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CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2018; 40(03): 115-120
DOI: 10.1055/s-0038-1639593
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Female Sexual Function in Women with Suspected Deep Infiltrating Endometriosis

Função sexual feminina em mulheres com suspeita de endometriose infiltrativa profunda
Ryane Vieira Lima
1   Hospital do Servidor Público Estadual, São Paulo, SP, Brazil
,
Ana Maria Gomes Pereira
1   Hospital do Servidor Público Estadual, São Paulo, SP, Brazil
,
Fernando Bray Beraldo
1   Hospital do Servidor Público Estadual, São Paulo, SP, Brazil
,
Cláudia Gazzo
1   Hospital do Servidor Público Estadual, São Paulo, SP, Brazil
,
João Alfredo Martins
1   Hospital do Servidor Público Estadual, São Paulo, SP, Brazil
,
Reginaldo Guedes Coelho Lopes
1   Hospital do Servidor Público Estadual, São Paulo, SP, Brazil
› Author Affiliations
Further Information

Publication History

16 September 2017

24 January 2018

Publication Date:
02 April 2018 (online)

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Abstract

Objective To evaluate the quality of the sexual function of women with suspected deep infiltrating endometriosis.

Methods A cross-sectional, observational and prospective study was conducted between May 2015 and August 2016, in which 67 patients with deep infiltrating endometriosis, suspected or diagnosed, were assessed for epidemiological and clinical characteristics, such as pain level through a visual analog scale (VAS), features of deep infiltrating endometriosis lesions and score on the Female Sexual Function Index (FSFI) before the onset of treatment. The statistical analysis was performed using the software STATA version 12.0 (StataCorp LLC, College Station, TX, USA) to compare the variables through multiple regression analysis.

Results The average age of the patients was 39.2 years old; most patients were symptomatic (92.5%); and the predominant location of the deep infiltrating lesions was on the rectosigmoid colon (50%), closely followed by the retrocervical region (48.3%). The median overall score on the FSFI was 23.4; in 67.2% of the cases the score was ≤ 26.5 (cutoff point for sexual dysfunction). Deep dyspareunia (p = 0.000, confidence interval [CI]: 0.64–0.83) and rectosigmoid endometriosis lesions (p = 0.008, CI: 0.72–0.95) showed significant correlation with lower FSFI scores, adjusted by bladder lesion, patients' age and size of lesions. Deep dyspareunia (p = 0.003, CI: 0.49–0.86) also exhibited significant correlation with FSFI pain domain, adjusted by cyclic bowel pain, vaginal lesion and use of gonadotropin-releasing hormone (GnRH) analog. These results reflect the influence of deep dyspareunia on the sexual dysfunction of the analyzed population.

Conclusion Most patients exhibited sexual dysfunction, and deep dyspareunia was the pelvic painful symptom that showed correlation with sexual dysfunction.

Resumo

Objetivo Avaliar a qualidade da função sexual em pacientes com suspeita de endometriose profunda infiltrativa.

Métodos Foi realizado um estudo observacional transversal prospectivo entre maio de 2015 e agosto de 2016, no qual foram analisados os dados clínicos e epidemiológicos de 67 pacientes com endometriose profunda presuntiva ou diagnosticada, níveis de dor através de escala visual analógica (EVA) e Índice de Função Sexual Feminina (questionário IFSF) antes do início do tratamento. A análise estatística foi realizada utilizando o programa estatístico STATA, na versão 12.0 (StataCorp LLC, College Station, TX, USA), para comparar as variáveis por meio de regressão múltipla.

