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Wahl K, Orr NL, Parmar G, Zhang SXJ, MacLeod RGK, Noga H, Albert A, Flannigan R, Brotto LA, Yong PJ. Ohnut vs waitlist control for the self-management of endometriosis-associated deep dyspareunia: a pilot randomized controlled trial. Sex Med 2024; 12:qfae049. [PMID: 39220343 PMCID: PMC11365696 DOI: 10.1093/sexmed/qfae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/18/2024] [Accepted: 07/24/2024] [Indexed: 09/04/2024] Open
Abstract
Background Deep dyspareunia affects 50% of people with endometriosis. The Ohnut is a set of interlocking rings that fit over the penis/insertive object. One or more rings can be used to limit insertion depth and reduce deep dyspareunia. Aim We conducted a pilot, parallel, open-label randomized controlled trial (RCT) to investigate the feasibility of the study design and the acceptability and preliminary efficacy of the Ohnut. Method Participants were recruited from a tertiary center for endometriosis. Eligibility criteria were surgically confirmed endometriosis, age 19-49 years, monogamous sexual relationship with a partner willing to participate in the study, and no comorbid superficial dyspareunia, anxiety, or depression. Couples were randomized into an intervention group or a waitlist control group using a 1:1 allocation ratio. All couples had sex as normal during weeks 1 to 4 (baseline period), and couples in the intervention group used the Ohnut with sex during weeks 5 to 10 (intervention period) while controls had sex as normal. Patient participants used daily diaries to record sexual activity and deep dyspareunia score (0-10) for the 10-week study. Intervention group participants completed an acceptability questionnaire at the end of the study. Outcomes The primary outcomes were feasibility of the study and acceptability of the Ohnut. We also assessed differences in deep dyspareunia scores in the participants who used the Ohnut compared to the control participants who did not. Results We recruited approximately 5 couples per month of active recruitment. Of 864 potentially eligible participants, we successfully contacted 44.7% (n = 386), of whom 8.0% (n = 31) consented, 64.8% (n = 250) were ineligible, and 27.2% (n = 105) declined. Thirty-one couples were randomly assigned to the intervention or control group, and 17 couples completed the study. Intervention group couples used the Ohnut for an average of 72.4% (32.7%) of sexual encounters during the intervention period. The mean acceptability index score for the Ohnut was 0.83 (0.078) among patients and 0.83 (0.049) among partners (index between 0 and 1). After controlling for baseline deep dyspareunia, there was a significant difference in the intervention period mean deep dyspareunia scores between the control and intervention group (4.69 (2.44) vs 2.46 (1.82), P = .012). Clinical Implications We identified preliminary evidence for the acceptability and efficacy of the Ohnut among both patients and partners, suggesting that the Ohnut may be a useful stand-alone or adjuvant management tool for endometriosis-associated deep dyspareunia. Strengths and Limitations Strengths of this study were the "real-world" use of the Ohnut and data collection from both patients and partners. Limitations of the study design included the strict eligibility criteria that affected feasibility and generalizability. Conclusion This pilot RCT indicated that the Ohnut may be an acceptable and effective intervention to reduce endometriosis-associated deep dyspareunia. We identified opportunities to improve design for a larger RCT. Clinical Trial Registration This clinical trial was registered with clinicaltrials.gov (#NCT04370444).
