Deep Dyspareunia, Superficial Dyspareunia, and Infertility Concerns Among Women With Endometriosis: A Cross-Sectional Study

Kate J Wahl, Natasha L Orr, Michelle Lisonek, Heather Noga, Mohamed A Bedaiwy, Christina Williams, Catherine Allaire, Arianne Y Albert, Kelly B Smith, Susan Cox, Paul J Yong, Kate J Wahl, Natasha L Orr, Michelle Lisonek, Heather Noga, Mohamed A Bedaiwy, Christina Williams, Catherine Allaire, Arianne Y Albert, Kelly B Smith, Susan Cox, Paul J Yong

Abstract

Introduction: Deep dyspareunia is a cardinal symptom of endometriosis, and as many as 40% of people with this condition experience comorbid superficial dyspareunia.

Aim: To evaluate the relationship between sexual pain and infertility concerns among women with endometriosis.

Methods: This is a cross-sectional study conducted at a university-based tertiary center for endometriosis. 300 reproductive-aged participants in the prospective Endometriosis Pelvic Pain Interdisciplinary Cohort (ClinicalTrials.gov Identifier: NCT02911090) with histologically confirmed endometriosis were included (2013-2017).

Main outcome measure: The total score on the infertility concerns module of the Endometriosis Health Profile-30 categorized into 5 groups (0, 1-4, 5-8, 9-12, 13-16).

Results: The odds of infertility concerns did not increase with severity of deep dyspareunia (odds ratio = 1.02, 95% CI: 0.95-1.09, P = .58). However, the odds of infertility concerns increased with severity of superficial dyspareunia (odds ratio = 1.09, 95% CI: 1.02-1.16, P = .011); this relationship persisted after adjusting for endometriosis-specific factors, infertility risk factors, reproductive history, and demographic characteristics (adjusted odds ratio [AOR] = 1.14, 95% CI: 1.06-1.24, P < .001). Other factors in the model independently associated with increased infertility concerns were previous difficulty conceiving (AOR = 2.09, 95% CI 1.04-4.19, P = .038), currently trying to conceive (AOR = 5.23, 95% CI 2.77-9.98, P < .001), nulliparity (AOR = 3.21, 95% CI 1.63-6.41, P < .001), and younger age (AOR = 0.94, 95% CI: 0.89-0.98, P = .005).

Conclusion: Severity of superficial dyspareunia, but not deep dyspareunia, was associated with increased odds of infertility concerns among women with endometriosis. Strengths of the study included the use of a validated measure of infertility concerns and disaggregation of sexual pain into deep and superficial dyspareunia. Limitations included the setting of a tertiary center for pelvic pain, which affects generalizability to fertility clinic and primary care settings. Women experiencing introital dyspareunia, who can have difficulties with achieving penetrative intercourse, may be concerned about their future fertility and should be counselled appropriately. Wahl KJ, Orr NL, Lisonek M, et al. Deep Dyspareunia, Superficial Dyspareunia, and Infertility Concerns Among Women With Endometriosis: A Cross-Sectional Study. Sex Med 2020;8:274-281.

Keywords: Dyspareunia; Endometriosis; Fertility; Infertility; Psychological Distress.

Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Selection of study sample. Flow chart of included and excluded cases.

