Does deep infiltrating endometriosis affect sexual activity?

Dr. Coccia group evaluated sexual function in women with deep infiltrating endometriosis.

Key Points

Highlight:

• The influence of deep infiltrating endometriosis (DIE) on sexual function has been poorly studied.
• Dr. Cozzolino et al. from Italy found that women with DIE had significant impairment of sexual activity when a partial or total infiltration of the rectovaginal septum occurred.

What’s done here:

• A total of 170 women with DIE have participated. All participants have a clinical and ultrasound diagnosis of DIE and histological confirmation of endometriosis.
• A questionnaire-based prospective study was conducted at Careggi University Hospital in Florence, Italy.
• Visual analog scale (VAS), ‘gold standard’ of pain assessment, was used to assess the following pain symptoms (dysmenorrhea, dyspareunia, dyschezia, Cronic Pelvic Pain (CPP), and dysuria).
• Sexual function was assessed using the Female Sexual Function Index (FSFI).

Key points:

• DIE is known to be associated with a significant reduction in quality of life and sexual function.
• Other factors including the site of the endometriosis lesions and smoking history were documented.
• Dysmenorrhea was reported to be severe by 66.5% of the study participants (113/170), dyspareunia by 41.8% (71/170), dyschezia by 32.4% (55/170), CPP by 67.1% (114/170) and dysuria by 6.5% (11/170). A VAS score of >7 was taken to indicate ‘severe’ pain.
• There were no statistically significant differences in FSFI scores in women with and without endometriosis lesions at particular sites, except for rectovaginal nodules, which were found to be associated with more impaired sexual activity and sexual function.

Conclusions and limitations:

• Women with DIE had significant impairment of sexual activity when a partial or total infiltration of the rectovaginal septum occurred.
• Therefore, particular attention should be given to women with this location of the endometriotic lesion.
• The questionnaire was administered only before surgery
• Questionnaire after surgery, at a certain follow-up, could help to clarify the role of DIE surgery in the sex life of these women.

Lay Summary

Endometriosis is one of the most common gynecological diseases in women of reproductive age, and pelvic pain and infertility are the most frequent complications. There are three different type of endometriosis lesions; superficial lesions, deep lesions, and ovarian cysts. In the patients with deep infiltrating endometriosis (DIE), the depth of infiltration seems to correlate with the intensity of pain, commonly presented as the form of dysmenorrhea, dyspareunia, CPP, dyschezia, and dysuria. Therefore, DIE is strongly associated with a significant reduction in quality of life and sexual function.

Here, Dr. Coccia group from Italy performed the prospective study to assess sexual activity and function in women with DIE using ‘gold standard’ of pain assessment indexes such as visual analog scale (VAS) and Female Sexual Function Index (FSFI).

A hundred and seventy women were participated after having a clinical and ultrasound diagnosis of DIE and histological confirmation of endometriosis. From this questionnaire-based prospective study, dysmenorrhea was reported to be severe by 66.5% of the study participants (113/170), dyspareunia by 41.8% (71/170), dyschezia by 32.4% (55/170), CPP by 67.1% (114/170) and dysuria by 6.5% (11/170). The mean FSFI total score was 20.50, which indicates significant sexual dysfunction. Interestingly, there were no statistically significant differences in FSFI scores in women with and without endometriosis lesions at particular sites, except for rectovaginal nodules, which were found to be strongly associated with impaired sexual activity and sexual function.

In conclusion, sexual activity was significantly impaired when a partial or total infiltration of the rectovaginal septum occurred than when it did not. Therefore, particular attention should be given to this site and the importance should not be underestimated.

One limitation of this study was that the questionnaire was administered only before surgery. To clarify the role of DIE surgery in the sex life of these women, administering the questionnaire with different time points would be necessary.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29804777