Dyspareunia Linked to Underlying Form of Endometriosis

Women who complain of dyspareunia are four times more likely to have endometriosis than healthy women, according to a Polish study published in the Archives of Perinatal Medicine. Few studies have investigated the relationship between dyspareunia and co-occurring gynecological problems, and this is the first research to associate a specific form of endometriosis with dyspareunia.

The researchers recruited 61 sexually active women aged 23 to 43 years to participate in a controlled study. All of the women had been diagnosed with endometriosis. Forty-five percent (n = 28) had endometrial (chocolate) ovarian cysts and 55% (n = 33) had endometrioid foci throughout the peritoneal cavity. Sixty healthy, sexually active women aged 23 to 41 years were randomly selected to serve as a control group. The investigators solicited information about dyspareunia during the medical interview, which included questions about sexual quality of life.

The results showed that endometriosis is a significant risk factor for dyspareunia, conferring an odds ratio of 6.22 (range 2.62-14.96, P < 0.001). Every fourth patient with dyspareunia was found to have endometriosis. In addition, the researchers found that women with dyspareunia were five times more likely to have peritoneal endometriosis (84.38%) as compared to endometroid ovarian cysts (16.62%). This finding was statistically significant at P < 0.001. The researchers noted that their results were consistent with a previous study that found a positive prognostic value of 40% for dyspareunia in women diagnosed with endometriosis.

The authors speculated that vaginal pain with intercourse related to endometriosis may be caused by adhesions, mediators of inflammation found in peritoneal fluid, or synthesis of post-inflammatory cytokines, which may be increased in women with peritoneal endometriosis compared to those with chocolate cysts of the ovaries.

Clinical Takeaways

Given the intersection of pain, which makes patients feel vulnerable, and the potential embarrassment in talking about sexuality that occurs in cases of dyspareunia, it is essential to treat women presenting with dyspareunia with “deep empathy and gentleness,” reported the authors. In addition, they recommended that clinicians consider advising women who have peritoneal endometriosis and dyspareunia to have sexual intercourse less frequently until endometriosis has been resolved in order to avoid secondary psychogenic vaginismus.