Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis

doi:10.1016/j.esxm.2018.04.006

. 2018 Sep;6(3):224-233.

doi: 10.1016/j.esxm.2018.04.006. Epub 2018 May 22.

Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis

Leona K Shum¹, Mohamed A Bedaiwy², Catherine Allaire³, Christina Williams³, Heather Noga⁴, Arianne Albert⁵, Sarka Lisonkova⁶, Paul J Yong⁷

Affiliations

¹ School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
² Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; BC Women's Center for Pelvic Pain and Endometriosis, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada.
³ Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; BC Women's Center for Pelvic Pain and Endometriosis, Vancouver, BC, Canada.
⁴ Women's Health Research Institute, Vancouver, BC, Canada.
⁵ Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada.
⁶ Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada.
⁷ Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; BC Women's Center for Pelvic Pain and Endometriosis, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada. Electronic address: paul.yong@vch.ca.

PMID: 29801714
PMCID: PMC6085224
DOI: 10.1016/j.esxm.2018.04.006

Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis

Leona K Shum et al. Sex Med. 2018 Sep.

. 2018 Sep;6(3):224-233.

doi: 10.1016/j.esxm.2018.04.006. Epub 2018 May 22.

Authors

Leona K Shum¹, Mohamed A Bedaiwy², Catherine Allaire³, Christina Williams³, Heather Noga⁴, Arianne Albert⁵, Sarka Lisonkova⁶, Paul J Yong⁷

Affiliations

¹ School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
² Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; BC Women's Center for Pelvic Pain and Endometriosis, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada.
³ Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; BC Women's Center for Pelvic Pain and Endometriosis, Vancouver, BC, Canada.
⁴ Women's Health Research Institute, Vancouver, BC, Canada.
⁵ Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada.
⁶ Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada.
⁷ Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; BC Women's Center for Pelvic Pain and Endometriosis, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada. Electronic address: paul.yong@vch.ca.

PMID: 29801714
PMCID: PMC6085224
DOI: 10.1016/j.esxm.2018.04.006

Abstract

Introduction: Deep dyspareunia occurs in half of women with endometriosis, a condition present in 10% of reproductive-age women and associated with negative effects on sexual quality of life (SQoL). However, women with endometriosis can have other clinical factors (eg, superficial dyspareunia, other pelvic pains, and psychological or pain conditions) possibly affecting SQoL.

Aims: To determine whether deep dyspareunia is associated with SQoL in women with endometriosis, independent of potential confounders.

Methods: This study involved a prospective patient registry of women at a tertiary-level referral center for endometriosis and pelvic pain. Inclusion criteria were (i) referrals to the center recruited into the registry from January 2014 through December 2016 and (ii) subsequent surgery at the center with histologic confirmation of endometriosis. Exclusion criteria included menopausal status, age at least 50 years, never sexually active, or did not answer dyspareunia or SQoL questions. Bi-variable tests and multiple linear regression analysis were performed.

Main outcome measures: SQoL measured by the 5-item sexual intercourse subscale of the Endometriosis Health Profile-30 (EHP-30) modular questionnaire (0-100%, with higher scores indicating worse SQoL).

Results: Consent rate for the prospective registry was 87%; 277 women met the study criteria (mean age = 34.2 ± 7.1 years). Most women had stage I to II endometriosis at time of surgery (64%), with the remaining having stage III to IV endometriosis. Through regression analysis, worse SQoL (higher EHP-30 sexual intercourse subscale score) was independently associated with: more severe deep dyspareunia (P < .0001), more severe superficial dyspareunia (P < .0001), increased depression (P < .001), higher pain catastrophizing (P = .04), bladder pain syndrome (P = .02), heterosexual orientation (P < .001), and new referral status (P = .02).

Conclusion: In women with endometriosis at a tertiary referral center, more severe deep dyspareunia was associated with worse SQoL, independent of superficial dyspareunia, psychological comorbidities, and other potential confounders. Shum LK, Bedaiwy MA, Allaire C, et al. Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis. Sex Med 2018;6:224-233.

Keywords: Deep Dyspareunia; Endometriosis; Sexual Quality of Life; Superficial Dyspareunia.

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Figures

**Figure 1**
Study population flowchart indicating the inclusion and exclusion criteria for this study. EHP-30 = Endometriosis Health Profile-30.

**Figure 2**
Correlation between deep dyspareunia severity and worse sexual quality of life (higher EHP-30 intercourse subscale score; r = 0.55, P < .0001). Error bars indicate the mean and SD in EHP-30 intercourse subscale score. EHP-30 = Endometriosis Health Profile-30.

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References

1. Jarząbek-Bielecka G., Radomski D., Pawlaczyk M. Dyspareunia as a sexual problem in women with endometriosis. Arch Perinat Med. 2010;16:51–53.
1. Yong P.J., Sadownik L., Brotto L.A. Concurrent deep-superficial dyspareunia: prevalence, associations, and outcomes in a multidisciplinary vulvodynia program. J Sex Med. 2015;12:219–227. - PubMed
1. Denny E., Mann C.H. Endometriosis-associated dyspareunia: the impact on women's lives. J Fam Plan Reprod Heal Care. 2007;33:189–193. - PubMed
1. Ferrero S., Esposito F., Abbamonte L.H. Quality of sex life in women with endometriosis and deep dyspareunia. Fertil Steril. 2005;83:573–579. - PubMed
1. Lukic A., Di Properzio M., De Carlo S. Quality of sex life in endometriosis patients with deep dyspareunia before and after laparoscopic treatment. Arch Gynecol Obstet. 2016;293:583–590. - PubMed

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[1] Jarząbek-Bielecka G., Radomski D., Pawlaczyk M. Dyspareunia as a sexual problem in women with endometriosis. Arch Perinat Med. 2010;16:51–53.

[2] Jarząbek-Bielecka G., Radomski D., Pawlaczyk M. Dyspareunia as a sexual problem in women with endometriosis. Arch Perinat Med. 2010;16:51–53.

[3] Yong P.J., Sadownik L., Brotto L.A. Concurrent deep-superficial dyspareunia: prevalence, associations, and outcomes in a multidisciplinary vulvodynia program. J Sex Med. 2015;12:219–227. - PubMed

[4] Yong P.J., Sadownik L., Brotto L.A. Concurrent deep-superficial dyspareunia: prevalence, associations, and outcomes in a multidisciplinary vulvodynia program. J Sex Med. 2015;12:219–227. - PubMed

[5] Denny E., Mann C.H. Endometriosis-associated dyspareunia: the impact on women's lives. J Fam Plan Reprod Heal Care. 2007;33:189–193. - PubMed

[6] Denny E., Mann C.H. Endometriosis-associated dyspareunia: the impact on women's lives. J Fam Plan Reprod Heal Care. 2007;33:189–193. - PubMed

[7] Ferrero S., Esposito F., Abbamonte L.H. Quality of sex life in women with endometriosis and deep dyspareunia. Fertil Steril. 2005;83:573–579. - PubMed

[8] Ferrero S., Esposito F., Abbamonte L.H. Quality of sex life in women with endometriosis and deep dyspareunia. Fertil Steril. 2005;83:573–579. - PubMed

[9] Lukic A., Di Properzio M., De Carlo S. Quality of sex life in endometriosis patients with deep dyspareunia before and after laparoscopic treatment. Arch Gynecol Obstet. 2016;293:583–590. - PubMed

[10] Lukic A., Di Properzio M., De Carlo S. Quality of sex life in endometriosis patients with deep dyspareunia before and after laparoscopic treatment. Arch Gynecol Obstet. 2016;293:583–590. - PubMed

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Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis

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Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis

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