Adenomyosis as a Barrier to Effective Surgery for Dyspareunia in Rectovaginal Endometriosis

Adenomyosis May Limit Surgical Success in Treating Painful Sex in Endometriosis Patients

Key Points

Importance:

• Despite radical surgery for rectovaginal septum endometriosis, post-surgical dyspareunia often persists, indicating factors that influence surgical success are still unclear.

Highlights:

• Adenomyosis may reduce surgical outcomes in patients with rectovaginal endometriosis.
• Patiens with both conditions showed less improvement in pain and sexual quality of life than those with isolated rectovaginal endometriosis.

What's done here:

• This retrospective cohort study, conducted at the University of Naples Federico II.
• It evaluated whether adenomyosis affects surgical outcomes in patients with dyspareunia due to rectovaginal septum endometriosis.
• Ninety-four women who underwent surgery for endometriosis between January 2020 and July 2023 were included.
• Th rectovaginal septum endometriosis nodules were < 3 cm (EnzianA1-2)
• The study assessed pain relief and sexual quality of life at 6 months post-surgery using validated questionnaires.

Key Results:

• There were 35 patients with both adenomyosis and rectovaginal endometriosis (Group A), while 59 had isolated rectovaginal endometriosis (Group B).
• Both groups showed significant pain reduction and improvements in sexual quality of life.
• However, Group B demonstrated a more pronounced improvement.
• Three cases of bowel perforation were managed without laparotomy. 

Lay Summary

Women with endometriosis often experience severe pain during intercourse, known as dyspareunia, which can deeply affect their quality of life and intimate relationships. One form of this condition, rectovaginal septum endometriosis, involves deep, scarred tissue that can cause pain during deep penetration.The efficacy of hormonal and medical treatment is limited in cases of deep-infiltrating endometriosis, surgery is often necessary to remove the affected tissue. However, even after surgery, some continue to struggle with persistent symptoms, including pain.

Recent research suggests that adenomyosis, a condition where tissue similar to the lining of the uterus grows into the uterine muscle, might worsen the outcomes of surgery for rectovaginal endometriosis. This study, performed by a team from the University of Naples, aimed to understand whether the presence of adenomyosis affects surgical success in women with rectovaginal endometriosis and persistent dyspareunia.

The study included 94 women who underwent surgery for rectovaginal endometriosis between 2020 and 2023. Some women had only rectovaginal endometriosis, while others also had adenomyosis. Six months after surgery, both groups showed improvements in pain relief and sexual quality of life. However, women with both conditions, namely rectovaginal endometriosis and adenomyosis, showed less improvement compared to those with rectovaginal endometriosis alone.

This study highlights the importance of considering adenomyosis during pre-surgical evaluations for women with rectovaginal endometriosis. Identifying and treating adenomyosis might improve surgical outcomes and help women achieve better relief from pain and improved sexual health after surgery.

Further research is needed to better understand how adenomyosis impacts treatment success and whether additional therapies might benefit these patients.

This insightful study has been recently published in the International Journal of Gynaecology and Obstetrics.

Research Source: https://pubmed.ncbi.nlm.nih.gov/39441537/