He noted that it was difficult for some women living with endometriosis and who had not been treated to enjoy sex because of the unbearable pain they experience during and after intercourse.
Ajayi, who is the founder of Endometriosis Support Group Nigeria and Chief Executive Officer of Nordica Fertility Centre, Lagos, noted that beyond experiencing unbearable pains during sexual intercourse, women with endometriosis often face fertility challenges, chronic pelvic pain, and heavy bleeding during periods.
The gynaecologist disclosed this during an awareness programme organised by ESGN to mark the 2023 Endometriosis Awareness Month.
The annual event takes place in March and is aimed at creating awareness about the disease which affects roughly 190 million women and girls of reproductive age worldwide.
The World Health Organisation says endometriosis affects roughly 10 per cent (190 million) of women within reproductive age and girls globally.
“It is a chronic disease associated with severe, life-impacting pain during periods, sexual intercourse, bowel movements and/or urination, chronic pelvic pain, abdominal bloating, nausea, fatigue, and sometimes depression, anxiety, and infertility”, the WHO added.
Ajayi explained that endometriosis is a medical condition where the tissue that usually lines the womb also grows in other parts of the body.
He said, “Pain during or after sexual intercourse is a common symptom associated with endometriosis – a disorder that affects women in their reproductive years.
“Some women experience unbearable pains during any form of intercourse, but others experience it only with deep penetration. They feel pain only at certain times of the month, such as around the time of the period, while others feel it throughout the month. These are the challenges women with endometriosis face.
“Severe abdominal pain and cramping can force most women to make changes in everyday life. As a woman with endometriosis, you need to explain to your partner the nature of your pain, and how it affects you, physically and emotionally.
“You also need to talk about your need to love and be loved and your fear of intercourse and fear of intimacy that may lead to intercourse. Talk about your guilt about not being able to have intercourse and your fear about unwillingness to have sexual intercourse which might be interpreted as a sign of rejection.”
Harping on the need for awareness creation, the clinical gynaecologist noted that appropriate and prompt diagnosis and treatment of endometriosis would help reduce the negative impact on women’s health.
Ajayi noted that the diagnosis and treatment of endometriosis had been identified as a significant factor in the treatment of female infertility.
The maternal health expert said that though endometriosis was often misunderstood and misdiagnosed, it is treatable and preventable.
“Endometriosis is often misdiagnosed leading to delays in treatment, sometimes for several years.
“The best way to diagnose endometriosis is by laparoscopy – an operation performed under general anaesthetic, where a small instrument called a laparoscope (a tube-like telescope with light in it), is inserted into the abdomen through a cut in the belly button. The goals of endometriosis treatment may include pain relief or enhancement of fertility”, he said.
Ajayi said health workers have to be aware of the condition and its existence, stressing that doctors can only think of diagnosing a condition if they know of its existence and possibility.
He said, “One of the issues health experts have is that endometriosis is a condition that presents in more ways that could suggest other conditions.
“For instance, an endometriosis patient can present as suffering from epilepsy, even as she continues to have severe pain around the abdomen. With that, a general practitioner or a gynaecologist may miss the underlying condition, unless he probes beyond the surface presentation of epilepsy.
“Sometimes too, an endometriosis patient could bleed while coughing, giving an impression that it is tuberculosis. The diagnosis would, however, be easily done if this presentation occurs around the monthly cycle of the patient.”
The fertility specialist cautioned that simple measures such as lifestyle modifications and diet changes are usually not effective in treating endometriosis, adding “which is why early intervention is key.”
The WHO says endometriosis has significant social, public health and economic implications, adding that it could decrease quality of life due to severe pain, fatigue, depression, anxiety and infertility.
“Some individuals with endometriosis experience debilitating pain that prevents them from going to work or school. Painful sex due to endometriosis can lead to interruption or avoidance of intercourse and affect the sexual health of affected individuals and their partners.
“Addressing endometriosis will empower those affected by it by supporting their human right to the highest standard of sexual and reproductive health, quality of life and overall well-being”, WHO stated.
In a 2022 study published in BioMed Central Women’s Health titled, ‘Challenges of and possible solutions for living with endometriosis: a qualitative study’, a team of researchers said lack of information about endometriosis had worsened challenges and difficulties faced by women and girls suffering from the condition.
BMC Women’s Health is an open-access, peer-reviewed journal that considers articles on all aspects of the health and well-being of adolescent girls and women, with a particular focus on the physical, mental, and emotional health of women in developed and developing nations.
In the study, it was noted that increased awareness and communication between women living with the condition and healthcare providers would help address the gap and improve the quality of life for sufferers.
“The present findings indicate that cooperation between health care professionals, psychologists, and support organisations will be necessary for the future to provide care and find possible solutions to the needs of women living with endometriosis.
“Communication must be improved, and psychosocial problems need to be recognized by health care providers to ensure that empathetic care is provided”, the researchers stated.
