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Merli CEM, Cetera GE, Caia C, Facchin F, Vercellini P. "The sound of silence" Giving voice to endometriosis-related positional dyspareunia. Arch Gynecol Obstet 2024; 309:887-893. [PMID: 37689593 DOI: 10.1007/s00404-023-07205-3] [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] [Received: 05/10/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023]
Abstract
Deep dyspareunia is one of the main symptoms of endometriosis. It appears to be submerged by a two-way disconnection between patients and their physicians. The aim of our review is to provide clear, ready-to-use advice on how to manage deep dyspareunia overcoming the gap in communication. Sexual history should always be taken as part of routine health care in these regards, using a patient-centered approach. An educational pelvic examination, which actively includes patients in the identification of painful areas, may prove useful to improve patients' understanding of their condition. Correlating painful pelvic areas with sexual positions and inviting patients to adopt alternative positions may represent a simple but extremely effective coping strategy to mitigate pain. Revealing and explaining to partners the nature of the pain is essential to allow them to take part in shared research of coping mechanisms, empowering the couple to make choices and changes. Couples who do not feel comfortable talking about intimacy by themselves may find that including a psychotherapist or a sexual therapist, may be a good way to start communication. Investigating and managing dyspareunia during medical encounters is a medical and ethical duty all healthcare practitioners should pursue.
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Affiliation(s)
- Camilla Erminia Maria Merli
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy.
| | - Giulia Emily Cetera
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy
| | - Carlotta Caia
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federica Facchin
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Paolo Vercellini
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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2
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Sarvestani MH, Noroozi M, Hashemi M, Mostafavi F. A comprehensive interventional program to improve the sexual function of women with endometriosis: a mixed-methods protocol study. Reprod Health 2024; 21:29. [PMID: 38414010 PMCID: PMC10900588 DOI: 10.1186/s12978-024-01759-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/21/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Endometriosis is a chronic disease affecting 6-10% of women worldwide. Sexual dysfunction has been reported in a significant percentage of these patients. Thus, the present study will be conducted to design, implement, and determine the effectiveness of an interventional program to improve the sexual function of women with endometriosis. MATERIALS AND METHODS This mixed-methods study will be carried out in three phases with a sequential exploratory approach. In the first phase (qualitative study) participants will be selected by purposive sampling in Isfahan, Iran. The data will be collected through in-depth interviews and field notes and analyzed using conventional content analysis. The interventional program will be designed in the second phase based on the results of the qualitative study and literature review and using the Delphi method and panel of experts. The interventional program will be implemented at the individual level in the third phase to investigate its effect on improving women's sexual function. This phase includes quasi-experimental research, in which the pre- and post-intervention data will be collected from the intervention and control groups using the FSFI questionnaire and analyzed by descriptive and inferential statistical methods. Ultimately, a suitable interventional program will be presented by combining the data obtained in the qualitative and quantitative phases of the research. CONCLUSION Conducting the present study, along with the design and implementation of an appropriate, native, and culturally sensitive interventional program, can contribute to improving the sexual function of women with endometriosis and enhancing the quality of sexual relations between couples.
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Affiliation(s)
- Maryam Heidari Sarvestani
- Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Noroozi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Maryam Hashemi
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firoozeh Mostafavi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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3
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Kfoury M, Barakat H, Hallit S, Saliba S. Association between endometriosis and sexual satisfaction among a sample of lebanese women. BMC Womens Health 2023; 23:164. [PMID: 37024920 PMCID: PMC10080926 DOI: 10.1186/s12905-023-02323-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/01/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Endometriosis is a complex disease that affects approximately 10% of women of childbearing age. It is characterized by the presence of endometrial-like tissue outside the uterus and often results in symptoms such as pelvic pain and infertility. This condition may disturb mental health and decrease both the mental and physical health related quality of life of women. The aim of this study was to assess the emotional state and the intimate relational aspect of life in Lebanese women living with endometriosis. METHODS This is a case-control study that included 317 women (65 participants with endometriosis and 252 controls (1:3 ratio)). Participants completed an online survey that included questions related to endometriosis, Sexual Satisfaction Scale for Women, Couple Satisfaction Index, Perceived Partner Responsiveness Scale and the Depression, Anxiety and Stress Scale. RESULTS A significantly higher mean sexual satisfaction score was found in women without endometriosis compared to those with endometriosis (90.83 vs. 83.42; p = 0.006). No significant difference was found in terms of couple satisfaction, depression, anxiety, stress, and perceived partner responsiveness between the two groups. Higher couple satisfaction (Beta = 1.30) and perceived partner responsiveness (Beta = 0.16) were significantly associated with higher sexual satisfaction, whereas higher depression (Beta=-1.70) and having endometriosis compared to not (Beta=-6.51) were significantly associated with lower sexual satisfaction. CONCLUSION This study validated the link between endometriosis and sexual satisfaction and invalidated the association between endometriosis and emotional state, as well as couple satisfaction and perceived partner responsiveness. Greater sexual satisfaction was, however, linked to greater perceived partner responsiveness and greater couple satisfaction, as well as decreased signs of depression, anxiety, and stress. More research is warranted to better understand how Lebanese women are coping with the disease and how clinicians may help them further.
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Affiliation(s)
- Maya Kfoury
- School of Arts and Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Habib Barakat
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Department of Obstetrics and Gynecology, Notre Dame des Secours University Hospital Center, Street 93, Postal Code 3, Byblos, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
| | - Sahar Saliba
- School of Arts and Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
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Bonavina G, Taylor HS. Endometriosis-associated infertility: From pathophysiology to tailored treatment. Front Endocrinol (Lausanne) 2022; 13:1020827. [PMID: 36387918 PMCID: PMC9643365 DOI: 10.3389/fendo.2022.1020827] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
Despite the clinically recognized association between endometriosis and infertility, the mechanisms implicated in endometriosis-associated infertility are not fully understood. Endometriosis is a multifactorial and systemic disease that has pleiotropic direct and indirect effects on reproduction. A complex interaction between endometriosis subtype, pain, inflammation, altered pelvic anatomy, adhesions, disrupted ovarian reserve/function, and compromised endometrial receptivity as well as systemic effects of the disease define endometriosis-associated infertility. The population of infertile women with endometriosis is heterogeneous, and diverse patients' phenotypes can be observed in the clinical setting, thus making difficult to establish a precise diagnosis and a single mechanism of endometriosis related infertility. Moreover, clinical management of infertility associated with endometriosis can be challenging due to this heterogeneity. Innovative non-invasive diagnostic tools are on the horizon that may allow us to target the specific dysfunctional alteration in the reproduction process. Currently the treatment should be individualized according to the clinical situation and to the suspected level of impairment. Here we review the etiology of endometriosis related infertility as well as current treatment options, including the roles of surgery and assisted reproductive technologies.
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Affiliation(s)
- Giulia Bonavina
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, United States
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5
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Kling JM, Ghaith S, Smith T, Kapoor E, Wasson M, Mara K, Enders FT, Faubion S, Kuhle C. Evaluating the Link Between Self-Reported Endometriosis and Female Sexual Dysfunction. J Sex Med 2022; 19:1553-1561. [PMID: 35970712 PMCID: PMC10110390 DOI: 10.1016/j.jsxm.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/11/2022] [Accepted: 07/22/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Studies have found that women with endometriosis have a higher risk of female sexual dysfunction (FSD). AIM To evaluate the relationship between self-reported endometriosis and FSD utilizing validated surveys. METHODS A cross-sectional analysis was conducted among sexually active women aged 18-90 who presented to 3 Mayo Clinic sites from 2015 to 2021. FSD was determined utilizing a combined endpoint of Female Sexual Function Index score ≤ 26.55 and Female Sexual Distress Scale-Revised score ≥ 11. Associations between history of endometriosis and FSD were evaluated by fitting 3 multivariable logistic models and were stratified by menopause status. In the first model, the association was adjusted for age, BMI, race/ethnicity, marital status, and education. The second model adjusted for the variables in Model 1 and hormone therapy, hormonal contraceptive use, self-reported history of abuse within the last year, and co-morbidities including the history of diabetes, heart disease, hypertension, osteoporosis, and stroke. The third model adjusted for the variables in Model 1, Model 2, and anxiety, depression, relationship satisfaction, and SSRI/SNRI use. OUTCOMES The outcomes included self-reported endometriosis and female sexual dysfunction determined utilizing a combined endpoint of Female Sexual Function Index score ≤ 26.55 and Female Sexual Distress Scale-Revised score ≥ 11. RESULTS Of 7118 patients (mean age 51.3), 92.2% were white, 78.4% were peri- or postmenopausal, 8.7% reported endometriosis history, and 57.2% met the criteria for FSD. Women with endometriosis were more likely to be overweight or obese, be smokers, have had a history of heart disease and osteoporosis, have had anxiety and depressed mood, have had a hysterectomy and bilateral salpingo-oophorectomy, and have used hormone therapy. Compared to those without endometriosis, women with endometriosis were significantly more likely to have FSD only among premenopausal women (74.2% vs 57.4%). Similarly, in multivariable analysis the relationship was only seen for premenopausal women in all 3 models (Model 1: OR 2.74 (95% CI 1.43-5.27); Model 2: OR 2.55 (95% CI 1.30-5.04); Model 3: OR 2.30 (95% CI 1.13-4.68)). CLINICAL IMPLICATIONS These findings highlight the opportunity for healthcare practitioners to evaluate sexual function in premenopausal women with endometriosis. For peri and postmenopausal women with endometriosis, the risk of FSD was lower than for premenopausal women with endometriosis. STRENGTHS AND LIMITATIONS This study analyzed the association between endometriosis and FSD in women by menopause status using validated tools that included a measure of distress associated with sexual dysfunction. Limitations include its cross-sectional design which does not allow for determination of the direction of this association. CONCLUSION The risk for FSD associated with endometriosis depends on menopause status. Endometriosis increased the odds of FSD only in premenopausal women. Kling JM, Ghaith S, Smith T, et al. Evaluating the Link Between Self-Reported Endometriosis and Female Sexual Dysfunction. J Sex Med 2022;19:1533-1561.
