Laparoscopy Significantly Improves Deep Dyspareunia Associated with Endometriosis

Laparoscopic treatment can significantly improve the sex lives of women with endometriosis by relieving deep dyspareunia, according to a study published in Archives of Gynecology and Obstetrics. Dyspareunia is not always given “sufficient attention and consideration by the medical profession,” reported the authors, who added that dyspareunia affects 60% to 70% of women with endometriosis who are undergoing laparoscopy and 50% to 90% of women with endometriosis who are receiving hormone therapy.

Italian researchers enrolled 67 women, average age 39 years, with both clinical and operative diagnosis of endometriosis to whom surgery had been recommended into a study in which they were asked to complete pre- and post-surgical questionnaires. All of the women were sexually active and fertile, and were operated on by the same surgeon. Exclusions included use of medical treatment for endometriosis within 6 months prior to surgery, psychiatric disorders, or physical causes of deep dyspareunia other than endometriosis such as pelvic varicocele, interstitial cystitis, and other conditions.

The subjects filled out a 4-part, 69-item survey prior to surgery and 6 months after surgery. The questionnaire asked the patients about their sex lives and instructed them to rate pain intensity on a visual analog scale (VAS) from 0, no pain, to 10, the worst pain imaginable. Most of the women reported they had suffered from endometriosis for an average of 9.49 years before diagnosis around age 31. Approximately half of the women (n = 32) were classified as having stage 3 disease and half (n = 35) were classified as having stage 4 disease. Seventy percent said they had pain only during intercourse and the other 30% said they had pain both during and after sex.

After the surgical intervention, the intensity of dyspareunia as measured by VAS decreased from 7.81+2.08 to 3.46+2.62 (P < 0.05). Younger women (aged < 30 years) were the mostly likely to benefit from surgery, and had the highest levels of pain prior to surgery compared to 31-to-45-year olds and those aged > 45 years. Table 1 highlights other improvements in the quality of the participants’ sex lives, based on the data published in Tables 2 and 3 of the research article.

Table 1. Improvements in Quality of Sex Life Pre- and Post-Laparoscopy

Parameter studied

Before surgery

After surgery

P Value

Sex life satisfactory (n=67)

21

39

P < 0.05

Achieve peak sexual pleasure (n=65)

37

50

P < 0.05

Sexual intercourse without difficulty (n=67)

29

49

P < 0.05

Pain did not affect sexual pleasure (n=67)

29

48

P = 0.004

Number of episodes of sexual intercourse in whole sample with dyspareunia (N=67)

15.95+10.88

20.81+14.08

P = 0.001

Number of episodes of sexual intercourse with dyspareunia only during intercourse (N=67)

16.53+11.82

21.66+14.62

P=0.001

The authors noted that dyspareunia can lead to a fear of dyspareunia, pain begetting pain, which is characterized by reductions in libido and vestibular lubrication, and painful spasms of the pelvic floor muscles. Ultimately, this may precipitate actual mechanical, vaginal, and urethral trauma. This fear of dyspareunia is notable in regard to the delay in diagnosis of endometriosis (around 9 years in this study) and can lay the groundwork for future sexual dysfunction. In addition to diagnosing endometriosis earlier in the course of the disease, the authors wrote that “It is essential to involve a multidisciplinary team to assess all the signs and symptoms that may appear in a woman of fertile age, so as to ensure a treatment that is as personalized as possible.”