What Is Known and Unknown About the Association Between Endometriosis and Sexual Functioning: A Systematic Review of the Literature

It is well known that endometriosis is associated with an increase in the risk of deep dyspareunia, with potential negative effects on global female sexual functioning and couple relationship. The aims of this study were to review the literature on the impact of endometriosis on female sexual functioning and to suggest new avenues for future research and treatment strategies. An electronic database research was performed to identify all the studies on the relation between endometriosis and sexual functioning published in the period 2000 to 2016. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After the screening process, a total of 9 studies investigating the relation between endometriosis and female sexual functioning were considered. Overall, these studies indicated that around two thirds of women with endometriosis have some form of sexual dysfunction not limited to deep dyspareunia. These findings suggest that the global sexual impact of endometriosis requires further investigation, focusing not only on pain during intercourse but also on psychological and relational dimensions, including partner’s sexual functioning. Because sexual functioning is a complex, multidimensional phenomenon, the ideal treatment for endometriosis-related sexual dysfunctions should be conducted by a multidisciplinary team composed of gynecologists, sexologists, and psychologists/psychotherapists.

[1]  P. Vercellini,et al.  “Free butterflies will come out of these deep wounds”: A grounded theory of how endometriosis affects women’s psychological health , 2018, Journal of health psychology.

[2]  P. Vercellini,et al.  When Love Hurts. A Systematic Review on the Effects of Endometriosis Surgical and Pharmacological Treatments on Female Sexual Functioning , 2017 .

[3]  L. Smits,et al.  Dyspareunia and depressive symptoms are associated with impaired sexual functioning in women with endometriosis, whereas sexual functioning in their male partners is not affected. , 2016, Human reproduction.

[4]  H. Taylor,et al.  Sexual function in endometriosis patients and their partners: effect of the disease and consequences of treatment. , 2016, Human reproduction update.

[5]  P. Vercellini,et al.  Personality in women with endometriosis: temperament and character dimensions and pelvic pain. , 2016, Human reproduction.

[6]  T. Rockall,et al.  Laparoscopic Surgery for Severe Rectovaginal Endometriosis Compromising the Bowel: A Prospective Cohort Study. , 2016, Journal of minimally invasive gynecology.

[7]  P. Vercellini,et al.  Impact of Mode of Delivery on Female Postpartum Sexual Functioning: Spontaneous Vaginal Delivery and Operative Vaginal Delivery vs. Cesarean Section. , 2016, The journal of sexual medicine.

[8]  P. Vercellini,et al.  Norethindrone acetate or dienogest for the treatment of symptomatic endometriosis: a before and after study. , 2016, Fertility and sterility.

[9]  L. Morelli,et al.  Robot-assisted surgery for the radical treatment of deep infiltrating endometriosis with colorectal involvement: short- and mid-term surgical and functional outcomes , 2016, International Journal of Colorectal Disease.

[10]  P. Oppelt,et al.  When sex is not on fire: a prospective multicentre study evaluating the short-term effects of radical resection of endometriosis on quality of sex life and dyspareunia. , 2016, European journal of obstetrics, gynecology, and reproductive biology.

[11]  S. Cianci,et al.  Quality of life and sexual function of women affected by endometriosis-associated pelvic pain when treated with dienogest , 2015, Journal of Endocrinological Investigation.

[12]  P. Vercellini,et al.  Impact of endometriosis on quality of life and mental health: pelvic pain makes the difference , 2015, Journal of psychosomatic obstetrics and gynaecology.

[13]  S. Ferrero,et al.  Dienogest in women with persistent endometriosis-related pelvic pain during norethisterone acetate treatment. , 2014, European journal of obstetrics, gynecology, and reproductive biology.

[14]  D. Ellwood,et al.  Impact of endometriosis on women’s lives: a qualitative study , 2014, BMC Women's Health.

[15]  M. Mauloni,et al.  Do women with endometriosis have to worry about sex? , 2014, European journal of obstetrics, gynecology, and reproductive biology.

[16]  P. Oppelt,et al.  More than just bad sex: sexual dysfunction and distress in patients with endometriosis , 2014 .

[17]  Jing Zhang,et al.  Is nerve-sparing surgery suitable for deeply infiltrating endometriosis? , 2014, European journal of obstetrics, gynecology, and reproductive biology.

[18]  A. Prentice,et al.  ESHRE guideline: management of women with endometriosis. , 2014, Human reproduction.