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Affiliation(s)
- Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale/Phoenix, AZ, USA; Mayo Clinic Women's Health, Rochester, MN, USA.
| | - Summer Ghaith
- Mayo Clinic Alix School of Medicine, Scottsdale/Phoenix, AZ, USA.
| | - Taryn Smith
- Mayo Clinic Women's Health, Rochester, MN, USA; Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ekta Kapoor
- Mayo Clinic Women's Health, Rochester, MN, USA; Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Megan Wasson
- Department of Medical and Surgical Gynecology, Mayo Clinic, Phoenix, AZ, USA
| | - Kristin Mara
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Felicity T Enders
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Stephanie Faubion
- Mayo Clinic Women's Health, Rochester, MN, USA; Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Carol Kuhle
- Mayo Clinic Women's Health, Rochester, MN, USA; Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Scheepers WFW, Maas JWM, van de Kar MMA. Bowel function and quality of life following surgery for deep endometriosis. J Psychosom Obstet Gynaecol 2022; 43:334-339. [PMID: 34309498 DOI: 10.1080/0167482x.2021.1952570] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To assess the influence of surgical approach, complications and patient characteristics and their postoperative functional outcomes on (sexual) quality of life (QoL) in patients with deep endometriosis (DE) with bowel involvement. METHODS Retrospective cohort study on patients surgically treated for DE in a Dutch tertiary referral hospital. Data are based on surgical records and questionnaires covering current postoperative bowel function and (sexual) QoL. RESULTS Postoperative functional score outcomes: constipation, fecal incontinence and Low Anterior Resection Syndrome (LARS) did not differ between patients treated with rectal shaving or segmental resection. Thirty percent of women treated with rectal shaving experienced LARS-like symptoms as well. Women who underwent segmental resection had a worse sexual QoL compared to patients managed by shaving. Patients who suffered from complications had a worse postoperative QoL. A higher postoperative constipation score was correlated with a significantly higher pain score and a lower overall and sexual QoL. LARS-score was correlated with a worsened sexual QoL. CONCLUSION Women who underwent surgery for deep endometriosis rated their overall QoL as lower when a complication occurred. Segmental resection resulted in a lower sexual QoL compared to shaving. We showed that a higher LARS-score correlates with a lower sexual QOL, and postoperative constipation with more pain and a lower overall and sexual QoL. Interestingly, after using the shaving technique one-third of the patients experienced LARS-like symptoms as well.
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Affiliation(s)
- Wessel F W Scheepers
- Máxima Medical Centre, Department of Obstetrics and Gynecology, Veldhoven, The Netherlands
| | - Jacques W M Maas
- Máxima Medical Centre, Department of Obstetrics and Gynecology, Veldhoven, The Netherlands
| | - Majorie M A van de Kar
- Máxima Medical Centre, Department of Obstetrics and Gynecology, Veldhoven, The Netherlands
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Maren S, Ariane G, Bettina B, Stephanie H, Magdalena G, Sabine R, Monika E, Kilian V, Bettina T, Thomas S, Tewes W, Beate D. Partners matter: The psychosocial well-being of couples when dealing with endometriosis. Health Qual Life Outcomes 2022; 20:86. [PMID: 35643578 PMCID: PMC9148469 DOI: 10.1186/s12955-022-01991-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endometriosis is often associated with severe dysmenorrhea, pelvic pain and dyspareunia and has a high impact on daily life as well as sexuality. Quality of partnership positively influences the course of various diseases and ability to cope with emotional and physical distress. However, studies focusing on the male partners of endometriosis patients are rare, and even less is known about the reciprocal relationship in these couples. Therefore, this study aims to explore the interrelations in couples with endometriosis in matters of psychological distress, sexual and partnership satisfaction and social support. METHODS The cross-sectional study was conducted in two university-affiliated fertility centres in Germany and Austria with n = 104 female/male couples affected by endometriosis. Participants completed a questionnaire regarding endometriosis, partnership, sexuality, stress, anxiety, depression and social support. Both women and men were asked about the impact of women's endometriosis-related pain (IEP) on their everyday life (e.g. leisure time). Data were analysed using the Actor-Partner-Interdependence Model. RESULTS Significant partner effects were evident: High depression, anxiety and stress scores in women were associated with a higher IEP in men (all p ≤ 0.01), reciprocally high stress and depression scores in men were correlated with a higher IEP in women (all p ≤ 0.05). Less sexual satisfaction in women was associated with a higher IEP in men (p = 0.040). There was a significant reciprocal association between the perceived lack of understanding from the social environment and a higher IEP, for both women (p = 0.022) and men (p = 0.027). CONCLUSIONS The male partner should be taken into account when counselling or treating women with endometriosis. Our study shows a high interdependence and reciprocal influence from both partners-positively and negatively-concerning psychological distress and sexual satisfaction. Furthermore, there ought to be more awareness for the psychosocial impact of endometriosis, especially in regard to social support and understanding. Talking about and improving sexual satisfaction as well as enhancing stress reducing techniques may hold great benefits for dealing with endometriosis. Registration number The study is registered with the German Clinical Trials Register (DRKS), number DRKS00014362.
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Affiliation(s)
- Schick Maren
- Institute of Medical Psychology, Heidelberg University Hospital, Ruprecht-Karls University, Heidelberg, Bergheimer Str. 20, 69115 Heidelberg, Germany
| | - Germeyer Ariane
- Department of Gynecological Endocrinology and Fertility Disorders, University Women’s Hospital Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Böttcher Bettina
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Hecht Stephanie
- Department of Gynecological Endocrinology and Fertility Disorders, University Women’s Hospital Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Geiser Magdalena
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Rösner Sabine
- Department of Gynecological Endocrinology and Fertility Disorders, University Women’s Hospital Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Eckstein Monika
- Institute of Medical Psychology, Heidelberg University Hospital, Ruprecht-Karls University, Heidelberg, Bergheimer Str. 20, 69115 Heidelberg, Germany
| | - Vomstein Kilian
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Toth Bettina
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Strowitzki Thomas
- Department of Gynecological Endocrinology and Fertility Disorders, University Women’s Hospital Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Wischmann Tewes
- Institute of Medical Psychology, Heidelberg University Hospital, Ruprecht-Karls University, Heidelberg, Bergheimer Str. 20, 69115 Heidelberg, Germany
| | - Ditzen Beate
- Institute of Medical Psychology, Heidelberg University Hospital, Ruprecht-Karls University, Heidelberg, Bergheimer Str. 20, 69115 Heidelberg, Germany
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8
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Rossi V, Galizia R, Tripodi F, Simonelli C, Porpora MG, Nimbi FM. Endometriosis and Sexual Functioning: How Much Do Cognitive and Psycho-Emotional Factors Matter? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095319. [PMID: 35564711 PMCID: PMC9100036 DOI: 10.3390/ijerph19095319] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 12/02/2022]
Abstract
Women with endometriosis often suffer from genito-pelvic pain. The objective of the present study was to analyze the relationship between cognitive and psycho-emotional factors and sexual functioning of women with endometriosis, comparing women with and without endometriosis. A total of 87 women with endometriosis (EG) and 100 women without endometriosis (CG) completed a socio-demographic questionnaire; the short-form of McGill Pain Questionnaire (SF-MPQ); the Female Sexual Functioning Index (FSFI); the Sexual Distress Scale (SDS); the Symptoms Checklist (SCL-90-R); the Toronto Alexithymia Scale (TAS-20); the Positive and Negative Affects Scale (PANAS); the Sexual Dysfunctional Belief Questionnaire (SDBQ); the Sexual Modes Questionnaire (SMQ); and the Questionnaire of Cognitive Schema Activation in Sexual Context (QCSASC). EG obtained worse scores than CG in SF-MPQ, Pain subscale of FSFI, and SDS. EG reached higher scores than CG on almost all scales of SCL-90-R and lower scores in the “Identifying Feelings” scale of TAS-20. Furthermore, EG reported more negative emotions toward sexuality than CG (PANAS) higher scores on the “Affection Primacy” scale of SDBQ and the “Helpless” sexual cognitive schema of QCSASC than CG. No significant differences were found in SMQ. Sexual health professionals should address psychological, emotional, and cognitive factors since they seem involved in patients’ sexual experiences.
