Sexual activity during menstruation: Any impact on endometriosis development?

Meta-analysis reveals potential connection between menstrual sex and endometriosis risk

Key Points

Highlights

• Sexual activity during menstruation is thought to potentially increase the risk of endometriosis.
• Heterogeneity among the studies and varying methodological quality highlight the need for further research with stronger designs for conclusive results.

Importance

• Retrograde menstruation is considered a leading theory for the development of endometriosis, and understanding its potential link with sexual activity during menstruation could have significant implications for preventive measures and women's health.
• Proper health education and counseling for women can play a crucial role in promoting sexual health and potentially preventing endometriosis.

What's done here

• A comprehensive review was conducted aiming to address the potential risk of endometriosis with sexual activity during menstruation and consider potential implications for women's quality of life and fertility.
• Multiple databases for relevant studies were searched following PRISMA guidelines.
• Four studies were included in their analysis, comprising two cross-sectional and two case-control studies from different countries.
• Methodological quality evaluation was performed using the Newcastle-Ottawa Quality Assessment Scale.

Key results

• One study suggested a protective effect of sexual activity during menstruation on endometriosis, while the other three indicated a higher risk.
• The overall meta-analysis showed approximately a two-fold higher probability of sexual activity during menstruation in women with endometriosis compared to those without.

Lay Summary

Retrograde menstruation is among the theories for the etiology of endometriosis and there is a hypothesis that sexual activity during menstruation could potentially increase retrograde menstruation, leading to the implantation of endometrial tissue in other areas and consequently increasing the risk of endometriosis. Some studies suggest a potentially higher risk of endometriosis in women who engage in sexual activity during menstruation, while others indicate a lower risk. The systematic review and meta-analysis by Mollazadeh et al. from Iran sought to address this question and consider potential implications for women's quality of life and fertility. The review was published in the January-March 2023 issue of the International Journal of Fertility and Sterility.

The review followed the PRISMA guidelines and searched multiple databases for relevant studies until September 2021. The researchers conducted a comprehensive search and identified 1905 studies from various databases. Through a rigorous selection process, four relevant studies were included in the analysis. The included studies consisted of two cross-sectional and two case-control studies from different countries. Among these studies, one suggested a protective effect of sexual activity during menstruation on endometriosis, while the other three indicated a higher risk of endometriosis in women engaging in sexual activity during menstruation. The methodological quality evaluation using the Newcastle-Ottawa Quality Assessment Scale revealed that two studies were of high methodological quality, while the other two were categorized as low quality. 

The meta-analysis, which involved a total of 3641 participants, showed that there was approximately a two-fold higher probability of having sexual activity during menstruation in the case group (women with endometriosis) compared to the control group (women without endometriosis). However, it's important to note that there was considerable heterogeneity among the included studies. The conflicting results of the previous studies were discussed by the authors, with some attributing a protective effect of sexual activity to potential benefits in menstrual discharge clearance. They also discussed the cultural and religious perspectives on sexual activity during menstruation, emphasizing its prohibition in several faiths. 

The authors suggest that sexual activity during menstruation may be a predisposing risk factor for endometriosis. However, the quality of the included studies varied, and the results were heterogeneous, indicating the need for further research with stronger designs. Proper health education and counseling for women of reproductive age can be beneficial in promoting sexual health and potentially preventing endometriosis. The findings of this study can serve as a valuable guide for medical professionals, particularly midwife consultants, in providing accurate information to young women and improving their sexual health.

Research Source: https://pubmed.ncbi.nlm.nih.gov/36617195/