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Affiliation(s)
- Kate Wahl
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC V6Z 2K8, Canada
- BC Women’s Centre for Pelvic Pain and Endometriosis and UBC Endometriosis and Pelvic Pain Lab, Vancouver, BC V6H 3N1, Canada
| | - Natasha L Orr
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC V6Z 2K8, Canada
- BC Women’s Centre for Pelvic Pain and Endometriosis and UBC Endometriosis and Pelvic Pain Lab, Vancouver, BC V6H 3N1, Canada
| | - Gurkiran Parmar
- BC Women’s Centre for Pelvic Pain and Endometriosis and UBC Endometriosis and Pelvic Pain Lab, Vancouver, BC V6H 3N1, Canada
| | - Sandy X J Zhang
- BC Women’s Centre for Pelvic Pain and Endometriosis and UBC Endometriosis and Pelvic Pain Lab, Vancouver, BC V6H 3N1, Canada
| | - Rebecca G K MacLeod
- BC Women’s Centre for Pelvic Pain and Endometriosis and UBC Endometriosis and Pelvic Pain Lab, Vancouver, BC V6H 3N1, Canada
| | - Heather Noga
- BC Women’s Centre for Pelvic Pain and Endometriosis and UBC Endometriosis and Pelvic Pain Lab, Vancouver, BC V6H 3N1, Canada
- Women’s Health Research Institute, Vancouver, BC V6H 3N1, Canada
| | - Arianne Albert
- Women’s Health Research Institute, Vancouver, BC V6H 3N1, Canada
| | - Ryan Flannigan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC V6Z 2K8, Canada
- Women’s Health Research Institute, Vancouver, BC V6H 3N1, Canada
| | - Paul J Yong
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC V6Z 2K8, Canada
- BC Women’s Centre for Pelvic Pain and Endometriosis and UBC Endometriosis and Pelvic Pain Lab, Vancouver, BC V6H 3N1, Canada
- Women’s Health Research Institute, Vancouver, BC V6H 3N1, Canada
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Abdulai AF, Howard AF, Parmar G, Noga H, Abdul-Ghafoor AA, Lisonek M, Yong PJ. The quality, suitability, and readability of web-based resources on endometriosis-associated dyspareunia: A systematic review. Health Informatics J 2024; 30:14604582241231151. [PMID: 38308637 DOI: 10.1177/14604582241231151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
People commonly and increasingly rely on the internet to search for health information, including those related to endometriosis-associated dyspareunia. Yet the content of such websites may be of variable accuracy and quality. This review aims to evaluate the quality, readability, and suitability of web-based resources on endometriosis-associated dyspareunia for patients. We searched 3 databases - Google, Bing, and Yahoo - to identify websites related to endometriosis-associated dyspareunia. Two independent reviewers screened the search results against inclusion and exclusion criteria. Another set of two reviewers evaluated the selected websites using validated measurement instruments. Out of 450 websites, 21 met the inclusion criteria and were evaluated. More than half of the websites had information on content updates, reported on authorship, or disclosed sponsorship information. The mean quality and suitability scores were 47.5 (SD = 13.3) and 65.2 (SD = 13.6) respectively, thus suggesting generally adequate quality and suitability levels. However, the mean readability scores exceeded the recommended level for health-related websites. The poor readability of the websites might limit accessibility for a significant proportion of patients with low educational levels. The findings of this review have implications for designing high-quality, readable and up-to-date web interventions for people who rely on web platforms as an alternative or complementary source of health information on dyspareunia.
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Affiliation(s)
| | - A Fuchsia Howard
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Gurkiran Parmar
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Heather Noga
- Women Health Research Institute, British Columbia Women's Hospital & Health Center, Vancouver, BC, Canada
| | | | - Michelle Lisonek
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paul J Yong
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
- Women Health Research Institute, British Columbia Women's Hospital & Health Center, Vancouver, BC, Canada
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Asencio FDA, Fins RJP, Mitie CK, Ussia A, Wattiez A, Ribeiro HS, Ribeiro PA, Koninckx PR. Segmental Rectum Resection for Deep Endometriosis and Excision Similarly Improve Sexual Function and Pain. Clin Pract 2023; 13:780-790. [PMID: 37489420 PMCID: PMC10366930 DOI: 10.3390/clinpract13040071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/08/2023] [Accepted: 06/30/2023] [Indexed: 07/26/2023] Open
Abstract
Segmental rectum resections for indications other than endometriosis were reported to result in up to 40% sexual dysfunctions. We, therefore, evaluated sexual function after low bowel resection (n = 33) for deep endometriosis in comparison with conservative excision (n = 23). Sexual function was evaluated with the FSFI-19 (Female Sexuality Functioning Index) and EHP 30 (Endometriosis Health Profile). The pain was evaluated with visual analogue scales. Linear excision and bowel resections improved FSFI, EHP 30, and postoperative pain comparably. By univariate analysis, a decreased sexual function was strongly associated with pain both before (p < 0.0001) and after surgery (p = 0.0012), age (p = 0.05), and duration of surgery (p = 0.023). By multivariate analysis (proc logistic), the FSFI after surgery was predicted only by FSFI before or EHP after surgery. No differences were found between low bowel segmental resection and a more conservative excision. In conclusion, improving pain after surgery can explain the improvement in sexual function. A deleterious effect of a bowel resection on sexual function was not observed for endometriosis. Sexual function in women with endometriosis can be evaluated using a simplified questionnaire such as FSFI-6.