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Affiliation(s)
- Valentina Rossi
- Institute of Clinical Sexology, 00198 Rome, Italy;
- Correspondence: ; Tel.: +39-3480324419
| | - Roberta Galizia
- Department of Dynamic, Clinical and Health Psychology, “Sapienza” University, 00185 Rome, Italy; (R.G.); (C.S.); (F.M.N.)
| | | | - Chiara Simonelli
- Department of Dynamic, Clinical and Health Psychology, “Sapienza” University, 00185 Rome, Italy; (R.G.); (C.S.); (F.M.N.)
| | - Maria Grazia Porpora
- Department of Maternal and Child Health and Urology, “Sapienza” University, 00161 Rome, Italy;
| | - Filippo Maria Nimbi
- Department of Dynamic, Clinical and Health Psychology, “Sapienza” University, 00185 Rome, Italy; (R.G.); (C.S.); (F.M.N.)
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9
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Buggio L, Barbara G, Facchin F, Ghezzi L, Dridi D, Vercellini P. The influence of hormonal contraception on depression and female sexuality: a narrative review of the literature. Gynecol Endocrinol 2022; 38:193-201. [PMID: 34913798 DOI: 10.1080/09513590.2021.2016693] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Over the past decades, an increasing number of women have been using hormonal contraception. The potential role of sex hormones in regulating vegetative, psychophysiological, and cognitive functions has been highlighted in several studies, and there is a need to further understand the impact of hormonal contraception on women's quality of life, especially as regards psychological health and sexuality. METHODS We conducted a narrative review aimed at clarifying the mechanisms involved in the interaction between sex hormones and the brain, also focusing on the association between hormonal contraception and mood and sexual function. RESULTS Our findings clarified that hormonal contraception may be associated with depressive symptoms, especially among adolescents, and with sexual dysfunction. However, the evidence included in this review was conflicting and did not support the hypothesis that hormonal contraception directly causes depressive symptoms, major depressive disorder, or sexual dysfunction. CONCLUSIONS The optimal hormonal contraception should be identified in the context of shared decision making, considering the preferences and needs of each woman, as well as her physical and psychosexual conditions.
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Affiliation(s)
- Laura Buggio
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giussy Barbara
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- SVSeD, Service for Sexual and Domestic Violence and Obstetric and Gynecology Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
| | - Federica Facchin
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Laura Ghezzi
- Department of Neurology, Washington University, St. Louis, MO, USA
- Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy
| | - Dhouha Dridi
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
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10
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Leuenberger J, Kohl Schwartz A, Geraedts K, Haeberlin F, Eberhard M, von Orelli S, Imesch P, Leeners B. Living with endometriosis: Comorbid pain disorders, characteristics of pain, and relevance for daily life. Eur J Pain 2022; 26:1021-1038. [PMID: 35184363 PMCID: PMC9306988 DOI: 10.1002/ejp.1926] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Methods Results Conclusions Significance
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Affiliation(s)
- J. Leuenberger
- University Hospital Zurich Department of Reproductive Endocrinology Frauenklinik‐strasse 10 8910 Zurich Switzerland
| | - A.S. Kohl Schwartz
- University Hospital Zurich Department of Reproductive Endocrinology Frauenklinik‐strasse 10 8910 Zurich Switzerland
| | - K. Geraedts
- University Hospital Zurich Department of Reproductive Endocrinology Frauenklinik‐strasse 10 8910 Zurich Switzerland
| | - F. Haeberlin
- Cantonal Hospital St Gallen, Department of Gynecology and Obstetrics, St. Gallen, Rorschacherstrasse 501 9007 St. Gallen Switzerland
| | - M. Eberhard
- Cantonal Hospital Schaffhausen Department of Gynecology and Obstetrics Geissbergstrasse 81 8208 Schaffhausen Switzerland
| | - S. von Orelli
- Triemli Hospital Department of Gynecology and Obstetrics Birmensdorferstrasse 497 8063 Zürich Switzerland
| | - P. Imesch
- University Hospital Zurich Department of Gynecology Frauenklinikstrasse 10 8910 Zurich Switzerland
| | - B. Leeners
- University Hospital Zurich Department of Reproductive Endocrinology Frauenklinik‐strasse 10 8910 Zurich Switzerland
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11
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Dior UP, Reddington C, Cheng C, Levin G, Healey M. Sexual Function of Women With Deep Endometriosis Before and After Surgery: A Prospective Study. J Sex Med 2022; 19:280-289. [PMID: 34930708 DOI: 10.1016/j.jsxm.2021.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Deep endometriosis (DE) may significantly affect women's quality of life. Limited data exists on the effect of surgery on the several domains of sexual function. AIM To prospectively compare various domains of sexual function before and after laparoscopic surgery for DE. METHODS A prospective observational cohort study in a tertiary university-affiliated referral center. Patients with suspected DE who were planned to undergo laparoscopic surgery completed the Female Sexual Function Index questionnaire before surgery. The same questionnaire was completed by the participants 6 weeks, 6 months, and 12 months after surgery. Rate of sexual dysfunction over time was compared using multilevel logistic regression. Summary scores were then compared at each time point to the corresponding score before surgery using multilevel linear regression. Multivariable analysis was performed of potential confounders. OUTCOMES Change in desire, arousal, orgasm, lubrication, satisfaction and pain summary scores as well as in the full-scale score between before and after surgery. RESULTS We followed 149 patients with surgically confirmed DE. Sexual dysfunction rate as per the full-scale score was 75.5% before surgery and remained over 60% to 12 months after. The full-scale sexual function score improved at 6 (change in score = 2.8 ± 9.5, P = .004) and 12 months (change in score = 2.1 ± 9.9, P = .03). None of the summary scores improved at 6 weeks. Desire score (P < .001), arousal score (P = .02), and pain score (P = .01) improved at 6 months. Desire score (P = .03) and pain score (P = .01) also improved at 12 months, as compared to before surgery. On multivariable multilevel analysis, scores before surgery significantly contributed to the scores after surgery (P < .001). CLINICAL TRANSLATION While sexual function improved after surgery, dysfunction rate remained substantial. Proper preoperative counseling should address sexual function measures and clinical and research attention should be given to seek ways to further reduce sexual dysfunction. STRENGTHS AND LIMITATIONS The main strengths of our study are the prospective design, the relatively long follow-up and the use of a detailed validated questionnaire allowing assessment of a large variety of clinically relevant sexual function domains and scores as well as a full-scale score. Among our limitations are the lower response rate at 12 months and the limited generalizability as this is a single center study. CONCLUSION Sexual function is a major and often under reported domain of quality of life. Further research is needed to identify the specific populations who may improve, not change or experience deterioration in their sexual functioning after surgery. Dior UP, Reddington C, Cheng C, et al. Sexual Function of Women With Deep Endometriosis Before and After Surgery: A Prospective Study. J Sex Med 2022;19:280-289.
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Affiliation(s)
- Uri P Dior
- Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital, Parkville, Victoria, Australia; Endometriosis Centre, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.
| | - Charlotte Reddington
- Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Claudia Cheng
- Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital, Parkville, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Gabriel Levin
- Endometriosis Centre, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Martin Healey
- Gynaecology Endometriosis and Pelvic Pain Unit, The Royal Women's Hospital, Parkville, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
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González-Mesa E, Moya-Bejarano D, Butrón-Hinojo CA, Marín-Sánchez P, Blasco-Alonso M, Jimenez-López JS, Villegas-Muñoz E, Lubián-López DM. Correlates of Sexual Function in a Sample of Spanish Women with Endometriosis. J Clin Med 2021; 10:4957. [PMID: 34768476 PMCID: PMC8584302 DOI: 10.3390/jcm10214957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/10/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In the present study, we aim to report on the sexual function of women experiencing symptoms of endometriosis, analysing the clinical and psychosocial factors that may be associated. METHODS A multicentre cross-sectional study was performed to analyse the sexual function in a sample of 196 Spanish women with endometriosis, using the Female Sexual Function Inventory. RESULTS The Female Sexual Function Inventory (FSFI) was validated in our endometriosis study group. The mean FSFI score for the sample was 22.5 (SD 6.6), with 20.9 and 26.9 being in the 25th and 75th percentiles, respectively. Although physical sexual pain and dyspareunia were factors that influenced the sexual function of women with endometriosis, our results show that the impairment was multifactorial. CONCLUSIONS We found impaired sexual function in women diagnosed with endometriosis. The final model included deep endometriosis, depression, age, and unemployment as strongest predictive factors for poor (deteriorated) sexual function.
