Female Care

Erika L. Meaddough, David L. Olive, Peggy Gallup, Michael Perlin, Harvey J. Kliman (Department of Public Health, Southern Connecticut State University, and Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Conn., USA)

Retrograde menstruation is widely accepted as playing a role in the etiology of endometriosis. Research has demonstrated the phenomenon of menstrual fluid backward flux, the viability of endometrial tissue in menstrual discharge, and the presence of endometrial tissue in peritoneal fluid found in the pelvic cavity. There is ample epidemiological evidence as well. Endometriosis is primarily seen among women of reproductive age. In addition, there is a higher incidence of endometriosis among women with prolonged menstruation, shorter cycles, or obstructed genital outflow tracts. The identification of factors that obstruct menstrual outflow or facilitate menstrual reflux would be worthwhile, since these factors may increase the amount of endometrial ‘seeding’ which occurs during menses. Olive and Henderson found that cervical obstruction increases the likelihood of endometriosis by increasing the menstrual debris available to the pelvic cavity. There are few studies which address the possible relationship between sexual behavior during menstruation and endometriosis. Filer and Wu sought to determine if coital habits during menses are associated with increased risk for endometriosis and pelvic inflammatory disease. While no association with pelvic inflammatory disease was revealed, they found that infertility patients who frequently or occasionally engaged in coitus during menstruation were almost twice as likely to have endometriosis than those who did not report coital behavior during menses. Filer and Wu proposed that this difference may be due to increased intrauterine pressure during orgasm, which assists in the transport of endometrial debris to an ectopic site. Darrow et al performed a study focusing on the belief that women with endometriosis typically delay childbirth. It was thought that orgasm and sexual penetration during menstruation may be contributing factors. In contrast to Filer and Wu, Darrow et al found no association between these factors and endometriosis.

The goal of the current study was to further investigate sexual behaviors and hygienic practices performed during menstruation as they relate to the development of endometriosis.

Specifically, the frequencies of sexual activity and orgasm during menstruation, tampon use, and douching, were measured to determine if these variables are associated with an increased risk for the development of endometriosis.

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Women frequently experience chronic pelvic pain that at times can be debilitating. There are many different medical causes but in some instances no obvious cause can be found. If the pelvic pain occurs monthly around the time of your new menstrual cycle and it seems much worse than typical menstrual cramps then perhaps you have endometriosis.

Normally when a woman begins a new monthly menstrual period the tissue lining of her uterus called endometrium is washed out in her menstrual flow. This process normally takes 4 to 7 days.
For women who suffer from endometriosis this endometrial tissue lining fails to completely wash out and instead ends up in their abdomens and pelvices attached to internal organs like the bladder, ovaries or intestines. This endometrial tissue is still functional so whenever a period occurs this displaced tissue swells and bleeds leading to severe pain. Other symptoms can include back pain, pain with intercourse (dyspareunia), and pain with bowel movements (dyschezia). Women who have difficulty getting pregnant are also more likely to have endometriosis since the repeated tissue swelling can cause scar tissue around the fallopian tubes and ovaries.

The diagnosis of endometriosis is very challenging because there are no accurate blood tests, ultrasounds or x-rays available. The only way to make a definitive diagnosis is for your doctor to perform a laparoscopy. This procedure performed under anesthesia is done by making a small skin incision usually through your navel and placing a camera scope into your abdomen. Your doctor can then visually check for possible areas of endometriosis.

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