Pelvic pain and painful sex may lead to infertility

MANILA, Philippines – Women’s refusal from sexual intercourse may be frustrating to men. Some women complain about pelvic pain or dread the painful intercourse, and it is something that men and more importantly women should take seriously.

According to experts, painful sex (dyspareunia), chronic pelvic pain and dysmenorrhea are the common symptoms of this health problem in women which is called endometriosis. The term may sound unfamiliar, but it is estimated that endometriosis affects 10 percent of reproductive-aged women.

Endometriosis is a medical condition wherein the tissue that lines the womb or the endometrium grows outside the uterus, often anywhere in the pelvic area or the lower abdomen, explains Dr. Delfin A. Tan, head of the Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology at the St. Luke’s Medical Center in Quezon City.

During the menstrual cycle, hormones produced cause the lining of a woman's uterus to build up with tissue and blood vessels. If a woman does not get pregnant, the uterus sheds this tissue and blood. It comes out of the body through the vagina as her menstrual period. The endometrium that grows outside the uterus also responds to the hormones. The tissue and blood that are shed into the body can cause inflammation, scar tissue and pain.

The pain symptoms of endometriosis have a huge impact on the women's quality of life and productivity.

"This is debilitating for women because of the pain they have to endure while carrying on with their daily activities," said Dr. Tan.

Endometriosis impairs the quality of life of women. It interferes with women's careers and social life. Because of the pain associated with endometriosis, this can also get in the way of the woman's relationship with her partner and family. Worse, it can also cause infertility.

Costly

Based on World Bank 2010 estimates, if there are 1,761,687,000 women in the world aged between 15 and 49 years, it could mean that about 176 million women have endometriosis during the prime years of their lives.

For women who are suffering from dysmenorrhea or painful menstrual periods, up to 60 percent could have endometriosis. This condition is also prevalent in approximately 70 percent of women who experience pelvic pain.

During the 26th annual meeting of the European Society of Human Reproduction and Embryology in 2010, Dr. Kelechi Nnoahan from the Department of Public Health and the Nuffield Department of Obstetrics and Gynaecology, University of Oxford, UK, said endometriosis accounts for a significant loss of productivity of over 11 hours per woman per week – 38 percent more than those without endometriosis.

Dr. Maria Jesusa Banal-Silao, president of the Philippine Society of Reproductive Endocrinology and Infertility said that of 65 percent of women with endometriosis presented with pain, 1/3 of these patients reported infertility.  Infertility alone, without pain, was reported in 14 percent of patients with endometriosis and 29 percent of patients who did not have endometriosis.

In a fact sheet of the American Society for Reproductive Medicine in 2012, it stated that among women with endometriosis, up to 30 percent to 50 percent may experience infertility.

Endometriosis is not only debilitating, but also costly. In the United States, the annual cost of endometriosis from the treatment to the monetary lost is estimated at $1.8 billion.

While the exact cause of the disease remains unknown, there are several treatment options available for women. Dr. Tan explained that there should be a multidisciplinary approach involving a combination of lifestyle modifications and medications. Allied health services should be used to limit the impact of this condition on activities of daily living and fertility.

In some cases, surgery is required to confirm the diagnosis and provide therapy to achieve the desired goal of pain relief or improved fertility. But for less invasive treatment options, there is a new evidence based treatment for endometriosis such as low-dosed progestin like Dienogest that has been shown to be as effective GnRH-agonist, with favorable safety and tolerability profile, allowing for long term use.

Meanwhile, there is nothing to be ashamed of if you are experiencing these symptoms. To know more about endometriosis and the available treatment options, you may consult your doctor.