Deep Dyspareunia, Superficial Dyspareunia, and Infertility Concerns Among Women With Endometriosis: A Cross-Sectional Study

Kate J Wahl; Natasha L Orr; Michelle Lisonek; Heather Noga; Mohamed A Bedaiwy; Christina Williams; Catherine Allaire; Arianne Y Albert; Kelly B Smith; Susan Cox; Paul J Yong

doi:10.1016/j.esxm.2020.01.002

Sexual Health · Sexual Pain

Deep Dyspareunia, Superficial Dyspareunia, and Infertility Concerns Among Women With Endometriosis: A Cross-Sectional Study

Wahl KJ, Orr NL, Lisonek M, Noga H, Bedaiwy MA, Williams C, Allaire C, Albert AY, Smith KB, Cox S, Yong PJ

Published June 2020 Sexual medicine

DOI 10.1016/j.esxm.2020.01.002 PMID 32061579 PMC PMC7261667

RRM Academy Synopsis

Pain at vaginal entry is linked to infertility worry in endometriosis

A cross-sectional study of 300 women with confirmed endometriosis found that women with more severe pain at the vaginal entrance reported more infertility concerns. Deep pelvic pain during sex showed no such link. Women who were trying to conceive, had no previous births, or were younger also reported more concern.

Key Findings

Greater severity of superficial dyspareunia (pain at the vaginal introitus) was associated with infertility concerns (95% CI 1.02–1.16, odds ratio = 1.09, P = .011).
Greater severity of deep dyspareunia was not associated with infertility concerns (95% CI 0.95–1.09, odds ratio = 1.02, P = .58).
In the main adjusted model, each one-point rise in superficial dyspareunia severity was associated with 14% higher odds of infertility concerns (AOR = 1.14, 95% CI: 1.06–1.24).
Superficial dyspareunia stayed associated with infertility concerns in models using endometriosis factors alone (AOR = 1.10), demographic variables alone (AOR = 1.07), or reproductive history alone (AOR = 1.13).
No previous births (AOR = 3.21, 95% CI 1.63–6.41), trying to conceive now (AOR = 5.23, 95% CI: 2.77–9.98), and previous difficulty conceiving (AOR = 2.09, 95% CI 1.04–4.19) were independently associated.

Interpretation

The study is cross-sectional, drawing on a registry at one tertiary pelvic pain center. Women answered questionnaires at a single point in time, so the results show association and cannot show cause. The authors call the gap between superficial and deep dyspareunia small and urge caution. The main adjusted model covered age, race, reproductive history, dysmenorrhea, and endometriosis stage, and left out women with hormonally induced amenorrhea or missing stage. Anxiety, depression, and pain catastrophizing could not be examined because those questionnaires overlapped with the infertility concerns measure. The authors note the findings may not apply to fertility clinics.

RRM Context

The authors note that some women with endometriosis may worry about their fertility before they try to conceive. Restorative reproductive medicine looks for the cause. It includes the partner and treats pain and fertility as parts of one disease.

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

Abstract

Introduction

Deep dyspareunia is a cardinal symptom of endometriosis, and as many as 40% of people with this condition experience comorbid superficial dyspareunia.

Aim

To evaluate the relationship between sexual pain and infertility concerns among women with endometriosis.

Methods

This is a cross-sectional study conducted at a university-based tertiary center for endometriosis. 300 reproductive-aged participants in the prospective Endometriosis Pelvic Pain Interdisciplinary Cohort (ClinicalTrials.gov Identifier: NCT02911090) with histologically confirmed endometriosis were included (2013-2017).

Main Outcome Measures

The total score on the infertility concerns module of the Endometriosis Health Profile-30 categorized into 5 groups (0, 1-4, 5-8, 9-12, 13-16).

Results

The odds of infertility concerns did not increase with severity of deep dyspareunia (odds ratio = 1.02, 95% CI: 0.95-1.09, P = .58). However, the odds of infertility concerns increased with severity of superficial dyspareunia (odds ratio = 1.09, 95% CI: 1.02-1.16, P = .011); this relationship persisted after adjusting for endometriosis-specific factors, infertility risk factors, reproductive history, and demographic characteristics (adjusted odds ratio [AOR] = 1.14, 95% CI: 1.06-1.24, P < .001). Other factors in the model independently associated with increased infertility concerns were previous difficulty conceiving (AOR = 2.09, 95% CI 1.04-4.19, P = .038), currently trying to conceive (AOR = 5.23, 95% CI 2.77-9.98, P < .001), nulliparity (AOR = 3.21, 95% CI 1.63-6.41, P < .001), and younger age (AOR = 0.94, 95% CI: 0.89-0.98, P = .005).

Conclusion

Severity of superficial dyspareunia, but not deep dyspareunia, was associated with increased odds of infertility concerns among women with endometriosis. Strengths of the study included the use of a validated measure of infertility concerns and disaggregation of sexual pain into deep and superficial dyspareunia. Limitations included the setting of a tertiary center for pelvic pain, which affects generalizability to fertility clinic and primary care settings. Women experiencing introital dyspareunia, who can have difficulties with achieving penetrative intercourse, may be concerned about their future fertility and should be counselled appropriately. Wahl KJ, Orr NL, Lisonek M, et al. Deep Dyspareunia, Superficial Dyspareunia, and Infertility Concerns Among Women With Endometriosis: A Cross-Sectional Study. Sex Med 2020;8:274-281.

Topics

Sexual Health › Sexual Pain › Dyspareunia · General Gynecology › Pelvic Pain › Chronic Pelvic Pain · Endometriosis › Fertility and Outcomes › Conception After Excision

Kate J Wahl, Natasha L Orr, Michelle Lisonek, Heather Noga, Mohamed A Bedaiwy, Christina Williams, Catherine Allaire, Arianne Y Albert, Kelly B Smith, Susan Cox, Paul J Yong

Catherine Wahl, Katherine Wahl, Kathryn Wahl, K Wahl, N Orr, M Lisonek, H Noga, M Bedaiwy, C Williams, Cathy Allaire, Kate Allaire, C Allaire, A Albert, K Smith, Sue Cox, S Cox, P Yong

PMID 32061579 32061579 DOI 10.1016/j.esxm.2020.01.002 10.1016/j.esxm.2020.01.002 Wahl et al. 2020, Wahl 2020

Deep Dyspareunia, Superficial Dyspareunia, and Infertility Concerns Among Women With Endometriosis: A Cross-Sectional Study

Pain at vaginal entry is linked to infertility worry in endometriosis

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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