Endometriosis is a condition that affects women with menstrual periods and can cause painful periods, menorrhagia, and infertility, especially during sexual intercourse. This occurs when tissue similar to the tissue that lines the uterus (endometrium) begins to grow outside the uterus. Because this tissue acts like the endometrium, it thickens and breaks down each month during a woman's menstrual cycle, just like uterine tissue. However, because they have no means of being expelled from the body, they irritate surrounding tissues, creating scar tissue, causing pelvic pain, and sometimes cysts and/or adhesions (terms for separate organs sticking together).
Deep endometriosis (DE) is the most severe form of the disease. DE penetrates deep into the pelvic tissue, affecting organs near the uterus, such as the bladder and/or bowel, and causing changes in the structure of pelvic organs (e.g., adhesions). Unfortunately, DE is closely associated with female sexual dysfunction (FSD).
The standard treatment for DE is laparoscopy, a surgery that involves making small incisions in the abdomen and using a camera to guide the procedure. During laparoscopic surgery for DE, the surgeon separates any adhesions, removes endometrial cysts, and removes endometrial tissue located outside the uterus.
Despite being a common procedure for DE, little is known about the impact of laparoscopic surgery on sexual function in patients with DE. To this end, recent authors Journal of Sexual Medicine The study assessed sexual function in a cohort of 149 women with DE at four specific time points: once before surgery and 6 weeks, 6 months, and 12 months after surgery.
Participants were asked to complete the Female Sexual Function Index (FSFI) questionnaire at each time point. The FSFI assesses women's sexual function across six areas: desire, arousal, orgasm, lubrication, satisfaction, and pain. It consists of 19 questions that participants can rate on a scale of 0 (if applicable) or 1 to 5, with higher numbers indicating improved sexual function. For the purposes of this study, researchers used an overall FSFI score of 26.55 or less as the cutoff point to indicate FSD.
The rate of FSD among preoperative study participants was very high at 75.5%. Not surprisingly, this rate increased slightly to 76.5% at 6 weeks postoperatively. This is because individuals typically require some recovery time after surgery and may not resume their sex life immediately. At 6 months after surgery, the FSD rate dropped to 71.8%, and at the final inspection 12 months after surgery, the FSD rate was 63.6%.
Although the rate of FSD among women in this cohort decreased at 6 and 12 months after surgery, the proportion of women who experienced FSD still remained significantly high. Moreover, the absence of FSD according to this measure does not necessarily mean that the remaining women do not have sexual difficulties. With this in mind, it may be helpful for people with DE to talk to their health care providers about any sexual concerns they have and to request additional resources to manage their sexual health. Clinicians can further support DE patients by taking the time to counsel them about expected outcomes related to sexual function after surgery and provide necessary referrals to sexual medicine specialists who can work with patients to address their specific concerns.
resource:
Dior, U.P., Reddington, C., Cheng, C., Levin, G., & Healey, M. (2022). Perioperative sexual function in women with severe endometriosis: a prospective study. Journal of Sexual Medicine, 19(2), 280-289. DOI: https://doi.org/10.1016/j.jsxm.2021.11.009
Mayo Clinic. (July 24, 2018). Endometriosis. https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656