Endometriosis and deep dyspareunia linked to worse sexual quality of life

In women with endometriosis, deep dyspareunia is associated with lower sexual quality of life (QoL), according to a study in Sexual Medicine.

“Endometriosis is a common condition, affecting 10% of reproductive-aged women,” said co-author Paul Yong, MD, PhD, an assistant professor in the Department of Obstetrics and Gynecology at the University of British Columbia in Vancouver, Canada. “Moreover, half of women with endometriosis experience deep dyspareunia, which is pelvic pain with deep penetration during sexual activity.”

Dr. Yong noted it has been previously shown that women with deep dyspareunia have worse sexual function than women without.  “However, there are many potential confounders, because patients with endometriosis can also experience superficial dyspareunia-pain at the vaginal opening with penetration during sexual activity-or have other types of pelvic pain, such as chronic pelvic pain, or comorbid psychological conditions like depression, that could also affect sexual function,” Dr. Yong told Contemporary OB/GYN.

The study enrolled 277 women, with a median age of 34.2 years, from a tertiary-level referral center for endometriosis and pelvic plain. Nearly two-thirds of the women had stage I or stage II endometriosis at time of subsequent surgery.

The primary outcome was sexual QoL as measured by the five-item subscale of the 30-item Endometriosis Health Profile (EHP-30) sexual intercourse modular questionnaire.

The subscale evaluates pain with intercourse, worry about having intercourse due to pain, guilt about not wanting intercourse, frustration about not enjoying intercourse and avoidance of intercourse. Each of the five questions was answered on a 5-point scale: 0 (never), 1 (rarely), 2 (sometimes), 3 (often) and 4 (always).  Patient scores were then totaled and divided by the maximum possible score of 20. Next, the score was multiplied by 100 to provide a percentage, with 0% indicating the best sexual QoL and 100% indicating the worse. Mean sexual quality of life was 60.9%.

As part of the patient registry data collection, information was also gleaned on pain severities, psychological comorbidities, and pain diagnoses. Deep dyspareunia was measured on a scale from 0 (no pain) to 10 (worse pain imaginable), for which the mean deep dyspareunia was 6.5. 

Roughly half the study patients had irritable bowel syndrome or bladder pain syndrome, nearly one-third had abdominal wall pain and one-third had pelvic floor myalgia. 

The study found that in women with endometriosis, “severity of deep dyspareunia is associated with worse sexual QoL, independent of superficial dyspareunia, other types of pelvic pain, psychological comorbidities and potential demographic confounders,” Dr. Yong said. “Therefore, deep dyspareunia does independently worsen sexual quality of life.”

Dr. Yong said that what is interesting about the study is that both deep dyspareunia and superficial dyspareunia exerted independent effects on sexual QoL. “Hence, both types of sexual pain are important for sexual function,” he noted.

Another finding is that depression and pain catastrophizing were linked to lower sexual QoL. Likewise, women with heterosexual orientation recorded lower QoL, as did new referrals compared to rereferrals.

One limitation of the study is that due to its observational nature, the study was unable to account for possible side effects of treating deep dyspareunia to improve sexual QoL. 

To improve sexual quality of life in women with endometriosis, it is important to consider specific treatment for such conditions as deep dyspareunia, superficial dyspareunia and psychological comorbidities, “as they may each exert an independent effect on sexual function,” Dr. Yong said.

Last year in Sexual Medicine Reviews, Dr. Young showed that the published literature on treatment of sexual pain in endometriosis is limited. “There is a need for randomized trials that are adequately powered to show changes in deep dyspareunia,” he said.