pelvic health, physical therapy, Sex, women's health

Dispelling Dyspareunia Part 3: Endometriosis

Endometriosis: Endometrial tissue, which forms the lining of the uterus, grows outside

SOC 152C endometriosis pic

of your uterus and implants itself onto your pelvic organs and tissues, like an entitled little _______ (insert your word of choice).

This terrible disorder affects roughly 10-15% of women of reproductive age. There are a few theories as to why this occurs, but no definitive answer, which makes endo difficult to treat effectively. So, if you’ve got this tangled up mess of tissue growing and clinging onto organs and structures within your pelvis, there are likely to be some painful consequences, including painful sex (dyspareunia).

Imagine a time when you had significant pain that persisted for a day or two – how did the rest of your body feel? Muscles tense in response to pain, to protect and guard, often resulting in additional issues. With endo being a chronic pain, attacking our beloved reproductive organs and other pelvic peritoneum contents, the pelvic floor muscles typically respond by increasing tension. When that happens, and you are unaware and unable to control them, further pelvic pain ensues and the vagina slaps down a big, “NOPE” to sex. Dyspareunia could also be defined by deep pelvic discomfort, likely due to the way the unwanted, implanted endometrial tissue has affected the pelvic contents/organs. Although pelvic health PT’s cannot eliminate the adhesions and scarring from the endometriosis, we can typically help with this pelvic and abdominal pain.

Dyspareunia due to endometriosis could be caused by symptoms of vaginismus, vulvodynia, and/or because of it’s effects on the pelvic peritoneum. The findings from taking a thorough medical and symptomatic history, as well as, performing an internal/external vaginal exam will help clarify the secondary issue(s) causing the dyspareunia. From there, the best course of treatment is determined and may include:

  • Dietary modifications
    • To reduce inflammation (plays a big role in endo)
    • To reduce estrogen
    • I am not a dietitian – I only make recommendations, not meal plans
  • Breathing techniques to reduce pelvic floor muscle tension (diaphragmatic breathing),
  • Biofeedback/pelvic floor muscle retraining,
  • Dilator use,
  • Behavioral modifications (sometimes with partner involvement)
  • Soft tissue mobilization,
    • of the pelvic floor muscles internally and/or externally
    • of the abdomen
  • Stretches for surrounding musculature
  • Etc…

**All of the hands-on interventions are performed pain-free. ALWAYS.**

Treatment of endometriosis absolutely requires the work of a team. It is so important to have supportive doctors, specialists, family and friends. If you have been diagnosed with endo and experience any symptoms you feel a pelvic health PT can treat, please talk to your doctor about sending you our way. Our goal is to fix the physical impairments that are within our scope of practice and give you techniques, education and resources to help manage your pain long term.

Please reach out to me if you need help finding a provider in your area, or if you have any questions or comments.




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