Endometriosis “affects up to 10% of women of reproductive age, of which approximately 50–70% show disease symptoms such as chronic pelvic pain, often of severe intensity.”(1)Hämmerli, S., et. al., 2018 We know endometriosis impacts sexuality in women (2)see article for lit review, but is there an impact to their male partners? This study done in Switzerland, Germany, and Austria looked at 236 couples with confirmed endometriosis compared with 236 matched control couples.

Results from the study were (copied from abstract):

Many partners of endometriosis patients reported changes in sexuality (75%). A majority of both groups was (very) satisfied with their sexual relationship (73.8% vs 58.1%, P = .002). Nevertheless, more partners of women diagnosed with endometriosis were not satisfied (P = .002) and their sexual problems more strongly interfered with relationship happiness (P = .001) than in partners of control women. Frequencies of sexual intercourse (P < .001) and all other partnered sexual activities (oral sex, petting) were significantly higher in the control group. The wish for an increased frequency of sexual activity (P = .387) and sexual desire (P = .919) did not differ statistically between both groups.

That both the experimental and control group reported high levels of sexual satisfaction is a positive in this study. While less satisfied than control partners (CP), most endometriosis partners (EP) were not unsatisfied sexually with 55% stating very satisfied. The data also showed EP’s enjoyed various sexual activities similar to CP’s and sexual desire was not diminished.

As expected, pain seemed to be a primary issue with over 45% of endometriosis couples reporting pain at least “sometimes” (p<.001).

Additionally, “about 28.8% of EP and 16.5% of CP reported that their partner had sexual intercourse at least sometimes despite experiencing pain in order to not jeopardize the relationship.”

In exploring how the couples deal with sexual pain, both EP and CP listed “open communication about critical positions or movements” (EP: 57.3%; CP: 61.9%) as their top response. Second response for EP was “nothing” (17.8%) where it was “adaptation of positions” (17.9%) for CP. “Nothing” was in last position (8.3%) for CP. Most partners said they worked to be “accepting and understanding” (69.6%) with only a small percentage reporting their most typical reaction to be “frustrated or annoyed,” (10.2%), “anxious and blaming self,” (10.2%) or “neutral or uncaring” (9.9%).
Counseling Implications

While not all women with endometriosis experience dyspareunia, for those who do, counselors will do well to help couples talk openly and freely about the pain. Help them be specific in understanding the pain – when, where, what makes it better or worse, how intense, does it stop immediately or last, etc. (Differences in the report of pain by the patient with endometriosis and partner suggest lack of communication.) Most importantly, help them sort through the associated emotion – especially in the out of control nature for both of them. Help the EP recognize the frustration and out of control feelings their spouse might experience in having endometriosis and the role it plays in their sex life. This may help them choose “accepting and understanding” rather than one of the more destructive, unhealthy choices.

One third of women with endometriosis need to interrupt intercourse frequently or almost always due to pain but another third report rarely.(3)Fritzer, N., Haas, D., Oppelt, P. et al. More than just bad sex: sexual dysfunction and distress in patients with endometriosis. Eur J Obstet Gynecol Reprod Biol. 2013; 169: 392–396. For those where the pain is regularly disruptive, help the couples to not accept the “nothing” choice in what can be done. Even if it is backing up to focused caressing (no intercourse) or focus on him (if any sexual arousal causes the pain for her), there may always be ways to move forward as a couple, if not in typical sexual play. Help them be creative and not stuck as victims of an uncontrollable disease

What do you think?

Add your thoughts in the “comments” section below.

Hämmerli, S., Kohl Schwartz, A. S., Geraedts, K., Imesch, P., Rauchfuss, M., Wölfler, M. M., . . . Leeners, B. (2018). Does Endometriosis Affect Sexual Activity and Satisfaction of the Man Partner? A Comparison of Partners From Women Diagnosed With Endometriosis and Controls. The Journal of Sexual Medicine, 15(6), 853-865. doi:10.1016/j.jsxm.2018.03.087

References   [ + ]

1. Hämmerli, S., et. al., 2018
2. see article for lit review
3. Fritzer, N., Haas, D., Oppelt, P. et al. More than just bad sex: sexual dysfunction and distress in patients with endometriosis. Eur J Obstet Gynecol Reprod Biol. 2013; 169: 392–396