Resultados A idade média foi de 39,2 anos; houve predominância de mulheres sintomáticas (92,5%) e da localização de lesões de endometriose profunda em retossigmoide (50%) seguida pela topografia retrocervical (48,3%). A pontuação total no IFSF mostrou uma mediana de 23,4, e em 67,2% das mulheres a pontuação foi ≤ 26,55 (cut-off que indica disfunção sexual). Dispareunia (p = 0.000, intervalo de confiança [IC]: 0.64–0.83) e lesão endometriótica em retossigmoide (p = 0.008, IC: 0.72–0.95) exibiram uma relação estatisticamente significante com valores baixos de pontuação no IFSF, ajustados por lesão em bexiga, idade da paciente e tamanho da lesão. A dispareunia de profundidade também mostrou correlação significante com o domínio dor do IFSF ajustado por dor cíclica intestinal, lesão vaginal e uso de análogo de hormônio liberador de gonadotrofina (GnRH). Os resultados refletem a influência da dispareunia de profundidade na disfunção sexual da população do estudo.

Conclusão A maioria das pacientes apresentava disfunção sexual e o sintoma mais relacionado a esta disfunção foi dispareunia de profundidade.

Keywords

endometriosis - sexuality - deeply infiltrating endometriosis

Palavras-chave

endometriose - sexualidade - endometriose profunda infiltrativa
 

  • References

  • 1 Abrão MS, Petraglia F, Falcone T, Keckstein J, Osuga Y, Chapron C. Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management. Hum Reprod Update 2015; 21 (03) 329-339 . Doi: 10.1093/humupd/dmv003
    CrossrefPubMedGoogle Scholar
  • 2 Wolthuis AM, Meuleman C, Tomassetti C, D'Hooghe T, de Buck van Overstraeten A, D'Hoore A. Bowel endometriosis: colorectal surgeon's perspective in a multidisciplinary surgical team. World J Gastroenterol 2014; 20 (42) 15616-15623 . Doi: 10.3748/wjg.v20.i42.15616
    CrossrefPubMedGoogle Scholar
  • 3 Kennedy S, Bergqvist A, Chapron C. , et al; ESHRE Special Interest Group for Endometriosis and Endometrium Guideline Development Group. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2005; 20 (10) 2698-2704 . Doi: 10.1093/humrep/dei135
    CrossrefPubMedGoogle Scholar
  • 4 Bricou A, Batt RE, Chapron C. Peritoneal fluid flow influences anatomical distribution of endometriotic lesions: why Sampson seems to be right. Eur J Obstet Gynecol Reprod Biol 2008; 138 (02) 127-134 . Doi: 10.1016/j.ejogrb.2008.01.014
    CrossrefPubMedGoogle Scholar
  • 5 Alkatout I, Egberts JH, Mettler L. , et al. [Interdisciplinary Diagnosis and Treatment of Deep Infiltrating Endometriosis]. Zentralbl Chir 2016; 141 (06) 630-638 . Doi: 10.1055/s-0034-1383272
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Nácul AP, Spritzer PM. [Current aspects on diagnosis and treatment of endometriosis]. Rev Bras Ginecol Obstet 2010; 32 (06) 298-307 . Doi: 10.1590/S0100-72032010000600008
    CrossrefPubMedGoogle Scholar
  • 7 Haas D, Chvatal R, Habelsberger A, Wurm P, Schimetta W, Oppelt P. Comparison of revised American Fertility Society and ENZIAN staging: a critical evaluation of classifications of endometriosis on the basis of our patient population. Fertil Steril 2011; 95 (05) 1574-1578 . Doi: 10.1016/j.fertnstert.2011.01.135
    CrossrefPubMedGoogle Scholar
  • 8 Haas D, Wurm P, Shamiyeh A, Shebl O, Chvatal R, Oppelt P. Efficacy of the revised Enzian classification: a retrospective analysis. Does the revised Enzian classification solve the problem of duplicate classification in rASRM and Enzian?. Arch Gynecol Obstet 2013; 287 (05) 941-945 . Doi: 10.1007/s00404-012-2647-1