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Affiliation(s)
| | | | - Carolina Kami Mitie
- Medicine College, University of Santa Casa de São Paulo, São Paulo 01224-001, Brazil
| | - Anastasia Ussia
- Gemelli Hospital, Universtità Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Arnauld Wattiez
- Department of Obstetrics and Gynaecology, University of Strasbourg, 67081 Strasbourg, France
- Latifa Hospital, Dubai P.O. Box 9115, United Arab Emirates
| | | | - Paulo Ayrosa Ribeiro
- Department of Gynaecology Endoscopy, Santa Casa de São Paulo Hospital, São Paulo 01221-010, Brazil
| | - Philippe Robert Koninckx
- Latifa Hospital, Dubai P.O. Box 9115, United Arab Emirates
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Catholic University Leuven, 3000 Leuven, Belgium
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Morgan O, Schnur J, Caban-Martinez AJ, Duenas-Lopez M, Huang M, Portelance L, Elkhadem A, Marshall DC. A qualitative analysis of female patient perspectives on physician communication regarding sexual dysfunction associated with pelvic radiotherapy. J Sex Med 2023; 20:813-820. [PMID: 37037772 PMCID: PMC10230644 DOI: 10.1093/jsxmed/qdad041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/16/2023] [Accepted: 03/03/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Sexual dysfunction is a known side effect of pelvic radiotherapy, resulting from a complex intersection of physiologic and psychosocial factors. Maintaining sexual function is relevant to long-term quality of life and is an important aspect of survivorship. Many female patients report being insufficiently informed before treatment about the potential sexual side effects of radiation therapy. AIM To elucidate how radiation oncologists communicate sexual function side effects with their female patients and how discussing sexual side effects of cancer treatment can positively affect patient-physician rapport. METHODS Semistructured interviews in English and Spanish were conducted with 20 female participants who received pelvic radiation as part of their cancer treatment. Patients responded to advertisements or were referred by physicians. All interviews were conducted virtually between June and October 2021. Thematic analysis was conducted with NVivo. Patients also completed an online demographics survey in REDCap. OUTCOMES We found 4 primary themes addressing patient perspectives on patient-physician communication of sexual dysfunction and how it affected the cancer care experience. RESULTS Theme 1: This may be expected, but I didn't expect it! The participants who were not properly informed about sexual side effects felt blindsided and embarrassed about their symptoms. Theme 2: I do not feel like a woman anymore . . . The psychological impact included lower self-esteem and no longer feeling sexy nor like a woman. Theme 3: Fine, I'll deal with this myself! Patients turned to the internet rather than their doctors for answers once they began experiencing symptoms, and they found information, normalization, and community online. Theme 4: Ask me about my sex life and find out if sex is a priority for me. Participants emphasized that their radiation oncologist should take a sexual history early to monitor sexual dysfunction and to identify individual patient priorities surrounding sex posttreatment. CLINICAL IMPLICATIONS This evidence provides a guide to patient-physician communication that may help to mitigate the impacts of radiotherapy on female sexual function as well as the negative impact that the absence of communication about sexual dysfunction may have on patient-physician trust. STRENGTHS AND LIMITATIONS While this project did have a small sample size, there is considerable diversity in race, education level, and age, with interviews conducted in Spanish and English. CONCLUSION Overall these findings provide physicians with important information about the unmet information needs of patients and their preferences for how to help them feel more prepared and less distressed when sexual dysfunction occurs.
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Affiliation(s)
- Orly Morgan
- Department of Public Health Science, University of Miami, Miami, FL 33146, United States
- Miller School of Medicine, University of Miami, Miami, FL 33146, United States
| | - Julie Schnur
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | | | - Mariana Duenas-Lopez
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, United States
| | - Marilyn Huang
- Miller School of Medicine, University of Miami, Miami, FL 33146, United States
| | - Lorraine Portelance
- Miller School of Medicine, University of Miami, Miami, FL 33146, United States
| | - Adam Elkhadem
- College of Arts and Sciences, Columbia University in the City of New York, New York, NY 10027, United States
| | - Deborah C Marshall
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
- Department of Radiation Oncology, Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
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Ashkenazi MS, Huseby OL, Kroken G, Trocha M, Henriksson A, Jasiak H, Cuartas K, Loschiavo A, Kuhn I, Støve D, Grindahl H, Latour E, Melbø M, Holstad K, Kwiatkowski S. The Clinical Presentation of Endometriosis and Its Association to Current Surgical Staging. J Clin Med 2023; 12:jcm12072688. [PMID: 37048771 PMCID: PMC10095514 DOI: 10.3390/jcm12072688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/25/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023] Open
Abstract
(1) Despite its high prevalence, the diagnostic delay of endometriosis is still estimated to be about 7 years. The objective of the present study is to understand the symptomatology of endometriosis in patients across various countries and to assess whether the severity of symptoms correlates with the diagnosed stage of disease. (2) An international online survey collected self-reported responses from 2964 participants from 59 countries. Finalization of the questionnaire and its distribution was achieved by cooperation with various organizations and centers around the globe. (3) Chronic pain presentation remarkably increased between Stage 1 and 2 (16.2% and 32.2%, respectively). The prevalence of pain only around and during menstruation was negatively correlated to the stage, presenting with 15.4% and 6.9% in Stages 1 and 4, respectively. Atypical presentation of pain was most commonly reported in stage 4 (11.4%). Pain related solely to triggering factors was the most uncommon presentation of pain (3.2%). (4) Characteristics of pain and quality of life tend to differ depending on the reported stage of the endometriosis. Further research may allow a better stage estimation and identification of patients with alarming symptomatic presentation indicative of a progressive stage, even those that are not yet laparoscopically diagnosed.