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Affiliation(s)
- Ernesto González-Mesa
- Department of Obstetrics and Gynecology, School of Medicine, University of Malaga, 29071 Málaga, Spain
- Department of Obstetrics and Gynecology, Regional University Hospital of Málaga, 29011 Málaga, Spain; (M.B.-A.); (J.S.J.-L.); (E.V.-M.)
| | - Davinia Moya-Bejarano
- Department of Obstetrics and Gynecology, Regional University Hospital of Málaga, 29011 Málaga, Spain; (M.B.-A.); (J.S.J.-L.); (E.V.-M.)
| | | | - Pilar Marín-Sánchez
- Department of Obstetrics and Gynecology, University Hospital Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Marta Blasco-Alonso
- Department of Obstetrics and Gynecology, Regional University Hospital of Málaga, 29011 Málaga, Spain; (M.B.-A.); (J.S.J.-L.); (E.V.-M.)
| | - Jesús Salvador Jimenez-López
- Department of Obstetrics and Gynecology, Regional University Hospital of Málaga, 29011 Málaga, Spain; (M.B.-A.); (J.S.J.-L.); (E.V.-M.)
| | - Emilia Villegas-Muñoz
- Department of Obstetrics and Gynecology, Regional University Hospital of Málaga, 29011 Málaga, Spain; (M.B.-A.); (J.S.J.-L.); (E.V.-M.)
| | - Daniel María Lubián-López
- Department of Obstetrics and Gynecology, University Hospital of Jerez de la Frontera, 11407 Cádiz, Spain;
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13
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Barbara G, Buggio L, Facchin F, Vercellini P. Medical Treatment for Endometriosis: Tolerability, Quality of Life and Adherence. Front Glob Womens Health 2021; 2:729601. [PMID: 34816243 PMCID: PMC8594049 DOI: 10.3389/fgwh.2021.729601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/01/2021] [Indexed: 11/21/2022] Open
Abstract
Endometriosis is associated with painful symptoms, infertility, sexological difficulties, and psychological suffering. All these symptoms have a negative impact on the overall quality of life of women with the disease, with significant personal, social and economic costs. Several medical options are available to manage symptomatic endometriosis. The pharmacological treatment for endometriosis-related pain may be necessary for decades, or at least until there is a desire for pregnancy or physiologic menopause occurs. In this perspective, clinicians should consider not only the efficacy, but also side effects, tolerability, and costs, along with women's preferences toward different treatments. In this mini-review, we analyzed the pros and cons of the available drugs for the medical therapy of endometriosis, such as estrogen-progestins, progestins, GnRH agonist and GnRH antagonists.
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Affiliation(s)
- Giussy Barbara
- Obstetric and Gynaecologic Emergency Department and SVSeD (Service for Sexual and Domestic Violence), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Laura Buggio
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Facchin
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Paolo Vercellini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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14
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Schmitt C, Mézan deMalartic C, Morel O, Ramseyer F. L’évaluation de la santé sexuelle des femmes porteuses d’endométriose. SEXOLOGIES 2021. [DOI: 10.1016/j.sexol.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Stigma and Endometriosis: A Brief Overview and Recommendations to Improve Psychosocial Well-Being and Diagnostic Delay. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158210. [PMID: 34360501 PMCID: PMC8346066 DOI: 10.3390/ijerph18158210] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 02/07/2023]
Abstract
Endometriosis is a chronic gynecological disease that affects approximately 1 in 10 women of reproductive age. Symptoms of severe pelvic pain, infertility, fatigue, and abnormal menstruation can cause significant negative effects on an individual’s physical and mental health, including interactions with their family, friends, and health care providers. Stigma associated with endometriosis has been under-studied and is rarely discussed in current literature. Herein, this paper aims to provide a brief overview of published literature to explore and establish the plausibility of stigma as a driver of suboptimal psychosocial well-being and diagnostic delay among individuals living with endometriosis. We present the clinical characteristics and physical and mental health consequences associated with endometriosis, highlight several theoretical constructs of stigma, and review the limited studies documenting women’s lived experiences of endometriosis-related stigma. To mitigate harmful effects of this phenomenon, we recommend increasing efforts to assess the prevalence of and to characterize endometriosis-related stigma, implementing awareness campaigns, and developing interventions that combat the multidimensional negative effects of stigma on timely care, treatment, and quality of life for individuals living with endometriosis.
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16
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As-Sanie S, Laufer MR, Missmer SA, Murji A, Vincent K, Eichner S, Cross S, Soliman AM, Tu F. Development of a visual, patient-reported tool for assessing the multi-dimensional burden of endometriosis. Curr Med Res Opin 2021; 37:1443-1449. [PMID: 34008451 DOI: 10.1080/03007995.2021.1929896] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Inadequate communication about endometriosis symptom burden between women and healthcare providers is a barrier for optimal treatment. This study describes the development of the EndoWheel, a patient-reported assessment tool that visualizes the multi-dimensional burden of endometriosis to facilitate patient-provider communication. METHODS Assessment questions for the tool were developed using an iterative Delphi consensus process. A consensus phase included additional practitioners and specialists to broaden perspectives and select revised statements. Semi-structured qualitative interviews were conducted with 13 women with endometriosis to assess the scoring and content of the measures. RESULTS Symptoms included in the tool were pelvic pain, vaginal bleeding, bowel/bladder symptoms, energy levels, fertility, impact on activities, emotional and sexual well-being, and self-perceived global health. Additional life impact areas included relationships, social and occupational activity, and self-perception. The 13 interviewees completed the tool in approximately 5-6 min (range 4.0-7.5 min). Most participants (92%) perceived that the tool would enable better patient-provider communication, including addressing symptoms and areas of impact not normally discussed during office visits. CONCLUSION Similar to visual circular tools used in burden assessment of other chronic diseases, the tool may facilitate improved patient dialogue with providers around endometriosis treatment goals and options.
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Affiliation(s)
- Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Marc R Laufer
- Boston Center for Endometriosis, Boston Children's and Brigham and Women's Hospitals, Boston, MA, USA
- Division of Gynecology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stacey A Missmer
- Boston Center for Endometriosis, Boston Children's and Brigham and Women's Hospitals, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA
| | - Ally Murji
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | | | | | | | - Frank Tu
- Department of Obstetrics and Gynecology, NorthShore University Health System & Pritzker School of Medicine University of Chicago, Evanston, IL, USA
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17
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Martins J, Ferreira G, Vilaça M, Ferreira H, Osório F, Nogueira-Silva C, Pereira M. Quality of life and sexual satisfaction in women with endometriosis: the moderator role of symptom severity. PSYCHOLOGY & SEXUALITY 2021. [DOI: 10.1080/19419899.2021.1943501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- J. Martins
- School of Psychology, University of Minho, Braga, Portugal
| | - G. Ferreira
- School of Psychology, University of Minho, Braga, Portugal
| | - M. Vilaça
- Psychology Research Center (Cipsi), School of Psychology, University of Minho, Braga, Portugal
| | - H. Ferreira
- Department of Gynecology, Centro Materno-Infantil Do Norte, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| | - F. Osório
- Departament of Gynecology and Obstetrics, Hospital Da Luz, Lisboa, Portugal, Departament of Obstetrics, Gynecology and Reproduction Medicine, Hospital Santa Maria, Lisboa, Portugal
| | - C. Nogueira-Silva
- Braga, Portugal and Department of Obstetrics and Gynaecology, Life and Health Sciences Research Institute /3b’s - PT Government Associate Laboratory, Hospital De Braga, Braga, Portugal
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18
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Long-term Follow-up of Sexual Quality of Life after Laparoscopic Surgery in Patients with Deep Infiltrating Endometriosis. J Minim Invasive Gynecol 2021; 28:1912-1919. [PMID: 33984510 DOI: 10.1016/j.jmig.2021.04.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/31/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE We performed a long-term follow-up to quantify the impairment of sexual quality of life (SQL) and health-related QL (HRQL) in sexually active women after laparoscopic excision of deep infiltrating endometriosis (DIE). DESIGN Prospective case-control study. SETTING Hospital Clinic of Barcelona. PATIENTS A total of 193 patients (after dropout and exclusions) were divided into 2 groups: one hundred twenty-nine premenopausal women with DIE (DIE group) and 64 healthy women who underwent tubal ligation (C group). INTERVENTIONS All patients underwent laparoscopic surgery: laparoscopic endometriosis surgery in the DIE group and laparoscopic tubal ligation in the C group. All women were followed for at least 36 months, and they completed the Medical Outcomes Study 36-item short form questionnaire to assess their HRQL and 3 self-administered questionnaires that evaluate different aspects of SQL: the generic Sexual Quality of Life-Female questionnaire, the Female Sexual Distress Scale to evaluate "sexually related distress," and the Brief Profile of Female Sexual Function to screen hypoactive sexual desire disorder. The patients with DIE as well as the controls completed the 4 questionnaires before surgery, and the patients with DIE also completed the questionnaires at 6 and 36 months after surgery. MEASUREMENTS AND MAIN RESULTS A comparison of the patients and controls before surgery showed a statistically significant impairment in SQL and HRQL among the patients with DIE. A statistically significant improvement in SQL and HRQL was observed in the DIE group 6 months after surgery, with scores being similar to those of the C group. An evaluation 36 months after surgery showed that SQL and HRQL were better than presurgical SQL and HRQL in the DIE group, with a slight reduction compared with the 6-month evaluation. CONCLUSION SQL and HRQL improved in patients with DIE undergoing complete laparoscopic endometriosis resection and were comparable to those of healthy women at 6 months after surgery, showing a slight reduction at 36 months of follow-up.
