The prevalence of deep and superficial dyspareunia in women with endometriosis..

Painful sexual intercourse causes unsatisfactory sexual life and quality of life.

Key Points

Importance:

• Endometriosis can lead to sexual dysfunction, primarily due to painful intercourse, which often triggers feelings of guilt and reduced femininity.

Highlights:

• Identifying and treating both deep and superficial dyspareunia in women with endometriosis is crucial for improving sexual function and overall quality of life.

What's done here:

• This bicentric, prospective, cross-sectional cohort study involved fertile women diagnosed with endometriosis who completed 2 questionnaires about their sexual experiences.
• The questionnaires included the Female Sexual Function Index and the International Quality of Life Assessment (SF-36).
• The Italian research team aimed to assess the prevalence and timing of deep and superficial dyspareunia and their impact on quality of life.

Key Results:

• A total of 334 patients participated: 238 from Bologna University Hospital and 96 from Madrid University Hospital.
• 3/4 reported experiencing dyspareunia; among them, nearly half had concomitant deep and superficial dyspareunia, 1/4 isolated superficial, and 6.3% isolated deep dyspareunia.
• Of the 145 women reporting concomitant dyspareunia, more than half indicated deep dyspareunia occurred first, 43.4% noted superficial dyspareunia started first.
• Physical functioning, physical role functioning, bodily pain, general health, and social role functioning were significantly impaired in women with concomitant dyspareunia.
• Vitality and social functioning were also significantly diminished in women with either concomitant or isolated deep dyspareunia.
• Women experiencing concomitant dyspareunia reported significantly worse sexual satisfaction and increased pain compared to those without dyspareunia.

Lay Summary

Almost half of the women affected by endometriosis experience both superficial and deep dyspareunia. While superficial dyspareunia is less studied, deep dyspareunia is often linked to mechanical pressure on endometriotic lesions or tissue rigidity. To address the sexual difficulties faced by women with endometriosis, pelvic floor physiotherapy, along with medical and surgical therapies, are being utilized.

To evaluate the prevalence of deep and superficial dyspareunia in women diagnosed with endometriosis, Forno et al. from the Department of Medical and Surgical Sciences at Bologna University in Italy conducted a bicentric, prospective, cross-sectional cohort study. The study's primary objective was to assess the prevalence of deep and superficial dyspareunia among participants from two referral centers. The secondary objective was to evaluate the temporal relationship between the onset of dyspareunia and its impact on quality of life and sexual dysfunction.

From June to December 2022, all consecutive patients diagnosed with endometriosis who attended the two centers—the university hospitals in Bologna, Italy, and Madrid, Spain—were invited to participate in the study. In addition to collecting demographic data and gynecologic history, participants reported the severity of their pain—including dysmenorrhea, dyschezia, dysuria, dyspareunia, chronic pelvic pain, and ovulatory pain—using the Numerical Rating Scale. The differences among the 4 study groups, namely isolated superficial dyspareunia, isolated deep dyspareunia, both superficial and deep dyspareunia, and no-dyspareunia, were assessed by using appropriate statistical parameters.

The main results of the study are that the concomitant dyspareunia cohort reported significantly worse sexual dysfunction than women with isolated or without dyspareunia. This cohort also reported the development of deep dyspareunia before superficial dyspareunia. This reverse-appearing pattern of onset might be due to the start of deep pain in the posterior compartment nodule and subsequently developing pelvic floor hypertonia as a defensive response, which they call superficial dyspareunia.

The authors concluded that clinicians should prioritize diagnosing and treating deep and superficial dyspareunia in women with endometriosis to improve their quality of life and overall well-being.

This important prospective study was recently published in Archives of Gynecology and Obstetrics.

Research Source: https://pubmed.ncbi.nlm.nih.gov/39052076/