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Affiliation(s)
- Matilda Shaked Ashkenazi
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Ole Linvåg Huseby
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Gard Kroken
- Fiskeridirektoratet, Strandgaten, 5004 Bergen, Norway
| | - Marcela Trocha
- Department of Obstetrics and Gynaecology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Aurora Henriksson
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Hanna Jasiak
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Karen Cuartas
- Department of Obstetrics and Gynaecology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Alessandra Loschiavo
- The Department of Woman, Child, and General and Specialized Surgery, Università della Campania Luigi Vanvitelli, 81100 Caserta, Italy
| | - Isabella Kuhn
- Musculoskeletal University Center Munich, Department of Orthopaedics and Trauma Surgery, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Dina Støve
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Hanna Grindahl
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Emilia Latour
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Mathias Melbø
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Katrine Holstad
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
| | - Sebastian Kwiatkowski
- Department of Obstetrics and Gynaecology, Pomeranian Medical University in Szcezcin, 70-204 Szczecin, Poland
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Facchin F, Barbara G, Buggio L, Dridi D, Frassineti A, Vercellini P. Assessing the experience of dyspareunia in the endometriosis population: the Subjective Impact of Dyspareunia Inventory (SIDI). Hum Reprod 2022; 37:2032-2041. [PMID: 35726864 DOI: 10.1093/humrep/deac141] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is the Subjective Impact of Dyspareunia Inventory (SIDI) a reliable tool to examine the experience of dyspareunia in the context of endometriosis? SUMMARY ANSWER In this study, the SIDI showed good structural and psychometric properties, and thus can be used as a reliable questionnaire to assess the impact of endometriosis-related dyspareunia on multiple dimensions, such as sexuality and intimate relationships. WHAT IS KNOWN ALREADY In the endometriosis population, dyspareunia has a tremendous negative impact on psychological health, overall sexual function and couple relationships. However, there is a paucity of tools that can be effectively used in either research or clinical practice to assess the subjective components of the dyspareunia experience, including coping strategies to deal with the pain. STUDY DESIGN, SIZE, DURATION In this cross-sectional study, the validity of the SIDI was examined by considering the responses provided by 638 participants with endometriosis and dyspareunia, who participated in an online survey conducted between 8 November and 21 December 2021. Participants were recruited using snowball sampling that involved posting the invitation to participate in the study on the social media of a patient association. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were women aged ≥18 with clinical or surgical diagnosis of endometriosis. The SIDI measures the subjective impact of dyspareunia and is composed of 16 items focused on the frequency of dyspareunia-related experiences in the last 6 months, rated on a 5-point Likert scale. Sexuality was assessed using the Female Sexual Function Index. Psychological health was measured using the Hospital Anxiety and Depression Scale and the Rosenberg Self-Esteem Scale. Sociodemographic and endometriosis-related information was collected using a researcher-made questionnaire. Statistical significance was set at P < 0.05. MAIN RESULTS AND THE ROLE OF CHANCE Factor analysis revealed that the SIDI has a four-factor structure and allows for examining the impact of dyspareunia in terms of Sexual Concerns (Factor 1), Relationship Concerns (Factor 2), Partner Support (Factor 3) and Endurance of Pain (Factor 4). The SIDI showed good structural and psychometric properties (including internal consistency), was associated with sexual function and psychological health and was able to discriminate between participants with and without sexual dysfunction. LIMITATIONS, REASONS FOR CAUTION Reasons for caution are related to the risk of self-selection bias depending on the study population and recruitment strategy. Moreover, all the information provided by the participants was self-reported, which may have affected the accuracy of the data collected, especially with regards to endometriosis-specific information. WIDER IMPLICATIONS OF THE FINDINGS This study may provide a new brief tool that can be used by clinicians and researchers to assess the impact of dyspareunia from a multidimensional perspective and to consider subjective aspects that can be usefully integrated with information about pain severity, timing and localization. STUDY FUNDING/COMPETING INTEREST(S) There was no funding for this study. A.F. is the President of APE-Odv (Associazione Progetto Endometriosi-Organizzazione di volontariato (Endometriosis Project Association-Volunteer Organization)), the largest nonprofit endometriosis patient association in Italy. The other authors have no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- F Facchin