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19
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Rossi V, Tripodi F, Simonelli C, Galizia R, Nimbi FM. Endometriosis-associated pain: a review of quality of life, sexual health and couple relationship. Minerva Obstet Gynecol 2021; 73:536-552. [PMID: 33904688 DOI: 10.23736/s2724-606x.21.04781-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Endometriosis is a chronic gynecological disease that affects women's quality of life, sexuality, and relationship. Endometriosis-associated pain plays an essential role in well-being impairment. The present review aimed to analyze literature about endometriosis-associated pain and quality of life, sexual health, and quality of the relationship, assessing the role of the biopsychosocial factors involved and the women's pain experience. EVIDENCE ACQUISITION Bibliographic research of relevant articles published from 2015 to 2020 in PubMed, Google Scholar, Web of Science, Scopus, EBSCO, and Cochrane Library. EVIDENCE SYNTHESIS Endometriosis is associated with impairing all women's quality of life domains, and pain appears to be the most influential variable. The pain mechanism is not simple and implies several biological, psychological, and social factors. Women's sexual health is also impaired, and patients report dyspareunia, sexual dysfunctions, dissatisfaction, and distress. Partners' sexual well being is compromised as well. Endometriosis negatively influences relationship quality, and the illness burden affects both couple members. CONCLUSIONS A multidisciplinary team using a couple-centered and a biopsychosocial approach is crucial to provide appropriate treatment for endometriosis-associated pain. A better comprehension of all bio-psycho-social aspects implicated in women's well-being and pain experience needs more research.
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Affiliation(s)
| | | | - Chiara Simonelli
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Roberta Galizia
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Filippo M Nimbi
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
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20
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Namazi M, Behboodi Moghadam Z, Zareiyan A, Jafarabadi M. Impact of endometriosis on reproductive health: an integrative review. J OBSTET GYNAECOL 2021; 41:1183-1191. [PMID: 33645413 DOI: 10.1080/01443615.2020.1862772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Endometriosis is a debilitating chronic disease that affects 10% of the general female population, with a frequency of 38% in infertile women. This review aims to provide an overview of the impact of endometriosis on different aspects of reproductive health. A literature search was performed in four international databases, including PubMed, Science Direct, Scopus, and Google scholar, from January 1995 to December 2019 to identify the potentially relevant articles. We included all relevant articles published in English and identified 46 studies on health issues in women with endometriosis. The research suggests that women with endometriosis are at risk for physical, psychosocial, social, and sexual disturbances and obstetrical complications. More research is needed to clarify better understanding of endometriosis complications specifically obstetrical consequences.
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Affiliation(s)
- Masoumeh Namazi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Armin Zareiyan
- Public Health Department, Nursing Faculty, Aja University of Medical Sciences, Tehran, Iran
| | - Mina Jafarabadi
- Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
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21
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Namazi M, Behboodi Moghadam Z, Zareiyan A, Jafarabadi M. Exploring the impact of endometriosis on women's lives: A qualitative study in Iran. Nurs Open 2020; 8:1275-1282. [PMID: 33354928 PMCID: PMC8046092 DOI: 10.1002/nop2.744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 11/12/2022] Open
Abstract
Aim Considering the wide impact of endometriosis on various aspects of health, this study aimed to explore the impact of endometriosis on Iranian women's lives. Design The present study used a qualitative approach and conventional content analysis. Methods Twenty patients suffering from endometriosis referring to Imam Khomeini Hospital in Tehran took part in this study. The sampling was done purposefully until data saturation. After deep semi‐structured interviews, the content analysis of the interviews was done according to the steps proposed by Zhang and Wildemuth. Results The mean age of the participants was 34.53 (SD: 5.81) years (range: 23–43) with duration of illness of 6.30 ± 5.86 years. Their educational level varied from high school to university, and most of them were employed. Analysis of the data from participants' experiences led to the formation of 5 categories under the titles "Physical suffering, instability of marital life, mental disorder, disruption in social life and self‐care" and 11 subcategories. Conclusion The findings of the present study showed that endometriosis can adversely affect women's lives including physical, sexual, psychological and social problems. Although in some cases patients adopt different strategies for self‐care, the need for more support is felt.
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Affiliation(s)
- Masoumeh Namazi
- School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Armin Zareiyan
- Public Health Department, Nursing Faculty, Aja University of Medical Sciences, Tehran, Iran
| | - Mina Jafarabadi
- Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran
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22
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Pérez-López FR, Ornat L, Pérez-Roncero GR, López-Baena MT, Sánchez-Prieto M, Chedraui P. The effect of endometriosis on sexual function as assessed with the Female Sexual Function Index: systematic review and meta-analysis. Gynecol Endocrinol 2020; 36:1015-1023. [PMID: 32880200 DOI: 10.1080/09513590.2020.1812570] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIM To systematically compare sexual function between non-treated women with and without endometriosis. METHODS A systematic review was performed on PubMed/Medline, Scopus, EMBASE, Web of Science and Cochrane Library databases searching studies that analyzed sexual function (assessed with the 19-item Female Sexual Function Index [FSFI]), and dyspareunia, chronic pelvic pain and dysmenorrhea (assessed with a visual analogue scale [VAS]) in women with and with endometriosis. RESULTS In 4 studies, non-treated women with endometriosis presented a higher risk of female sexual dysfunction (mean total FSFI score ≤ 26.55; OR = 2.38; 95% confidence interval [CI] = 1.12, 5.04). Although mean total FSFI scores were not significantly different between women with and without endometriosis (mean difference [MD] = -2.15; 95% CI -4.96, 0.67); all FSFI domain scores were significantly lower in women with endometriosis (n = 4 studies): desire (MD = -0.43; 95% CI -0.57, -0.19); arousal (MD = -0.66; 95% CI -1.15, -0.17); lubrication (MD = -0.41; 95% CI -0.79, -0.02); orgasm (MD = -0.40; 95% CI -0.73, -0.06); satisfaction (MD = -0.45; 95% CI -0.72, -0.18); and pain (MD = -1.03; 95% CI -1.34, -0.72). Women with endometriosis displayed differences (more severity) in terms of VAS scores (2 studies) for dyspareunia (MD = 1.88; 95% CI 0.38, 3.37) and chronic pelvic pain (MD = 2.92; 95% CI 1.26, 4.58); but not for dysmenorrhea. CONCLUSION Non-treated women with endometriosis displayed altered sexual function as evidenced by lower scores in all FSFI domains, and severity of dyspareunia and chronic pelvic pain.
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Affiliation(s)
- Faustino R Pérez-López
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine, Zaragoza, Spain
| | - Lía Ornat
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine, Zaragoza, Spain
| | | | | | - Manuel Sánchez-Prieto
- Departament of Obstetrics and Gynecology, Instituto Universitario Dexeus, Barcelona, Spain
| | - Peter Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
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Oppenheimer A, Verdun S, Perot M, Du Cheyron J, Panel P, Fauconnier A. Do high-dose progestins impair sexual function in women treated for endometriosis? A prospective observational longitudinal study. Acta Obstet Gynecol Scand 2020; 100:850-859. [PMID: 33011982 DOI: 10.1111/aogs.14014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/30/2020] [Accepted: 09/27/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION High-dose progestins are used as an effective therapy for painful symptoms of endometriosis but their impact on sexual function has been poorly studied. The study aims to assess the impact of high-dose progestin on sexual function among women treated for endometriosis. MATERIAL AND METHODS In this bicenter prospective observational study, women with endometriosis who received medical or surgical treatment for endometriosis and who were sexually active were included. They completed the Sexual Activity Questionnaire (SAQ, a validated tool) before (T0) and 12 months after (T1) endometriosis treatment. We classified patients into two groups according to whether they were using high-dose progestins at T1: a high-dose progestin group and a control group. The main outcome was sexual function measured by the SAQ score (from 0 to 30) at T1. The secondary outcomes were each individual SAQ item, the dyspareunia 100-mm visual analog scale (VAS) and the quality of life assessed with EuroQoL Group 5D Index (EQ-5D) at T1. We also assessed the change in dyspareunia VAS and quality of life between T0 and T1. The Ethics Committee of Ile-de-France (Act 2004-806, 9 August 2004) approved the study. RESULTS Among 214 women included, 25 (12%) were exposed to high-dose progestins at T1. The SAQ score of women exposed to high-dose progestins was significantly lower compared with the control group, with or without adjustment for covariates (15.5 ± 6.3 vs 18.3 ± 6.2, P = .03, adjusted effect size -0.44 [95% CI -0.86 to -0.02], P = .04). High-dose progestin intake at T1 was associated with a lower subscore on two SAQ items: pleasure (1.8 ± 0.8 vs 2.2 ± 0.9, P = .02), and satisfaction with frequency of intercourse (1.2 ± 1.2 vs 1.8 ± 1.1, P = .02). In the overall population, dyspareunia VAS and quality of life assessed by EQ-5D improved between T0 and T1 (45 ± 29 at T0 vs 28 ± 29 at T1, P < .001; 0.78 ± 0.14 at T0 vs 0.86 ± 0.14 at T1, P < .001, respectively). At T1, the groups did not differ significantly for dyspareunia VAS (effect size 0.36 [95% CI -0.06 to 0.78], P = .10) and quality of life (EQ-5D, effect size 0.02 [95% CI -0.40 to 0.44], P = .91). CONCLUSION In this observational study, high-dose progestins impair the sexual function of women treated for endometriosis even though they improved dyspareunia.
