A Look at Our Human Needs
In looking at Maslow's Hierarchy of Human Needs we can see that under one of the basic needs we have in this life is sex. If we move up his ladder of human needs, we can also see that under psychological needs we have a need for intimacy. In a heterosexual relationship (I can't speak for homosexual relationships as I haven't studied them in depth), our needs for sex and intimacy are often combined into one. I have read quite a bit on how the male gender tends to express intimacy through physical actions (hugging, caressing, making love, etc), whereas females are more open to the verbal as well as the physical. I include Maslow's human needs as when we do not have these needs met, we are at risk of having a part of our self concept under-developed.
The Implications of having Endo on Sexual Relationships
The common place problem with women who have endometriosis is that the physical expression of love might be a source of pain. The physical pain of sex has implications for both partners. Several women in my support group have commented that the pain leads them to try to avoid sexual relations with their partners, and sometimes that their partners give up trying to initiate sex as they don't want to cause them pain. In my support group, I have met many women who fear the thought of making love, as they know afterwards that they can be in pain for days. It's hard to feel like a sexual being when you have to take a pain pill just to have sex or because you had sex. When the physical expression of two individuals love for one another is no longer possible, for some people it can feel like their partner is pulling away from them. When a man who expresses his love in a physical manner, is no longer able to express it, communication can breakdown between the couple and lead towards one or both individuals feeling "unloved".
For women with endo, it can be difficult for us to see that we are sexual beings. We can come to resent our reproductive organs for what they are putting us through. We might feel that we are "less of a woman" due to our disease, our inability to conceive and carry to term, surgeries that we may have had to remove ovaries or even having complete hysterectomies. Many of the medications that we try in order to alleviate our symptoms can not only lead towards a lowered libido but can also lead towards weight gain. Quite a few of the ladies in my support group have commented on how the weight gain has caused them to feel unattractive. Also, the physical pain itself can make us feel unattractive, and it is hard to "be in the mood" when you are in a lot of pain. A few women have also commented on how they fear that their partners may seek physical comfort in other places due to what they lack from us in a relationship. It's not a far stretch for sexual problems to lead towards communication problems and issues of insecurity in the relationship.
A Perspective on Dealing with Physical Intimacy
Sometimes we need to shift our perspective on exactly what physical intimacy is. Yes, we do tend to think automatically of sexual intercourse when we talk of intimacy, however that is only a small part. For partners who want to show their affection physically, gentle caresses even to the cheek can communicate feelings of love, as can being held close. Research on the power of touch have proven that humans require physical touch and that it may be a source of healing from a variety of illnesses, from cancer to chronic pain. Massage can communicate our deepest emotions which words can fail to describe.
On the Topic of Intercourse
To help with sexual intercourse, it is necessary to try to remain as relaxed as possible, and to think to yourself that this experience is going to be better than the last one. If we focus on how much it has hurt us in the past, it will tense up the muscles and make this experience an unpleasant one. It's always beneficial to start with a clean slate. You might also want to keep track of when you are in the most pain, both with positions and timing of the month. It's possible that certain positions won't hurt during a certain time, but might be more painful at other times. This is normal as the endo can cause internal swelling and the added pressure and movement can set off more pain. It might be helpful to invest in a good sexual manual to help with discovering new positions that might not be as painful as others.
The most important key to coping with this is communication. Let your partner know how you feel, find alternative ways of expressing your love, and keep experimenting with different ways of being with one another. Remember that this disease is only a part of you and does not define you, it does not make you less of a woman in any way, shape or form.