    CrossrefPubMedGoogle Scholar
  • 9 Guerriero S, Ajossa S, Orozco R. , et al. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in the rectosigmoid: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2016; 47 (03) 281-289 . Doi: 10.1002/uog.15662
    CrossrefPubMedGoogle Scholar
  • 10 Medeiros LR, Rosa MI, Silva BR. , et al. Accuracy of magnetic resonance in deeply infiltrating endometriosis: a systematic review and meta-analysis. Arch Gynecol Obstet 2015; 291 (03) 611-621 . Doi: 10.1007/s00404-014-3470-7
    CrossrefPubMedGoogle Scholar
  • 11 Vercellini P, Fedele L, Aimi G, Pietropaolo G, Consonni D, Crosignani PG. Association between endometriosis stage, lesion type, patient characteristics and severity of pelvic pain symptoms: a multivariate analysis of over 1000 patients. Hum Reprod 2007; 22 (01) 266-271 . Doi: 10.1093/humrep/del339
    CrossrefPubMedGoogle Scholar
  • 12 Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod Genet 2010; 27 (08) 441-447 . Doi: 10.1007/s10815-010-9436-1
    CrossrefPubMedGoogle Scholar
  • 13 Jacobson TZ, Barlow DH, Koninckx PR, Olive D, Farquhar C. Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database Syst Rev 2002; (04) CD001398 . Doi: 10.1002/14651858.CD001398
    PubMedGoogle Scholar
  • 14 Vercellini P, Somigliana E, Buggio L, Barbara G, Frattaruolo MP, Fedele L. “I can't get no satisfaction”: deep dyspareunia and sexual functioning in women with rectovaginal endometriosis. Fertil Steril 2012; 98 (06) 1503-11.e1 . Doi: 10.1016/j.fertnstert.2012.07.1129
    CrossrefPubMedGoogle Scholar
  • 15 Morsch DM, Carneiro MM, Lecke SB. , et al. c-fos gene and protein expression in pelvic endometriosis: a local marker of estrogen action. J Mol Histol 2009; 40 (01) 53-58 . Doi: 10.1007/s10735-009-9212-7
    CrossrefPubMedGoogle Scholar
  • 16 Di Donato N, Montanari G, Benfenati A. , et al. Do women with endometriosis have to worry about sex?. Eur J Obstet Gynecol Reprod Biol 2014; 179: 69-74 . Doi: 10.1016/j.ejogrb.2014.05.022
    CrossrefPubMedGoogle Scholar
  • 17 Jones G, Jenkinson C, Kennedy S. The impact of endometriosis upon quality of life: a qualitative analysis. J Psychosom Obstet Gynaecol 2004; 25 (02) 123-133 . Doi: 10.1080/01674820400002279
    CrossrefPubMedGoogle Scholar
  • 18 Pluchino N, Wenger JM, Petignat P. , et al. Sexual function in endometriosis patients and their partners: effect of the disease and consequences of treatment. Hum Reprod Update 2016; 22 (06) 762-774 . Doi: 10.1093/humupd/dmw031
    CrossrefPubMedGoogle Scholar
  • 19 Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281 (06) 537-544 . Doi: 10.1001/jama.281.6.537
    CrossrefPubMedGoogle Scholar
  • 20 Elmerstig E, Wijma B, Berterö C. Why do young women continue to have sexual intercourse despite pain?. J Adolesc Health 2008; 43 (04) 357-363 . Doi: 10.1016/j.jadohealth.2008.02.011
    CrossrefPubMedGoogle Scholar
  • 21 Leite APL, Moura EA, Salles AAS, Mattar R, Souza E, Camano L. Validation of the Female Sexual Function Index in Brazilian pregnant women. Rev Bras Ginecol Obstet 2007; 29: 396-401 . Doi: 10.1590/S0100-72032007000800003
    CrossrefPubMedGoogle Scholar
  • 22 Hentschel H, Alberton DL, Capp E, Goldim JR, Passos EP. Validação do Female Sexual Function Index (FSFI) para uso em português. Rev HCPA 2007; 27: 10-14
    PubMedGoogle Scholar
