The effect of endometriosis surgery on female sexual functions

Surgical removal of endometriotic lesions significantly improves sexual function in women with endometriosis.

Key Points

Importance:

• The most effectively improved sexual dysfunction after surgery was "desire" in both endometriosis and other benign gynecologic disease groups.

Highlights:

• This prospective study analyzed sexual function outcomes in women with endometriosis and other benign gynecological conditions, using a control group for comparison.
• No statistically significant differences in full-scale FSFI scores were observed between groups; however, women with endometriosis showed notable improvements in "desire" and "satisfaction."
• Dyspareunia was the only pain category significantly worse in women with endometriosis preoperatively.

What's done here: 

• Perricos et al. conducted a five-year prospective study at the Medical University of Vienna, evaluating surgical impacts on sexual function.
• Participants included 102 patients undergoing surgery for endometriosis, fibroids, adnexal cysts, or infertility, categorized into two groups: endometriosis (n = 64) and other benign conditions (n = 38).
• Sexual function was assessed using the FSFI questionnaire preoperatively and 8–18 weeks post-surgery.

Key Results:

• The groups were similar in terms of BMI, gravidity, parity, or menarche.
• Endometriosis patients reported significantly higher dyspareunia intensity preoperatively compared to controls.
• Post-surgery, full-scale FSFI scores improved significantly for endometriosis patients, particularly in "desire" and "satisfaction." Improvements in other domains were observed but were not statistically significant.
• The control group showed no significant improvement in FSFI scores after surgery.

Lay Summary

Sexual dysfunction is almost twice as prevalent in women with endometriosis compared to those with other benign gynecological conditions. Deep dyspareunia, a hallmark symptom of deeply infiltrating endometriosis, poses a ninefold higher risk in affected women. This symptom profoundly impacts sexual function, particularly desire, orgasm, and satisfaction, leading to a diminished quality of sexual life.

While retrospective studies have suggested improvements in dyspareunia after endometriosis surgery, there has been a lack of prospective studies assessing the broader impact of surgery on sexual function.

To address this gap, Dr. Perricos and colleagues from the Department of Obstetrics and Gynecology at the Medical University of Vienna conducted a prospective study from 2015 to 2020. They evaluated the effects of laparoscopic surgery on sexual function in women with endometriosis and other benign gynecological conditions. Depending on their diagnoses, participants underwent procedures such as diagnostic laparoscopy, cystectomy, myomectomy, or lesion excision. Patients were categorized into two groups: those with endometriosis and those with other benign conditions.

Sexual function was assessed preoperatively and again at 8 and 18 weeks post-surgery using the Female Sexual Function Index (FSFI) questionnaire. This 19-item tool evaluates six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. Scores range from 0 to 5 for each domain, with a total score below 26.5 indicating sexual dysfunction. Postoperative sexual intercourse was permitted 2 to 4 weeks after surgery.

The results showed significant improvements in sexual function. Women with endometriosis experienced statistically significant enhancements in the "desire" and "satisfaction" domains, while the control group showed improvement only in "desire." Non-significant improvements were observed in other domains for both groups. Notably, no further changes were seen between 8 and 18 weeks post-surgery.

The authors concluded that surgical treatment for endometriosis could improve sexual function, especially in areas of desire and satisfaction. They emphasized the need for larger studies with extended follow-ups to validate these findings. The study was recently published in BMC Medicine.

Research Source: https://pubmed.ncbi.nlm.nih.gov/39501251/