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Affiliation(s)
- Anne Oppenheimer
- EA 7285 Research Unit 'Risk and Safety in Clinical Medicine for Women and Perinatal Health', Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France.,Department of Reproductive Medicine and Fertility Preservation, Hôpital universitaire Antoine Béclère, Clamart, France
| | - Stéphane Verdun
- Biostatistics Department-Delegations for Clinical Research and Innovation, Lille Catholic Hospitals, Lille Catholic University, Lille, France
| | - Mathilde Perot
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Joseph Du Cheyron
- Clinical Research Department, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France
| | - Pierre Panel
- Department of Gynecology and Obstetrics, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Arnaud Fauconnier
- EA 7285 Research Unit 'Risk and Safety in Clinical Medicine for Women and Perinatal Health', Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France.,Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France
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van Poll M, van Barneveld E, Aerts L, Maas JWM, Lim AC, de Greef BTA, Bongers MY, van Hanegem N. Endometriosis and Sexual Quality of Life. Sex Med 2020; 8:532-544. [PMID: 32712127 PMCID: PMC7471125 DOI: 10.1016/j.esxm.2020.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Endometriosis is a benign gynecological disease with a high disease burden and significant, multifaceted impact on health-related quality of life (HRQoL) and sexual quality of life (SQoL). Aim To explore which patient- and disease-specific characteristics were independently associated with SQoL. Methods A literature search was carried out to identify characteristics with an evidence-based or hypothesized effect on SQoL. Subsequently, data on HRQoL in women with endometriosis (n = 224), collected between 2013 and 2018 in a prospective longitudinal Dutch cohort study performed in 7 referral centers, were used to perform a cross-sectional cohort study. Data were collected using an online self-administered survey including the validated Endometriosis Health Profile-30. Inclusion criteria were recently diagnosed endometriosis patients or newly referred patients with a clinical diagnosis of endometriosis. Patients were excluded in case of incomplete answers on the SQoL questions. Univariate analyses and multiple linear regression analyses were performed. Outcomes SQoL, measured by the 5-item “sexual intercourse” dimension score of the modular Endometriosis Health Profile-30 questionnaire, was the primary outcome with scores ranging from 0 to 100 (0 indicating the best and 100 indicating the worst health status). Results Based on a literature search, 29 characteristics potentially associated with SQoL were selected from the survey and included in the analyses. In total, 192 women (mean age 36 years) met the inclusion criteria. The majority of women (86.5%) had had intercourse in the period before completing the survey and the study population showed a mean SQoL score of 47.5 ± 29.6, indicating moderate SQoL. Worse SQoL was independently associated with dyspareunia (P < .001), worse HRQoL (P = .001), severity of dysmenorrhea (P = .017), and unemployed work status (P = .022). Conclusion In a cohort of women with endometriosis, worse SQoL was significantly and independently associated with the presence of dyspareunia, more severe dysmenorrhea, worse HRQoL, and unemployed work status. van Poll M, van Barneveld E, Aerts L, et al. Endometriosis and Sexual Quality of Life. Sex Med 2020;8:532–544.
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Affiliation(s)
- Mikal van Poll
- Department of Obstetrics and Gynaecology, Endometriosis Team, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Esther van Barneveld
- Department of Obstetrics and Gynaecology, Endometriosis Team, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Luca Aerts
- Department of Obstetrics and Gynaecology, Endometriosis Team, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jacques W M Maas
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Arianne C Lim
- Department of Obstetrics and Gynaecology, Endometriosis Team, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Bianca T A de Greef
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marlies Y Bongers
- Department of Obstetrics and Gynaecology, Endometriosis Team, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Nehalennia van Hanegem
- Department of Obstetrics and Gynaecology, Endometriosis Team, Maastricht University Medical Centre, Maastricht, the Netherlands
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25
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Namazi M, Zareiyan A, Jafarabadi M, Behboodi Moghadam Z. Endometriosis reproductive health questionnaire (ERHQ): A self-administered questionnaire to measure the reproductive health in women with endometriosis. J Gynecol Obstet Hum Reprod 2020; 50:101860. [PMID: 32652304 DOI: 10.1016/j.jogoh.2020.101860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/25/2020] [Accepted: 07/01/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Endometriosis is a disabling disease impacting on different aspects of reproductive health. The present study aims to develop and evaluate the psychometric properties of a questionnaire to measure the reproductive health in women with endometriosis. MATERIAL AND METHODS This study used an exploratory mixed-methods design and included three phases. In the first phase, a sample of 20 women with endometriosis participated in semi-structured interviews. In the second phase, item pools were generated. In the third phase, face validity, content validity, and construct validity were assessed. To estimate the reliability of the tool internal consistency and test-retest methods were used. RESULTS sixty items were included in the psychometric evaluation stage of the scale. After the assessment of the content validity ratio (CVR), content validity index (CVI), and exploratory factor analysis, 15 items were omitted, leaving 35 items in the final scale. The exploratory factor analysis revealed four factors: physical problems, psychological problems, counteracting strategies, and instability of marital life. The reliability, according to Cronbach's alpha was 0.809, and the external reliability, as evaluated by the test-retest method and the intraclass correlation, was 0.825. CONCLUSION ERHQ is a new, valid, and reliable patient-generated instrument to measure the reproductive health in women with endometriosis. It can be used by researchers and health providers to provide a better understanding of the impact of endometriosis on different aspects of reproductive health over time and to meet the needs of patients living with this condition.
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Affiliation(s)
- Masoumeh Namazi
- School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Armin Zareiyan
- Public Health Department, Nursing Faculty, Aja University of Medical Sciences, Tehran, Iran.
| | - Mina Jafarabadi
- Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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26
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Oppenheimer A, Panel P, Rouquette A, du Cheyron J, Deffieux X, Fauconnier A. Validation of the Sexual Activity Questionnaire in women with endometriosis. Hum Reprod 2020; 34:824-833. [PMID: 30989214 DOI: 10.1093/humrep/dez037] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/12/2019] [Accepted: 02/23/2019] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Is the Sexual Activity Questionnaire (SAQ) a valid tool for patients treated for symptomatic endometriosis? SUMMARY ANSWER For women having surgical treatment for endometriosis, we determined that the SAQ is a valid and responsive tool. WHAT IS KNOWN ALREADY Endometriosis adversely affects sexual quality of life. Suitable validated sexual quality of life instruments for endometriosis are lacking both in clinical practice and for research. STUDY, DESIGN, SIZE, DURATION A total of 367 women with proven endometriosis undergoing medical or surgical treatment were included in an observational study conducted between 1 January 2012 and 31 December 2014 in two French tertiary care centers. Both hospitals are reference centers for endometriosis treatment. Of these 367 women, 267 were sexually active and constituted the baseline population. PARTICPANTS/MATERIALS, SETTINGS, METHODS Women >18 years old with histological or radiological proven endometriosis, consulting for painful symptoms of at least 3 months duration, infertility, or other symptoms (bleeding, cysts) were invited to complete self-administered questionnaires before (T0) and 12 months after treatment (T1). Tests of data quality included descriptive statistics of the data, missing data levels, floor and ceiling effects, structural validity and internal consistency.The construct validity was obtained by testing presupposed relationships between previously established SAQ scores and prespecified characteristics of the patients by comparing different subgroups of patients at T0. Sensitivity to change was subsequently calculated by comparing the SAQ score between T1 and T0 overall and for different subgroups of treatment. Effect sizes (to T1) were calculated according to Cohen's method. The minimally important difference was estimated by a step-wise triangulation approach (including anchor-based method). MAIN RESULTS AND THE ROLE OF CHANCE In total, 267 sexually active patients (204 surgical and 63 medical treatment) completed the SAQ at T0 and 136 (50.9%) at T1. The SAQ score ranged from 2.0 to 28.0 (mean ± SD: 16.8 ± 5.7).The SAQ score was one-dimensional according to the scree plot with good internal consistency (Cronbach alpha = 0.78, 95% CI 0.74-0.81) and had good discriminative ability according to pain descriptors and quality of life in endometriosis. The SAQ was responsive in patients treated by surgery but the effect size was low (0.3, 95% CI (0.0-0.6), P = 0.01). The minimally important difference was determined at 2.2. LIMITATIONS, REASONS FOR CAUTION The effect size for medical treatment was non-significant. Other effect sizes were low but statistically significant. This could be explained by lower libido due to progestin intake, which was used for both surgically and medically treated patients. WIDER IMPLICATIONS OF THE FINDINGS The SAQ is easy to use, valid and effective in assessing sexual quality of life in patients with endometriosis. This patient-reported score could be used as a primary outcome for future clinical studies. The minimally important difference estimation will be useful for future research. We recommend using 2.2 for the minimally important difference of the SAQ. STUDY FUNDING/COMPETING INTEREST(S) This work was funded by the 'Direction à la Recherche Clinique et à l'Innovation' of Versailles, France and the 'Institut de Recherche en Santé de la Femme' (IRSF). The authors have no conflicts of interest to declare.