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - G Barbara
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - L Buggio
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - D Dridi
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Frassineti
- Associazione Progetto Endometriosi-Organizzazione di Volontariato (APE-Odv), Reggio Emilia, Italy
| | - P Vercellini
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Yong PJ. Deep dyspareunia: a narrative review of impact on sexual function and quality-of-life. Minerva Obstet Gynecol 2022; 74:222-233. [PMID: 35107234 DOI: 10.23736/s2724-606x.22.04974-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Deep dyspareunia refers to pain with deep penetration or insertion into the vagina, which affects quality-of-life. The aim of this narrative review is to examine how the underlying conditions that give rise to deep dyspareunia, and the symptoms of these conditions, can affect sexual function and quality-of-life beyond the deep dyspareunia itself. For example, deep dyspareunia may be associated with gynaecological pathologies that cause cyclical pain symptoms (e.g dysmenorrhea, dyschezia/dysuria), resulting in quality-of-life changes related to menstrual cycle events such as ovulation or menstruation. Recurrent dysmenorrhea can cause hyperalgesic priming that sensitizes the nervous system, leading to chronic pelvic pain that can be exacerbated with sexual activity. The co-existence of functional bowel or bladder disorders can result in urgency and frequency that affect the sexual response cycle. Myofascial/musculoskeletal origins of deep dyspareunia may affect body positioning during sexual activity. Central nervous system sensitization can underlie these different factors, and also be associated with mental health conditions, which together can cause symptomatology across body systems that can affect all aspects of one's sexual life. Recognition and management of the far-reaching impacts of deep dyspareunia and its associated comorbidities may be important in clinical care to meaningfully improve quality-of-life. Future research should include a comprehensive empirical validation of the hypotheses and potential mechanisms in this review.
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Affiliation(s)
- Paul J Yong
- Divisions of Gynaecologic Specialities & Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada -
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Facchin F, Buggio L, Dridi D, Barbara G, Vercellini P. The Subjective Experience of Dyspareunia in Women with Endometriosis: A Systematic Review with Narrative Synthesis of Qualitative Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212112. [PMID: 34831868 PMCID: PMC8623407 DOI: 10.3390/ijerph182212112] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/15/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023]
Abstract
Although dyspareunia (pain during intercourse) is common in women with endometriosis, there is poor qualitative evidence describing women’s subjective experience of this symptom. This systematic review of qualitative research aimed to provide an in-depth exploration of women’s lived experience of dyspareunia (i.e., how they perceive and describe their pain, how they deal with it, how it affects their psychological health and intimate relationships). A total of 17 published articles were included. Our findings, derived from thematic analysis, highlighted that endometriosis-related dyspareunia manifests itself in multiple forms (deep, introital, and/or positional dyspareunia, at orgasm, during and/or after intercourse). Women use a variety of coping strategies to deal with sexual pain, such as interrupting or avoiding intercourse, enduring pain to seek pregnancy, and/or finding alternative ways to enjoy sexuality. Dyspareunia impairs women’s psychological health, especially in terms of poor self-esteem and sense of femininity and has negative consequences on intimate relationships. Unfortunately, both women and physicians are often reluctant to discuss sexual issues. Sexual health should be routinely assessed during counselling with endometriosis patients. Helping women find targeted strategies to enjoy sexuality despite endometriosis may significantly improve their psychological health and quality of life.
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Affiliation(s)
- Federica Facchin
- Department of Psychology, Catholic University of the Sacred Heart, Largo Gemelli 1, 20123 Milan, Italy
- Correspondence:
| | - Laura Buggio
- Gynaecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda 12, 20122 Milan, Italy; (L.B.); (D.D.); (G.B.)
| | - Dhouha Dridi
- Gynaecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda 12, 20122 Milan, Italy; (L.B.); (D.D.); (G.B.)
| | - Giussy Barbara
- Gynaecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda 12, 20122 Milan, Italy; (L.B.); (D.D.); (G.B.)
- SVSeD—Service for Sexual and Domestic Violence and Obstetrics and Gynaecology Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda 12, 20122 Milan, Italy
| | - Paolo Vercellini
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy;
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