Could sexual activity during menses be a risk factor in endometriosis?

Another hot topic in the pathogenesis of endometriosis: menstrual sexual activity

Key Points

Highlights:

• Retrograde menstruation and defects in immunity in clearing displaced endometrial cells are dominant theories for endometriosis pathophysiology.

Importance:

• It is essential to clarify whether coitus and/or orgasm during menses could lead to endometriosis via increased retrograde menstruation.

What's done here:

• The authors conducted comprehensive PubMed research for original, full-length studies on menstrual coitus (or other sexual activities leading to orgasm during menses) and the prevalence of endometriosis.

Main key feature:

• Published studies do not have a clear final outcome; the possibility of  association between menstrual coitus and endometriosis is not precise as yet.

Limitation of the study:

• Non-English studies were not included in this survey, which may hamper the conclusions reached in this review.

Lay Summary

Italian researchers recently published a literature review in Women’s Health exploring the potential role of endometriosis and menstrual sexual activity.

The retrograde menstruation theory, first proposed in the early 20th century, remains a popular hypothesis suggesting that menstrual debris contribute to the development of endometriosis in the peritoneal cavity. It is proposed that uterine contractions during sexual intercourse, with or without orgasm, could enhance the retrograde flow of endometrial debris through the uterine tubes.

A research team led by Dr.Vercellini conducted an extensive PubMed search for original, full-length studies in English on the relationship between menstrual coitus or other sexual activities leading to orgasm during menstruation, and the prevalence of endometriosis.

Filer and Wu (1989) found a higher frequency of surgically confirmed endometriosis among women who had sexual intercourse during menstruation (17.5% vs. 10.9%; p < 0.05). This was supported by a more recent study by Roudsari group, which also reported an increased incidence of endometriosis among women engaging in menstrual coitus. In contrast, Kliman and colleagues hypothesized that sexual activity during menstruation could result in anterograde blood flow through the cervix, finding a lower prevalence of endometriosis in women with such activity (27% vs. 35%; p = 0.002). This was further corroborated by Treloar et al. study in Australia.

The authors conclude that, due to conflicting results, no definitive recommendations can yet be made regarding the impact of sexual activity during menstruation on endometriosis risk.

Research Source: https://pubmed.ncbi.nlm.nih.gov/39976526/