Endometriosis: One Illness in One Person, but More Than Just One Victim

Endometriosis pain

Endometriosis is a gynecological condition in which abnormally placed glandular tissue—similar to the lining of your womb—exits outside of your womb. This indicates a presence somewhere else, of course, such as your abdomen and pelvis, and even remotely outside of your abdominal cavity.

This is hormonally reactive tissue that is not discardable like the bloody period debris on a tampon or sanitary napkin. Trapped and unable to escape, this abnormally placed tissue anchors to other organs, such as the ovary, bladder, rectum, and other sites. Simply, it does not play well with others. When you cycle, it creates a massive amount of inflammation which also incites your body to match it with its own immunological reactions. This makes for a lot of pain and misery for you, the victim. You, “as victim,” is the same as you, “as patient,” and most of the medical literature centers around the unfortunate combination of endometriosis and the one person—the victim—who suffers with it.

Destructive arithmetic: two minus one is no longer two.

Relationship stability is only as secure as the most vulnerable person in it, and endometriosis can create discord in any relationship when one of its members suffers deterioration of her quality of life. The most obvious peril to the relationship between a woman with endometriosis and her spouse or companion is the deterioration of intimacy. However, any relationship can suffer when one person is in pain, is psychologically troubled about future fertility, or whether or not she will ever feel normal again. These things can suspend the usual socializing by preventing participation in friends’ gatherings, shopping and running a household, sports and recreation, and hobbies. Work and vocation are equally jeopardized. As the quality of life suffers in a woman, all those who are close with her will witness a strain when she is not herself, because a woman with endometriosis really isn’t; but she wants desperately to become herself again.  

Intimacy is both spiritual and physical.

When intimacy and affection cannot be expressed physically, the psychodynamics and emotional failings that occur are major saboteurs of the usual bonds between two people. Of course, we’re talking about sex. But sex is much more than aligning sexual organs. The neurotransmitters in the brain that facilitate bonding and love are greatly involved in not only the sexual act but in the anticipation of sex. When sex becomes out of the question because of pain, the psychological dominoes can begin falling rapidly. Anger, guilt, low self-esteem, blame, and lack of fulfillment and validation all conspire to sink your relationship if there is endometriosis. Additionally, many of those with this condition undergo a series of surgeries, and the entire family—be it a couple or a whole household of persons—all have to stop their lives to accommodate this need. When it seems that it will never end, it can wear thin on loved one(s).

There are ghosts, too, with endometriosis.

There are yet other victims, never mentioned, and these are the persons who will never be because of the delay or absence of pregnancy that endometriosis causes. This concept borders on speculative and whimsical philosophical existence, but not to the couple who are not pregnant when they want to be. Every delay means the hopes and dreams of the joys of childrearing are delayed, and this is compounded by the worry that it may be not so much of when pregnancy will finally happen, but if it will ever happen. Any woman who has suffered a miscarriage cannot help but wonder, years after, what that child would be. Likewise, a pregnancy not achieved when it is desired is a miscarriage of happiness, fulfillment, and a love that has nowhere to go.

How many surgeries are too many?

As mentioned above, the woman who suffers with endometriosis will typically have more than one surgery because of it. This raises the question of how many are too many? Besides the simple additive accrual of risk as the number of procedures goes up, there is the intangible question of when to give up. This adds yet another drama into the mix. It is for this reason that, if endometriosis is to be addressed surgically, a woman is best served by having a surgery that does the best job and offers the greatest likelihood of ending the condition so she can begin her family and “feel normal” again—in comfort and in her relationships.

It’s the same endometriosis, but it’s not the same surgery.

Yesterday’s endometriosis is exactly the same as today’s endometriosis. In the past, however, women were just written off as “barren.” However, in just one generation the tools to pursue its eradication have changed significantly. More recently minimally invasive surgery and robotic surgery, performed by GYN surgical specialists, have proven themselves crucial in stacking the deck in favor of the woman against the ravages of endometriosis. This is because these techniques and technologies offer the most opportunity to remove all of it while preserving all of the normal tissue a patient wants to keep. Also, the delicate actions toward tissue assures a gentleness which decreases the risks of scar tissue causing problems later. Because of these advantages, procedures such as robotic excision of endometriosis help to bring down the “victim count,” and there never has been any time before now when this condition could be tackled so completely and successfully.

To be or not to be.

Endometriosis is unfair and its victims are innocent. Serious relationships originally are intended to be lived “happily ever after,” but when they perish because of a physical condition, this is the cruelest of victimization, as a whole pyramid of generational what-ifs decay into oblivion. People who were meant to be conceived and who aren’t makes for a tragedy that can only be appreciated by those who wait for the next cycle, the next ovulation, the next conception, the next life. Today, this open-ended postponement has been shortened by the medical and surgical advancements that provide the best chance for those—meant to be—to be.


Ulas Bozdogan, MD

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