Guest Author - Heather C. Guidone

As the reigning Queen of "Not Tonight, Honey...," I have somewhat learned how to deal with this unfortunate by-product of Endometriosis. Make no mistake: Endometriosis is a disease that affects more than just the woman. It affects her partner almost as much, and dealing with it as a couple is crucial.

Let's first address why some patients with Endometriosis experience dyspareunia (painful intercourse): the lesions may obstruct, bind or invade tissues and organs; it can secrete inflammatory substances known as prostaglandins and histamines that irritate surrounding tissue; it can cause scarring which can restrict blood vessels; and it can make our pain receptors much more sensitive. Cul-de-sac (the membranous wall between the rectum and the vagina) Endo is a known culprit for causing painful intercourse, particularly upon deep penetration. Take these physical aspects of the disease and combine them with treatment medications that kill our libido, throw our hormones into overdrive and in some cases, make us gain weight so we can have a whole new set of body-concious issues to deal with, and you've got a recipe guaranteed to have "Not Tonight, Honey..." coming soon to a bedroom near you.

Further, let us not forget that infertility also factors into the mix for some. There are those of us, some on fertility drugs that make sex the furthest thing from our minds, who go month after month attempting to conceive. When we're having sex because our dreams of fertility depend on it, we sometimes forget in the process that sex can and should also be an intimate sharing between partners...and frankly, fun.

So what do we do? Pull the covers over our heads and try to ignore the near palpable frustration in the room? That won't solve anything - I know, I've done it. Here are some things that I've learned, both through personal experience and discussions with others.

You Must Work Together With Your Partner.
This is the cardinal rule. Two-person problems are never resolved by one-person efforts. Work together to find what seems best for you as a couple. This includes having your partner join you at doctor visits and encouraging them to ask questions of their own. Don't be afraid to ask for help - if the problem becomes bigger than both of you, seek the assistance of a qualified sex therapist who understands the disease. Blame, doubt, fear, anger, sadness and even shame - of self and of each other - can appear in the bedroom when Endometriosis is a factor. There is nothing wrong with getting professional guidance, and it is not the same as saying "it's in your head" or "you're imagining the pain."

Treat the Disease.
Research proves that thorough eradication of Endometriosis from all affected areas can leave a patient symptom-free, and if desired, even improve fertility. Finding a doctor who is skilled in the treatment of the disease can be your first step in feeling better overall.

Timing is Everything.
For example, a lot of women feel physically best before ovulation. Determine what your "good" time is and plan accordingly. I like to call it "scheduled spontaneity."

Lubricate, Lubricate, Lubricate.
Then lubricate some more. GnRH therapy and other medications can cause vaginal dryness, as can surgery; for example, a bi-lateral oophorectomy (removal of ovaries). There are numerous products available to compensate for this, such as KY jelly, Astroglide and Gyne-Moistrin. Please note: if you are attempting to conceive, certain lubricants such as KY jelly can decrease sperm motility or destroy sperm altogether. Similarly, if you are using a barrier form of birth control such as condoms, vaseline-based products can deteriorate the latex. Ask your gynecologist for a few safe suggestions that might work for your situation.

Stop the Pain Before it Starts.
If you need to, take your pain medication beforehand - but don't overdo it!

Remember that Making Love is not Just Intercourse.
Intimacy can be established through numerous other means: hugging, holding, kissing, etc. You can heighten these experiences through candlelight, music, sharing a bath or whatever makes you feel good. Best of all, these activities can be done even when you're not feeling great, so you can both still share intimacy.

Communicate.
Establish a signal with your partner that indicates when you feel ready for penetration. Take it slow and most importantly, be gentle.

Have Fun!
Experiment with positions that are enjoyable for you both. Female dominant and side by side are very popular with Endo ladies, but find ones that work for you. If penetration is still too painful, consider oral intimacy.
Endometriosis does not have to mean a death sentence to your relationship. In fact, it can bring you closer together as a couple as you battle the disease together. I have found, in my life, that there was a greater need for real honesty and communication between us. Establishing both of these things made for a much happier partnership both in and out of the bedroom. It's not an overnight process; we are still learning...but we are learning together.

Where to Get Help
Men should not feel left out of the Endometriosis support experience. For more information, support, ideas and experience exchanges on all aspects of Endo, please visit the invaluable website, MENDO. It is the first organization formed for "Men Who Love Women With Endo." See links below for details.