Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis

Leona K Shum; Mohamed A Bedaiwy; Catherine Allaire; Christina Williams; Heather Noga; Arianne Albert; Sarka Lisonkova; Paul J Yong

doi:10.1016/j.esxm.2018.04.006

Sexual Health · Sexual Pain

Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis

Shum LK, Bedaiwy MA, Allaire C, Williams C, Noga H, Albert A, Lisonkova S, Yong PJ

Published September 2018 Sexual medicine, 6(3), 224-233

DOI 10.1016/j.esxm.2018.04.006 PMID 29801714 PMC PMC6085224

RRM Academy Synopsis

Endometriosis deep dyspareunia links to worse sexual quality of life

In a registry study of 277 women with surgically confirmed endometriosis, more severe deep dyspareunia went with worse sexual quality of life, even after adjusting for other pain and mood factors. Deep dyspareunia means pain with deep penetration. Of all factors tested, it correlated most strongly.

Key Findings

277 women met the criteria. Their mean sexual quality of life score was 60.9% (0 to 100%, higher is worse). Mean deep dyspareunia severity was 6.5 of 10.
Deep dyspareunia correlated most strongly with the score among all factors compared (Spearman ρ = 0.55).
In the final model, more severe deep dyspareunia was associated with a worse score (b = 4.50, P < .0001). More severe superficial dyspareunia was too (b = 1.92, P < .0001).
Depression (b = 0.86, P < .001), pain catastrophizing (b = 0.22, P = .04) and bladder pain syndrome (b = 5.69, P = .02) also stayed in the model.
Endometriosis stage did not confound the link between deep dyspareunia and sexual quality of life.

Interpretation

The study analyzed a prospective registry at one tertiary referral center. The design shows association only. A randomized controlled trial would be needed to show that treating deep dyspareunia improves sexual quality of life, the authors say. Every woman had surgery with histologic confirmation of endometriosis. Acute causes of deep dyspareunia, such as salpingitis or cervicitis, were excluded. Other settings may give different results.

RRM Context

The authors propose a framework in which deep dyspareunia in endometriosis can involve the lesions, bladder pain syndrome, depression and central sensitization. RRM treats painful intercourse as a symptom calling for evaluation before treatment. Sexual quality of life involves both partners in a couple.

Our editorial summary of this paper, not the article's abstract.

Abstract

Introduction

Deep dyspareunia occurs in half of women with endometriosis, a condition present in 10% of reproductive-age women and associated with negative effects on sexual quality of life (SQoL). However, women with endometriosis can have other clinical factors (eg, superficial dyspareunia, other pelvic pains, and psychological or pain conditions) possibly affecting SQoL.

Aims

To determine whether deep dyspareunia is associated with SQoL in women with endometriosis, independent of potential confounders.

Methods

This study involved a prospective patient registry of women at a tertiary-level referral center for endometriosis and pelvic pain. Inclusion criteria were (i) referrals to the center recruited into the registry from January 2014 through December 2016 and (ii) subsequent surgery at the center with histologic confirmation of endometriosis. Exclusion criteria included menopausal status, age at least 50 years, never sexually active, or did not answer dyspareunia or SQoL questions. Bi-variable tests and multiple linear regression analysis were performed.

Main Outcome Measures

SQoL measured by the 5-item sexual intercourse subscale of the Endometriosis Health Profile-30 (EHP-30) modular questionnaire (0-100%, with higher scores indicating worse SQoL).

Results

Consent rate for the prospective registry was 87%; 277 women met the study criteria (mean age = 34.2 ± 7.1 years). Most women had stage I to II endometriosis at time of surgery (64%), with the remaining having stage III to IV endometriosis. Through regression analysis, worse SQoL (higher EHP-30 sexual intercourse subscale score) was independently associated with: more severe deep dyspareunia (P < .0001), more severe superficial dyspareunia (P < .0001), increased depression (P < .001), higher pain catastrophizing (P = .04), bladder pain syndrome (P = .02), heterosexual orientation (P < .001), and new referral status (P = .02).

Conclusion

In women with endometriosis at a tertiary referral center, more severe deep dyspareunia was associated with worse SQoL, independent of superficial dyspareunia, psychological comorbidities, and other potential confounders. Shum LK, Bedaiwy MA, Allaire C, et al. Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis. Sex Med 2018;6:224-233.

Topics

Sexual Health › Sexual Pain › Dyspareunia · General Gynecology › Pelvic Pain › Chronic Pelvic Pain

Leona K Shum, Mohamed A Bedaiwy, Catherine Allaire, Christina Williams, Heather Noga, Arianne Albert, Sarka Lisonkova, Paul J Yong

L Shum, M Bedaiwy, Cathy Allaire, Kate Allaire, C Allaire, C Williams, H Noga, A Albert, S Lisonkova, P Yong

PMID 29801714 29801714 DOI 10.1016/j.esxm.2018.04.006 10.1016/j.esxm.2018.04.006 Shum et al. 2018, Shum 2018

Keywords

Deep Dyspareunia, Endometriosis, Sexual Quality of Life, Superficial Dyspareunia

Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis

Endometriosis deep dyspareunia links to worse sexual quality of life

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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Keywords