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Affiliation(s)
- A Oppenheimer
- EA 7285 Research Unit 'Risk and Safety in Clinical Medicine for Women and Perinatal Health', Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France.,Department of Reproductive Medicine and Fertility Preservation, Hôpital universitaire Antoine Béclère, 157, rue de la Porte de Trivaux, Clamart, France
| | - P Panel
- Department of Gynecology and Obstetrics, Centre Hospitalier de Versailles, Le Chesnay, France
| | - A Rouquette
- CESP, Faculté de Médecine, Université Paris Sud, Faculté de Médecine UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,AP-HP, Bicêtre Hôpitaux Universitaires Paris Sud, Public Health and Epidemiology Department, Le Kremlin-Bicêtre, France
| | - J du Cheyron
- Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France
| | - X Deffieux
- EA 7285 Research Unit 'Risk and Safety in Clinical Medicine for Women and Perinatal Health', Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France.,Department of Gynecology and Obstetrics, Hôpital universitaire Antoine-Béclère, AP-HP, Clamart, France
| | - A Fauconnier
- EA 7285 Research Unit 'Risk and Safety in Clinical Medicine for Women and Perinatal Health', Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France.,Department of Gynecology and Obstetrics, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Poissy, France
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27
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Natural Pregnancy Seeking in Subfertile Women with Endometriosis. Reprod Sci 2020; 27:389-394. [PMID: 32046409 DOI: 10.1007/s43032-019-00068-7] [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: 03/21/2019] [Accepted: 05/05/2019] [Indexed: 10/25/2022]
Abstract
Several pathogenetic mechanisms have been postulated to explain the association between endometriosis and subfertility. However, to date, definitive conclusions cannot be drawn. In this study, we hypothesized that the reduced exploitation of the natural chances of conception could be an additional detrimental factor. Due to dyspareunia or the need for hormonal treatment to temper pelvic pain, one may expect affected women to exploit less the chances of natural pregnancy. In this cross-sectional study of 292 women undergoing IVF, we investigated the severity of pelvic pain symptoms, the sexual function (using the Female Sexual Function Index [FSFI]), and the reproductive strategies of women with (n = 62) and without (n = 230) endometriosis. Basal clinical and demographic characteristics did not differ between the two groups. Conversely, all pelvic pain symptom scores were increased in women with endometriosis. Endometriosis patients also showed greater pain at the FSFI, but no other significant differences were detected as regards sexual function. The use of hormonal contraceptive agents did not differ between the study groups. Moreover, questions aimed at disentangle whether affected women exploited less the natural chances of pregnancy did not reveal any significant difference. In conclusion, this study does not support the hypothesis that women with endometriosis exploit less the chances of natural pregnancy, despite the presence of pelvic pain.
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La Rosa VL, De Franciscis P, Barra F, Schiattarella A, Tropea A, Tesarik J, Shah M, Kahramanoglu I, Marques Cerentini T, Ponta M, Ferrero S. Sexuality in women with endometriosis: a critical narrative review. Minerva Med 2019; 111:79-89. [PMID: 31726815 DOI: 10.23736/s0026-4806.19.06299-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Endometriosis is a chronic gynecological disease that generally affects young and sexually active women in different stages of their development and sexual life. Because endometriosis affects about 5-10% of women in reproductive age, it is possible to estimate that about 2-4% of those who are sexually active may suffer from sexual dysfunction caused by this disease. Surgical and pharmacological treatments of endometriosis can improve the patient's sexual function in the medium and long term, but not necessarily lead to a definitive resolution of the sexual issue. For this reason, the ideal treatment should be conducted by a multidisciplinary team, with the aim to improve overall sexual functioning and not only to reduce the painful symptoms during intercourse. In light of these considerations, the aim of this narrative review was to provide a general overview about the impact of endometriosis on sexuality of women affected and the effectiveness of surgical and pharmacological treatments in improving sexual function.
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Affiliation(s)
- Valentina L La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Catania, Italy -
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Fabio Barra
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Tropea
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), University of Pittsburgh Medical Center, Palermo, Italy
| | | | - Mohsin Shah
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Ilker Kahramanoglu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | | | - Marco Ponta
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.,Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Bernays V, Schwartz AK, Geraedts K, Rauchfuss M, Wölfler MM, Haeberlin F, von Orelli S, Eberhard M, Imthurn B, Fink D, Imesch P, Leeners B. Qualitative and quantitative aspects of sex life in the context of endometriosis: a multicentre case control study. Reprod Biomed Online 2019; 40:296-304. [PMID: 31954612 DOI: 10.1016/j.rbmo.2019.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/27/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023]
Abstract
RESEARCH QUESTION What are the specific characteristics of sexual activity in women with endometriosis compared with women without endometriosis? DESIGN Multicentre case control study. Participants were recruited from university hospitals, district hospitals and doctor's offices in Germany, Switzerland and Austria. A total of 565 women with endometriosis were pair-matched to 565 control women by age and ethnic background. Diagnosis of endometriosis was confirmed by histology, and disease stage was classified according to American Society for Reproductive Medicine criteria. Data on sexuality were collected using selected questions from the Brief Index of Sexual Function and the Sexual History Form. RESULTS Altogether, 69.1% of women with endometriosis and 77.8% of control women engaged in sexual activity during the month before the study period (P < 0.001). Overall, 42.3% of endometriosis-affected women and 30.5% of the control women desired a higher frequency of sexual activity (P < 0.001). Petting, foreplay and vaginal sexual intercourse were reported to be practised less often by women with endometriosis. Frequencies for masturbation, reciprocal masturbation, oral and anal sex were similar in both groups. Dyspareunia was negatively associated with sexual activity (OR 2.42, 95% CI 1.26 to 4.63), whereas chronic pain showed no association with sexual activity (OR 1.35, 95% CI 0.93, 1.96). CONCLUSIONS Women with endometriosis have lower frequencies of petting, foreplay and vaginal sexual intercourse than control women; this difference has to be attributed, at least in part, to dyspareunia. Potentially pain-free sexual options are used to a limited degree. As endometriosis-affected women desire higher levels of sexual activity, sexual counselling should be included in medical support.
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Affiliation(s)
- Valerie Bernays
- University Hospital Zürich, Department of Reproductive Endocrinology, 8910 Zürich, Switzerland
| | - Alexandra Kohl Schwartz
- University Hospital Zürich, Department of Reproductive Endocrinology, 8910 Zürich, Switzerland; University Women's Hospital, Division of Gynecological Endocrinology and Reproductive Medicine, Bern, 3010 Bern, Switzerland
| | - Kirsten Geraedts
- University Hospital Zürich, Department of Reproductive Endocrinology, 8910 Zürich, Switzerland
| | - Martina Rauchfuss
- Charité Berlin, University Hospital, Department of Psychosomatics, 10117 Berlin, Germany
| | - Monika Maria Wölfler
- University Hospital Graz, Department of Gynecology and Obstetrics, 8036 Graz, Austria
| | - Felix Haeberlin
- Cantonal Hospital St. Gallen, Department of Gynecology and Obstetrics, 9007 St. Gallen, Switzerland
| | - Stephanie von Orelli
- Triemli Hospital Zürich, Department of Gynecology and Obstetrics, 8036 Zürich, Switzerland
| | - Markus Eberhard
- Canton Hospital Schaffhausen, Department of Gynecology and Obstetrics, 8208 Schaffhausen, Switzerland
| | - Bruno Imthurn
- University Hospital Zürich, Department of Reproductive Endocrinology, 8910 Zürich, Switzerland
| | - Daniel Fink
- University Hospital Zürich, Department of Gynecology, 8910 Zürich, Switzerland
| | - Patrick Imesch
- University Hospital Zürich, Department of Gynecology, 8910 Zürich, Switzerland
| | - Brigitte Leeners
- University Hospital Zürich, Department of Reproductive Endocrinology, 8910 Zürich, Switzerland.
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Negative metacognitive beliefs predict sexual distress over and above pain in women with endometriosis. Arch Womens Ment Health 2019; 22:575-582. [PMID: 30446830 DOI: 10.1007/s00737-018-0928-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
Abstract
The aim of the study was to assess the predictive value of dyspareunia, general chronic pain, and metacognitive beliefs to sexual distress in a sample of women with endometriosis. Ninety-six women (mean age = 34.60 ± 6.44 years) with a diagnosis of endometriosis took part to this cross-sectional study. Sociodemographic and clinical data were collected by means of a structured ad hoc questionnaire. Metacognitive beliefs and sexual distress were assessed by means of the Metacognitions Questionnaire (MCQ30) and the Female Sexual Distress Scale-R (FSDS-r). General chronic pain intensity was collected by means of a Numeric Rating Scale. Data were subjected to Hierarchical logistic regression. We found high percentages of dyspareunia and sexual distress (i.e., 66% and 76%). Findings suggested that dyspareunia and chronic pain did not predict sexual distress, while negative beliefs about worries predicted sexual distress over and above them (p = .040, odd ratio 1.159). In the target population, metacognitive beliefs may have more influence on sexual distress than pain symptomatology.