  • 23 Rosen R, Brown C, Heiman J. , et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 2000; 26 (02) 191-208 . Doi: 10.1080/009262300278597
    CrossrefPubMedGoogle Scholar
  • 24 Thomassin I, Bazot M, Detchev R, Barranger E, Cortez A, Darai E. Symptoms before and after surgical removal of colorectal endometriosis that are assessed by magnetic resonance imaging and rectal endoscopic sonography. Am J Obstet Gynecol 2004; 190 (05) 1264-1271 . Doi: 10.1016/j.ajog.2003.12.004
    CrossrefPubMedGoogle Scholar
  • 25 Van den Broeck U, Meuleman C, Tomassetti C. , et al. Effect of laparoscopic surgery for moderate and severe endometriosis on depression, relationship satisfaction and sexual functioning: comparison of patients with and without bowel resection. Hum Reprod 2013; 28 (09) 2389-2397 . Doi: 10.1093/humrep/det260
    CrossrefPubMedGoogle Scholar
  • 26 Crosignani PG, Luciano A, Ray A, Bergqvist A. Subcutaneous depot medroxyprogesterone acetate versus leuprolide acetate in the treatment of endometriosis-associated pain. Hum Reprod 2006; 21 (01) 248-256 . Doi: 10.1093/humrep/dei290
    CrossrefPubMedGoogle Scholar
  • 27 Vercellini P, Pietropaolo G, De Giorgi O, Pasin R, Chiodini A, Crosignani PG. Treatment of symptomatic rectovaginal endometriosis with an estrogen-progestogen combination versus low-dose norethindrone acetate. Fertil Steril 2005; 84 (05) 1375-1387 . Doi: 10.1016/j.fertnstert.2005.03.083
    CrossrefPubMedGoogle Scholar
  • 28 Schlaff WD, Carson SA, Luciano A, Ross D, Bergqvist A. Subcutaneous injection of depot medroxyprogesterone acetate compared with leuprolide acetate in the treatment of endometriosis-associated pain. Fertil Steril 2006; 85 (02) 314-325 . Doi: 10.1016/j.fertnstert.2005.07.1315
    CrossrefPubMedGoogle Scholar
  • 29 Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther 2005; 31 (01) 1-20 . Doi: 10.1080/00926230590475206
    CrossrefPubMedGoogle Scholar
  • 30 Bellelis P, Dias Jr JA, Podgaec S, Gonzales M, Baracat EC, Abrão MS. Epidemiological and clinical aspects of pelvic endometriosis–a case series. Rev Assoc Med Bras 2010; 56: 467-471 . Doi: 10.1590/S0104-42302010000400022
    CrossrefPubMedGoogle Scholar
  • 31 Arruda MS, Petta CA, Abrão MS, Benetti-Pinto CL. Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women. Hum Reprod 2003; 18 (04) 756-759 . Doi: 10.1093/humrep/deg136
    CrossrefPubMedGoogle Scholar
  • 32 Giudice LC, Kao LC. Endometriosis. Lancet 2004; 364 (9447): 1789-1799 . Doi: 10.1016/S0140-6736(04)17403-5
    CrossrefPubMedGoogle Scholar
  • 33 Jia SZ, Leng JH, Sun PR, Lang JH. Prevalence and associated factors of female sexual dysfunction in women with endometriosis. Obstet Gynecol 2013; 121 (03) 601-606 . Doi: 10.1097/AOG.0b013e3182835777
    CrossrefPubMedGoogle Scholar
  • 34 Lara LA, Rosa e Silva AC, Romão AP, Junqueira FR. [The assessment and management of female sexual dysfunction]. Rev Bras Ginecol Obstet 2008; 30 (06) 312-321 . Doi: 10.1590/S0100-72032008000600008
    CrossrefPubMedGoogle Scholar
  • 35 Mendonça CR, Silva TM, Arrudai JT, García-Zapata MTA, Amaral WN. Função sexual feminina: aspectos normais e patológicos, prevalência no Brasil, diagnóstico e tratamento. Femina 2012; 40: 195-202
    PubMedGoogle Scholar
  • 36 Evangelista A, Dantas T, Zendron C, Soares T, Vaz G, Oliveira MA. Sexual function in patients with deep infiltrating endometriosis. J Sex Med 2014; 11 (01) 140-145 . Doi: 10.1111/jsm.12349
    CrossrefPubMedGoogle Scholar