  

Physical Therapies

1. Pelvic Floor Physical Therapy: Helps strengthen and relax the pelvic muscles, reducing spasms and pain.  This may be combined with vaginal diazepam. 
2. Heat Therapy: Applying a heating pad to the lower abdomen can help alleviate cramping and discomfort.
3. TENS: Transcutaneous electrical nerve stimulation, and related similar therapies including implantable units, can be an inexpensive method to help reduce pelvic floor dysfunction using very specific applicators. 

Lifestyle and Integrative Approaches

1. Diet and Nutrition: An anti-inflammatory diet rich in omega-3 fatty acids, antioxidants, and low in processed foods can help manage symptoms.
2. Stress Management: Techniques like yoga, meditation, and acupuncture can help reduce overall stress and pain levels.
3. Acupuncture: In expert hands, acupuncture can be effective to relax the pelvic floor and stimulate blood flow to the area.  
4. Red Light Therapy: This therapy reduces inflammation and promotes healing, potentially alleviating pain post-orgasm (Hamblin, 2017).

Sexual Health Tips

1. Use of Lubricants: To combat vaginal dryness and reduce friction during intercourse.
2. Open Communication: Discussing pain and preferences with your partner can help adjust sexual activities to reduce discomfort.
3. Experimenting with Sexual Intercourse Positions: Finding positions that avoid deep penetration can minimize pain.

Addressing Related Conditions

Other conditions such as ovarian cysts, uterine fibroids, and a tilted uterus can also contribute to pelvic pain during sexual activity. A comprehensive evaluation by a gynecologist who specializes in pelvic pain and, if endo is suspected or known to exist, involvement by an endometriosis specialist is crucial to rule out these conditions and tailor treatment accordingly.

Conclusion

Endometriosis-related pain after orgasm and pain with intercourse in general is a challenging circumstance, but with the right combination of treatments and management strategies, it can be significantly improved or eliminated. It is very prudent to consider an opinion with a endometriosis surgical excision expert.  

References

1. Falcone T, Flyckt R. Clinical Management of Endometriosis. Obstet Gynecol. 2018;131(3):557-571. doi:10.1097/AOG.0000000000002460. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6078976/
2. Ferrero S, Evangelisti G, Barra F. Current and Emerging Treatment Options for Endometriosis. Expert Opin Pharmacother. 2018;19(11):1109-1125. doi:10.1080/14656566.2018.1507067. https://pubmed.ncbi.nlm.nih.gov/30096049/
3. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020;382(13):1244-1256. doi:10.1056/NEJMra1810764. https://pubmed.ncbi.nlm.nih.gov/32212520/
4. Hamblin MR. Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophys. 2017;4(3):337-361. doi:10.3934/biophy.2017.3.337. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5523874/

Updated Post: July 10, 2024