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31
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Mabrouk M, Raimondo D, Altieri M, Arena A, Del Forno S, Moro E, Mattioli G, Iodice R, Seracchioli R. Surgical, Clinical, and Functional Outcomes in Patients with Rectosigmoid Endometriosis in the Gray Zone: 13-Year Long-Term Follow-up. J Minim Invasive Gynecol 2019; 26:1110-1116. [DOI: 10.1016/j.jmig.2018.08.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 07/27/2018] [Accepted: 08/17/2018] [Indexed: 02/07/2023]
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Lermann J, Topal N, Renner SP, Beckmann MW, Burghaus S, Adler W, Heindl F. Comparison of preoperative and postoperative sexual function in patients with deeply infiltrating endometriosis with and without bowel resection. Eur J Obstet Gynecol Reprod Biol 2019; 239:21-29. [PMID: 31163353 DOI: 10.1016/j.ejogrb.2019.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 03/20/2019] [Accepted: 05/09/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze preoperative and postoperative sexual function following surgery for deeply infiltrating endometriosis (DIE) with and without bowel involvement. STUDY DESIGN Patients with DIE who underwent surgery between 2001 and 2011 with segmental bowel resection (WB) or without segmental bowel resection (WOB) were surveyed using the German version of the Massachusetts General Hospital Sexual Functioning Questionnaire (KFSP). Responses were given on a six-point scale for the items sexual interest, sexual arousal, orgasm, lubrication, and general sexual satisfaction. As there are no cut-off values for the existence of sexual function disorders, a control group with no history of endometriosis was evaluated. Differences between the preoperative and postoperative results, as well as between WB, WOB, and a control group, were compared using the Wilcoxon test, Mann-Whitney U test, and Fisher's exact test. RESULTS Eighty-nine patients without bowel resection (mean age 34.3 years; mean follow-up 63.2 months), 87 patients with bowel resection (mean age 37.7 years; mean follow-up 69.6 months), and 100 control patients aged 21-58 years (mean age 35.0 years) were evaluated. Preoperatively, both treatment groups had significantly poorer scores in all categories in comparison with the control group. The WOB group improved significantly in all categories postoperatively, with no further significant differences from the control group. No significant postoperative improvement was observed in the WB group, and the group had significantly poorer scores in comparison with the control group. The number of previous operations is associated with significantly poorer postoperative KFSP results. Sterility and age > 40 years are associated with significantly less improvement in the KFSP, although with lower initial values. CONCLUSIONS Patients with DIE with or without bowel involvement have significantly impaired sexual function preoperatively. Complete resection of endometriosis in the WOB group was able to improve sexual function, as the women had sexual scores similar to those in the healthy control group postoperatively. Possible explanations for the lack of postoperative improvement of sexual function after segmental bowel resection include the type of surgery carried out, or injury to the affected nerves resulting from the endometriosis.
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Affiliation(s)
- Johannes Lermann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany; Department of Obstetrics and Gynecology, Klinikum Bayreuth, Germany.
| | - Nalan Topal
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Stefan P Renner
- Department of Obstetrics and Gynecology, Klinikum Bayreuth, Germany; Department of Obstetrics and Gynecology, Klinikverbund Südwest, Klinikum Sindelfingen-Böblingen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Stefanie Burghaus
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Werner Adler
- Department of Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Germany
| | - Felix Heindl
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Germany
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Interrelationships among endometriosis-related pain symptoms and their effects on health-related quality of life: a sectional observational study. Obstet Gynecol Sci 2018; 61:605-614. [PMID: 30254997 PMCID: PMC6137011 DOI: 10.5468/ogs.2018.61.5.605] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/18/2017] [Accepted: 01/03/2018] [Indexed: 11/08/2022] Open
Abstract
Objective To assess the correlation between different pain symptoms and different domains of women's health-related quality of life (HRQoL). Methods Seventy-seven women with deep infiltrating endometriosis were successively enrolled between June 2011 and August 2013 while being prepared to undergo laparoscopy due to pain and/or infertility. We quantified the intensities of dysmenorrhea, deep dyspareunia, chronic pelvic pain, and dyschezia (menstrual and non-menstrual) using a 11-point visual analog scale (VAS: 0-10) and the validated full versions of the Short Form 36 (SF36) and Endometriosis Health Profile (EHP30) questionnaires to assess HRQoL. The pain symptoms were considered simultaneously in a hierarchical agglomerative clustering method (exploratory multivariate approach) and the associations among scores were tested by bivariate correlation. Results Dysmenorrhea showed the lowest similarity on to the multivariate cluster analysis and no statistically significant correlation with the other pain symptoms: deep dyspareunia (P=0.244), chronic pelvic pain (P=0.108), menstrual dyschezia (P=0.238), and non-menstrual dyschezia (P=0.380). Dysmenorrhea and chronic pelvic pain were the main symptoms correlated with all domains of the SF36 and the EHP30 (core instrument) questionnaires (P<0.05). Conclusion Dysmenorrhea and chronic pelvic pain were independent factors associated with HRQoL.
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Franck C, Poulsen MH, Karampas G, Giraldi A, Rudnicki M. Questionnaire-based evaluation of sexual life after laparoscopic surgery for endometriosis: a systematic review of prospective studies. Acta Obstet Gynecol Scand 2018; 97:1091-1104. [DOI: 10.1111/aogs.13369] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 04/27/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Cecilie Franck
- Faculty of Health Sciences; University of Southern Denmark; Odense Denmark
| | - Marlene H. Poulsen
- Faculty of Health Sciences; University of Southern Denmark; Odense Denmark
| | - Grigorios Karampas
- Department of Obstetrics & Gynecology; Skåne University Hospital; Malmö-Lund Sweden
| | - Annamaria Giraldi
- Sexological Clinic; Psychiatric Center Copenhagen; Copenhagen Denmark
| | - Martin Rudnicki
- Department of Obstetrics & Gynecology; Odense University Hospital; Odense Denmark
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Role of medical therapy in the management of deep rectovaginal endometriosis. Fertil Steril 2017; 108:913-930. [DOI: 10.1016/j.fertnstert.2017.08.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 12/17/2022]
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Use of the endometriosis fertility index in daily practice: A prospective evaluation. Eur J Obstet Gynecol Reprod Biol 2017; 219:28-34. [DOI: 10.1016/j.ejogrb.2017.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/11/2017] [Accepted: 10/02/2017] [Indexed: 12/11/2022]
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Yong PJ. Deep Dyspareunia in Endometriosis: A Proposed Framework Based on Pain Mechanisms and Genito-Pelvic Pain Penetration Disorder. Sex Med Rev 2017; 5:495-507. [DOI: 10.1016/j.sxmr.2017.06.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/19/2017] [Accepted: 06/24/2017] [Indexed: 12/30/2022]
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Riiskjær M, Egekvist A, Hartwell D, Forman A, Seyer-Hansen M, Kesmodel U. Bowel Endometriosis Syndrome: a new scoring system for pelvic organ dysfunction and quality of life. Hum Reprod 2017; 32:1812-1818. [DOI: 10.1093/humrep/dex248] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/01/2017] [Indexed: 11/13/2022] Open
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Buggio L, Barbara G, Facchin F, Frattaruolo MP, Aimi G, Berlanda N. Self-management and psychological-sexological interventions in patients with endometriosis: strategies, outcomes, and integration into clinical care. Int J Womens Health 2017; 9:281-293. [PMID: 28496368 PMCID: PMC5422563 DOI: 10.2147/ijwh.s119724] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Endometriosis has a multifactorial etiology. The onset and progression of the disease are believed to be related to different pathogenic mechanisms. Among them, the environment and lifestyle may play significant roles. Diet, dietary supplements, physical exercise, osteopathy, massage, acupuncture, transcutaneous electrical nerve stimulation, and Chinese herbal medicine may represent a complementary and feasible approach in the treatment of symptoms related to the disease. In this narrative review, we aimed to examine the most updated evidence on these alternative approaches implicated in the self-management of the disease. In addition, several studies have demonstrated that endometriosis may negatively impact mental health and quality of life, suggesting that affected women may have an increased risk of developing psychological suffering as well as sexual problems due to the presence of pain. In light of these findings, we discuss the importance of integrating psychological interventions (including psychotherapy) and sexual therapy in endometriosis treatment.
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Affiliation(s)
- Laura Buggio
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano.,Departmental Operating Unit of Surgical Gynecology and Endometriosis, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico
| | - Giussy Barbara
- Department of Obstetrics and Gynecology and Service for Sexual and Domestic Violence (SVSeD), Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico
| | - Federica Facchin
- Faculty of Psychology, Catholic University of Milan, Milan, Italy
| | - Maria Pina Frattaruolo
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano.,Departmental Operating Unit of Surgical Gynecology and Endometriosis, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico
| | - Giorgio Aimi
- Departmental Operating Unit of Surgical Gynecology and Endometriosis, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico
| | - Nicola Berlanda
- Departmental Operating Unit of Surgical Gynecology and Endometriosis, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico
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