Female Sexual Function in Women with Suspected Deep Infiltrating Endometriosis

Abstract

Objective To evaluate the quality of the sexual function of women with suspected deep infiltrating endometriosis. Methods A cross-sectional, observational and prospective study was conducted between May 2015 and August 2016, in which 67 patients with deep infiltrating endometriosis, suspected or diagnosed, were assessed for epidemiological and clinical characteristics, such as pain level through a visual analog scale (VAS), features of deep infiltrating endometriosis lesions and score on the Female Sexual Function Index (FSFI) before the onset of treatment. The statistical analysis was performed using the software STATA version 12.0 (StataCorp LLC, College Station, TX, USA) to compare the variables through multiple regression analysis. Results The average age of the patients was 39.2 years old; most patients were symptomatic (92.5%); and the predominant location of the deep infiltrating lesions was on the rectosigmoid colon (50%), closely followed by the retrocervical region (48.3%). The median overall score on the FSFI was 23.4; in 67.2% of the cases the score was 26.5 (cutoff point for sexual dysfunction). Deep dyspareunia (p ¼ 0.000, confidence interval [CI]: 0.64-0.83) and rectosigmoid endometriosis lesions (p ¼ 0.008, CI: 0.72-0.95) showed significant correlation with lower FSFI scores, adjusted by bladder lesion, patients' age and size of lesions. Deep dyspareunia (p ¼ 0.003, CI: 0.49-0.86) also exhibited significant correlation with FSFI pain domain, adjusted by cyclic bowel pain, vaginal lesion and use of gonadotropin-releasing hormone (GnRH) analog. These results reflect the influence of deep dyspareunia on the sexual dysfunction of the analyzed population. Conclusion Most patients exhibited sexual dysfunction, and deep dyspareunia was the pelvic painful symptom that showed correlation with sexual dysfunction. ResumoObjetivo Avaliar a qualidade da função sexual em pacientes com suspeita de endometriose profunda infiltrativa. Métodos Foi realizado um estudo observacional transversal prospectivo entre maio de 2015 e agosto de 2016, no qual foram analisados os dados clínicos e

Impact of Endometriosis on Life-Course Potential: A Narrative Review

“…In a Brazilian crosssectional study of women with suspected or diagnosed deep endometriosis, more than one-third met the criteria for sexual dysfunction according to the FSFI. 76 Results from analyses using multiple logistic regression revealed a significant inverse correlation between higher overall FSFI score and rectosigmoid endometriosis lesions (P<0.01). These results were consistent with findings from an Italian cross-sectional study in which sexual functioning was compromised to a greater extent in women with severe dyspareunia compared with women with mild or moderate dyspareunia.…”

“…We identified 13 studies in women with endometriosis that address the impact of endometriosis on the personal relationships component of the life course. 34,45,62,[70][71][72][73][74][75][76][77][78][79] The category of "personal relationships" is inclusive of social and family connections as well as intimate partner relationships. Endometriosis may interfere with all types of interpersonal relationships, 34,62 but it is sexual health that has garnered the most research interest.…”

“…Several studies have attempted to correlate sexual dysfunction with the location of endometriosis. 71,73,76,78 Vercellini et al 78 reported impairment of sexual functioning among Italian women with endometriosis, regardless of type (rectovaginal, peritoneal, or ovarian). Sexual interest, satisfaction with their sex life, and sexual pleasure were all affected by endometriosis.…”

Clinical Treatment of Deep Infiltrating Endometriosis – Impacts on Sexual Function

“…The mean age found in this study corresponds to the age group in which endometriosis is typically diagnosed, the 4th decade of life [9,[19][20][21]. Regarding obstetric history, there was a high prevalence of primary or secondary infertility.…”

“…In addition to the symptoms described above, quality of life is usually severely impaired in patients with endometriosis [7,8]. Dyspareunia is associated with anxiety and sexual dysfunction in all areas [8,9]. It is well described that sexual experiences are reinforced in subsequent relationships; thus, negative experiences can perpetuate sexual dysfunction and cause suffering, distress or interpersonal difficulty, making women unable to participate in sexual intercourse as they would like [10][11][12].…”