References

    1. Orr N., Wahl K., Joannou A., Hartmann D., Valle L., Yong P. Deep dyspareunia: review of pathophysiology and proposed future research priorities. Sex Med Rev. 2020;8:3–17.
    1. Yong P.J., Mui J., Allaire C. Pelvic floor tenderness in the etiology of superficial dyspareunia. J Obstet Gynaecol Can. 2014;36:1002–1009.
    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.
    1. Practice Committee of the American Society for Reproductive Medicine Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril. 2012;98:1103–1111.
    1. Prescott J., Farland L.V., Tobias D.K. A prospective cohort study of endometriosis and subsequent risk of infertility. Hum Reprod. 2016;31:1475–1482.
    1. Young K., Kirkman M., Holton S. Fertility experiences in women reporting endometriosis: findings from the understanding fertility management in contemporary Australia survey. Eur J Contracept Reprod Health Care. 2018;23:434–440.
    1. Young K., Fisher J., Kirkman M. Endometriosis and fertility: women’s accounts of healthcare. Hum Reprod. 2016;31:554–562.
    1. Culley L., Hudson N., Mitchell H. The impact of endometriosis on planning for and having children: findings from the Endopart Study. J Fertil Counsel. 2014;21:22–25.
    1. Culley L., Law C., Hudson N. The social and psychological impact of endometriosis on women’s lives: a critical narrative review. Hum Reprod Update. 2013;19:625–639.
    1. Facchin F., Saita E., Barbara G. “Free butterflies will come out of these deep wounds”: a grounded theory of how endometriosis affects women’s psychological health. J Health Psychol. 2018;23:538–549.
    1. Facchin F., Buggio L., Dridi D. A woman’s worth: the psychological impact of beliefs about motherhood, female identity, and infertility on childless women with endometriosis. J Health Psychol. 2019 1359105319863093.
    1. de Mendonca C.R., Arruda J.T., Noll M. Sexual dysfunction in infertile women: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2017;215:153–163.
    1. Jindal U.N., Jindal S. Use by gynecologists of a modified sensate focus technique to treat vaginismus causing infertility. Fertil Steril. 2010;94:2393–2395.
    1. de Ziegler D., Borghese B., Chapron C. Endometriosis and infertility: pathophysiology and management. Lancet. 2010;376:730–738.
    1. Basson R. Rethinking low sexual desire in women. BJOG. 2002;109:357–363.
    1. Jones G., Jenkinson C., Kennedy S. The impact of endometriosis upon quality of life: a qualitative analysis. J Psychosom Obstet Gynaecol. 2004;25:123–133.
    1. Ruddy K.J., Gelber S.I., Tamimi R.M. Prospective study of fertility concerns and preservation strategies in young women with breast cancer. J Clin Oncol. 2014;32:1151–1156.
    1. Encyclopedia of survey research methods. Sage Publications; Thousand Oaks, CA: 2008. Cross-sectional data [internet] Available at:
    1. Yosef A., Yosef A., Allaire C. Multifactorial contributors to the severity of chronic pelvic pain in women. Am J Obstet Gynecol. 2016;215:760.e1–760.e14.
    1. Orr N.L., Noga H., Williams C. Deep dyspareunia in endometriosis: role of the bladder and pelvic floor. J Sex Med. 2018;15:1158–1166.
    1. Jones G., Kennedy S., Barnard A. Development of an endometriosis quality-of-life instrument: the endometriosis health profile-30. Obstet Gynecol. 2001;98:258–264.
    1. Vincent K., Kennedy S., Stratton P. Pain scoring in endometriosis: entry criteria and outcome measures for clinical trials. Report from the Art and Science of Endometriosis meeting. Fertil Steril. 2010;93:62–67.
    1. Dunselman G.A.J., Vermeulen N., Becker C. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29:400–412.
    1. Ballard K.D., Seaman H.E., De Vries C.S. Can symptomatology help in the diagnosis of endometriosis? Findings from a national case–control study—Part 1. BJOG. 2008;115:1382–1391.
    1. Agarwal S.K., Chapron C., Giudice L.C. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019;220:354.e1–354.e12.
    1. Greene R., Stratton P., Cleary S.D. Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertil Steril. 2009;91:32–39.
    1. Soliman A.M., Coyne K.S., Gries K.S. The effect of endometriosis symptoms on absenteeism and presenteeism in the workplace and at home. J Manag Care Spec Pharm. 2017;23:745–754.
    1. R Core Team . R Foundation for Statistical Computing; Vienna, Austria: 2008. R: a language and environment for statistical computing [internet] Available at:
    1. Kleiber C., Zeileis A. Springer-Verlag; New York, NY: 2008. Applied econometrics with R.
    1. Venables V.N., Ripley B.D. 4th ed. Springer Science; New York, NY: 2002. Modern applied statistics.
    1. Peduzzi P., Concato J., Kemper E. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49:1373–1379.
    1. Denny E., Mann C.H. Endometriosis-associated dyspareunia: the impact on women’s lives. J Fam Plann Reprod Health Care. 2007;33:189–193.
    1. Johnson N.S., Harwood E.M., Nguyen R.H.N. “You have to go through it and have your children”: reproductive experiences among women with vulvodynia. BMC Pregnancy Childbirth. 2015;15:114.
    1. Mazuy M, de la Rochebrochard E. Fertility problems: a widespread concern among women. Results from the French generations and gender survey [internet]. Population Association of America (PAA) Annual Meeting. April 17-19, 2018; New Orleans, LA. Available at: . Accessed October 18, 2018
    1. Brauer M., Kuile M.M. ter, Laan E. Cognitive-affective correlates and predictors of superficial dyspareunia. J Sex Marital Ther. 2008;35:1–24.
    1. Sullivan M.J.L., Bishop S.R., Pivik J. The Pain Catastrophizing Scale: development and validation. Psychol Assess. 1995;7:524–532.
    1. Spitzer R.L., Kroenke K., Williams J.B.W. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–1097.
    1. Kroenke K., Spitzer R.L., Williams J.B.W. The PHQ-9. J Gen Intern Med. 2001;16:606–613.
    1. Abbott J., Hawe J., Hunter D. Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Fertil Steril. 2004;82:878–884.
    1. Dmowski W.P., Lesniewicz R., Rana N. Changing trends in the diagnosis of endometriosis: a comparative study of women with pelvic endometriosis presenting with chronic pelvic pain or infertility. Fertil Steril. 1997;67:238–243.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere