Our natural inclination is to excuse these behaviors because of the illness. This is very easy in short-term illnesses where the diagnosis is straightforward and simple for others to understand. However, when there is trouble getting a diagnosis, or when the diagnosis is difficult to understand, or when the disease seems unending, the behaviors of the sick person can seem unacceptable.

Relationships that are already weak are the most vulnerable to the strains an illness produces. When partners lack communication skills, or don't use them, when they are quick to accuse and slow to forgive, then illness can cause a crippling blow.

Endometriosis is a disease of women. Men do not get endometriosis (they never even experience a normal period, much less the pain of endo). Women with the disease have these questions about their partners:

• Why isn't he involved?
   
• Why doesn't he believe I'm in pain?
   
• Why is he so quiet when I'm hurting?
   
• How can I meet his physical needs (and my own) when intercourse is so painful?

This question implies that men should understand your pain and disease. Let's agree that they should try to understand. As noted, the entire menstrual cycle is foreign to a man's experience, and endometriosis can be totally confusing. For example, a common question from men is, "If the problem is with the reproductive organs, why does my wife blame her fatigue on endometriosis?"

If men are involved in the entire process of evaluating the problem and seeking a correct diagnosis, they tend to reach a greater level of understanding. Therefore, we in the medical profession need to encourage men to be a co-student in the learning process. More often than not, when I see men with their wives at consultations, pre-op, and post-op visits, I feel I am dealing with a couple who are actively building their relationship, and not allowing it to dissolve.

When I talk to men who are not involved I hear a number of different excuses. Some men say that they think their wives want them not to be present. Some say they are uncomfortable in any medical situation. Lots of men are ill at ease when situations seem out of their control. One man said, "I don't see how we can spend any more money, nothing has worked so far, and we are deep in debt."

Endometriosis can't been readily seen or touched. Adequate communication about the disease and the way you feel is essential in helping your partner understand. He can't read your mind: you must tell him how and where you hurt.

Some men are themselves very insensitive to pain, or have never had an experience where pain immobilized them. They do not automatically understand or have sympathy for the variety and intensity of pain that endometriosis can bring.

Sadly, some relationships include routine disbelief between partners. In such situations, communications break down because the truth is always questioned.

Men are trained from childhood to provide for and protect their mates. A man watching his wife endure severe pain that he can't stop often faces a serious threat to his manhood. He feels helpless to save her from something that is ruining the quality of her life.

A common response to this situation is to withdraw. Your husband may feel that there is no way to fight the enemy, and so he may throw up his hands wondering what to do. It is so very difficult to comfort someone you feel you have let down. The result may be silence.

• Let him know that you don't expect him to fix the problem. Remind him that it's no one's fault that you have endometriosis, and certainly not his.
   
• Tell him how much his closeness means to you. It will help him to know that just comforting you is meeting his duties as a husband.
   
• Convince him that he has not let you down.

It is very rare for men to experience anything that interferes with their sex drives. It is even more uncommon for intercourse to cause pain for a man. This makes it hard for a man to understand how pain and the fear of it can interfere with a woman's sex drive. 

Sometimes the woman suffers through intercourse without saying anything. She loves her husband and wants to satisfy him. However, it's hard to play an enthusiastic, responsive partner when you're in pain. And the man who loves her can often tell that something is wrong, but he doesn't know what. He may assume that he has failed to satisfy her. The couple may move further apart.

• Tell your partner everything he does to satisfy your sexual needs. Men and women approach sexuality differently, and he may not understand just how important touching, caressing, and cuddling can be to you. Reassure him often.
   
• Don't let painful intercourse keep you from other forms of sexual expression. Do for your husband all that you can, and let him know the things you like him to do for you. Be creative!
   
• Spend time developing in his mind your determined hope to be able to enjoy physical intimacy to its ultimate. He needs to know that he is still the one you desire above all others.