Does interdisciplinary care improve deep dyspareunia treatment?

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Though much research has focused on treatment options for superficial dyspareunia, less is known about response to treatment and predictors of deep dyspareunia. A recent study, appearing in The Journal of Sexual Medicine, assessed severity of deep dyspareunia in a 1-year prospective observational cohort at an interdisciplinary center to identify baseline predictors of more persistent deep dyspareunia at 1 year. Sexual quality of life was measured as a secondary outcome to see whether reducing pain resulted in improved sexual well-being. 

The authors performed their study at a center for pelvic pain and endometriosis where a range of interdisciplinary treatments (surgical, hormonal, physical, and psychological) are provided. The patients completed baseline online questionnaires and a gynecologist formulated a treatment plan following an assessment and made recommendations for interdisciplinary interventions. After 1 year, follow-up online questionnaires were sent to the patients to gauge the severity of their chronic pain. 

Data collected from the cohort were assessed using self-reported pain scores on an 11-point numeric scale (0-10), the Endometriosis Health Profile-30, a validated scale for quality of life, and physical exam data. Psychological data such as depression, anxiety, and catastrophizing were also assessed. 

The cohort included 278 patients. Interventions received by them during the 1-year period included laparoscopic surgery (n=121), hormonal suppressive therapy (n=33 taking at both baseline and 1 year), pain adjuvant medication (n=29 taking at both baseline and 1 year), and enrollment in a pain program (pain education, physiotherapy, psychological therapy) (n=45). At baseline, 55% of the women rated their deep dyspareunia as severe (7-10), 7.7% rated severity as moderate (4-6) and 27.3% rated it as none-mild (0-3). At 1-year follow-up, 30.4% rated their pain as severe, 25% rated it as moderate, and 44.6% rated it as none-mild. Sexual quality of life also improved after 1 year, from 56% at baseline to 43% on the sex subscale of the Endometriosis Health Profile-30 (a higher score indicates worse sexual quality of life). 

The authors noted that two baseline features were significantly associated with deep dyspareunia severity at 1 year: younger age (OR=0.94; 95% CI = 0.91-0.97, P = .008) and higher depression score (OR=1.07; 95% CI = 1.03-1.11, P = .01). The other measured baselines did not predict severity. Among the interventions, a treatment effect was detected for surgery after adjustment for baseline age and depression. No significant difference was observed between those who had ≥ 2 interventions versus ≤1. observed. 

The authors identified a few strengths and limitations to the study. Among the noted strengths were its prospective nature and assessment of deep dyspareunia exclusively. However, the non-randomized design and patients lost to follow-up over the 1 year were among the identified limitations. 

The authors believe that their findings illustrate that interdisciplinary care has a role in treating deep dyspareunia. While more research is necessary, the results show that clinicians should screen for depression in their deep dyspareunia patients and should consider treating it in conjunction with conventional gynecologic therapy.