The predictors for sexual dysfunction in infertile women with endometriosis

Sexual dysfunction, pelvic pain, infertility, psychological distress, sleep disturbances, and endometriosis

Key Points

Highlights:

• Several predictors are affecting the sexual health of endometriosis patients such as pelvic pain, endometriosis stage, sleep quality, anxiety, depression, body mass index, physical activity, education level, and psychological well-being.

 Importance:

• Infertile women with laparoscopically confirmed endometriosis may need care due to a possible sexual dysfunction.

What’s done here?

• This cross-sectional study was conducted to determine the predictors influencing the sexual health in infertile women with endometriosis.
• The study population was selected from the infertile women admitted to the Infertility Clinic of Arash Hospital; socio-demographic characteristics were obtained.
• The stage of endometriosis was scored according to the revised classification of the American Fertility Society (AFS).
• The Female Sexual Function Index (FSFI) was used to evaluate the patients’ sexual function during the last 4 weeks.
• The Hospital Anxiety and Depression Scale (HADS) was used to detect and classify the severity of anxiety and depression.
• The Visual Analogue Scale (VAS) was used to measure the intensity of pelvic pain and dyspareunia.
• The Persian version of the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality during the previous 4 weeks.

Key results:

• The mean age of women in the study was 32.1±5.4, endometriosis stage by laparoscopy had an almost equal distribution (stage I: 29.2%, stage II: 22%, stage III: 25.4%, stage IV: 23.4%).
• The results of all questionnaires were submitted to the path model.
• It was found that sexual dysfunction in infertile women with endometriosis was mostly associated with anxiety, depression, body mass index, pelvic pain, dyspareunia, endometriosis stage, and sleep quality.
• The higher scores of sleep quality, anxiety, pelvic pain, and depression were associated with a decrease in the sexual function of the patients.
• The lower level of physical activity and the higher body mass index also suppressed the sexual activity of the patients.

Strengths and Limitations

• This study was the first research evaluating the relationship between the physical and psychological consequences of endometriosis and sexual dysfunction in infertile women with endometriosis.
• All patients in the study had laparoscopically confirmed endometriosis.
• The questionnaires used in the study (FSFI, HADS, VAS, PSQI) were validated.
• Not considering the impact of variables such as hormonal level, love, partner violence on sexual function could be accepted as the limitation of this study.
• The recruitment of the study population from the infertility clinic was another limitation.
• Another limitation was social desirability bias among the subjects regarding the religion and culture of Iranian women.

Lay Summary

Endometriosis is a disease defined as the localization of endometrial glandular and stromal tissue outside the uterine cavity. Its incidence ranges up to 10% of reproductive-aged women. The most common symptoms in these women are chronic pelvic pain, dyspareunia, and infertility. 

Endometriosis patients also suffer from psychological distress, anxiety, and depression. All of these symptoms impair the quality of life and sexual function of these patients.

Youseflu et al., from Iran, published a cross-sectional study titled “Influential factors on sexual function in infertile women with endometriosis: a path analysis” in the journal "BMC Women's Health". These authors sought to determine the predictors for sexual dysfunction in infertile women with endometriosis. They included infertile women with a diagnosis of laparoscopically confirmed endometriosis.

The severity of endometriosis was staged, sexual function during the last 4 weeks, anxiety and depression, the intensity of pelvic pain and dyspareunia, the sleep quality during the previous 4 weeks were evaluated. All results obtained from the questionnaires were submitted to the path model and the influential factors on sexual dysfunction were determined.

The authors found that the sexual dysfunction in infertile women with endometriosis was mostly associated with anxiety, depression, body mass index, pelvic pain, dyspareunia, endometriosis stage, and sleep quality. The higher scores of sleep quality, anxiety, pelvic pain, and depression were associated with a decrease in the sexual function of the patients. The lower level of physical activity and the higher body mass index also impaired the sexual activity of the patients.

“In the care of women with endometriosis, not only laparoscopy and medical treatment should be performed but also psychotherapeutic and psychosexual help should be offered,”  they added.

Research Source: https://pubmed.ncbi.nlm.nih.gov/32370796