[19]  H. Salzer,et al.  Dyspareunia and quality of sex life after surgical excision of endometriosis: a systematic review. , 2014, European journal of obstetrics, gynecology, and reproductive biology.

[20]  R. Angioli,et al.  Surgical treatment of rectovaginal endometriosis with extensive vaginal infiltration: results of a systematic three-step vagino-laparoscopic approach. , 2014, European journal of obstetrics, gynecology, and reproductive biology.

[21]  E. Denny,et al.  The social and psychological impact of endometriosis on women's lives: a critical narrative review. , 2013, Human reproduction update.

[22]  F. Renouvel,et al.  Évolution des symptômes et de la qualité de vie des patientes après chirurgie de l’endométriose digestive , 2013 .

[23]  P. Vercellini,et al.  Let's talk about sex and endometriosis , 2013, Journal of Family Planning and Reproductive Health Care.

[24]  J. Buster.  Managing female sexual dysfunction. , 2013, Fertility and sterility.

[25]  C. Dirksen,et al.  The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey. , 2013, Human reproduction.

[26]  A. Wolthuis,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. , 2013, Human reproduction.

[27]  Letizia Zannoni,et al.  Women with deep infiltrating endometriosis: sexual satisfaction, desire, orgasm, and pelvic problem interference with sex. , 2013, The journal of sexual medicine.

[28]  P. Vercellini,et al.  Surgical versus low-dose progestin treatment for endometriosis-associated severe deep dyspareunia II: effect on sexual functioning, psychological status and health-related quality of life. , 2013, Human reproduction.

[29]  J. Leng,et al.  Prevalence and Associated Factors of Female Sexual Dysfunction in Women With Endometriosis , 2013, Obstetrics and gynecology.

[30]  M. Luostarinen,et al.  Quality of life and sexual function 1 year after laparoscopic rectosigmoid resection for endometriosis , 2013, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[31]  P. Vercellini,et al.  Can ' t Get No Satisfaction ’ ’ * : deep dyspareunia and sexual functioning in women with rectovaginal endometriosis , 2012 .

[32]  P. Vercellini,et al.  Surgical versus medical treatment for endometriosis-associated severe deep dyspareunia: I. Effect on pain during intercourse and patient satisfaction. , 2012, Human reproduction.

[33]  C. Davis,et al.  Does minimally invasive surgery for endometriosis improve pelvic symptoms and quality of life? , 2012, Current opinion in obstetrics & gynecology.

[34]  J. Kössi,et al.  Sexual functioning, quality of life and pelvic pain 12 months after endometriosis surgery including vaginal resection , 2012, Acta obstetricia et gynecologica Scandinavica.

[35]  E. Geraci,et al.  What is the impact on sexual function of laparoscopic treatment and subsequent combined oral contraceptive therapy in women with deep infiltrating endometriosis? , 2012, The journal of sexual medicine.

[36]  R. Clarizia,et al.  Nerve-sparing laparoscopic eradication of deep endometriosis with segmental rectal and parametrial resection: the Negrar method. A single-center, prospective, clinical trial , 2012, Surgical Endoscopy.

[37]  P. Vercellini,et al.  2. Endometriosis: Epidemiology, and Etiological Factors , 2012 .

[38]  S. Fieuws,et al.  Clinical outcome after CO₂ laser laparoscopic radical excision of endometriosis with colorectal wall invasion combined with laparoscopic segmental bowel resection and reanastomosis. , 2011, Human reproduction.

[39]  D. Guzick,et al.  Randomized trial of leuprolide versus continuous oral contraceptives in the treatment of endometriosis-associated pelvic pain. , 2011, Fertility and sterility.

[40]  M. Girão,et al.  Evaluation of quality of life and sexual satisfaction in women suffering from chronic pelvic pain with or without endometriosis. , 2011, The journal of sexual medicine.

[41]  P. Vercellini,et al.  Priorities for Endometriosis Research , 2011, Reproductive Sciences.

[42]  R. Schonman,et al.  Bowel resection for deep endometriosis: a systematic review , 2011, BJOG : an international journal of obstetrics and gynaecology.

[43]  R. Pauls,et al.  Impact of gynecological surgery on female sexual function , 2010, International Journal of Impotence Research.

[44]  G. Camerini,et al.  Letrozole combined with norethisterone acetate compared with norethisterone acetate alone in the treatment of pain symptoms caused by endometriosis. , 2009, Human reproduction.

[45]  P. Vercellini,et al.  Medical treatment for rectovaginal endometriosis: what is the evidence? , 2009, Human reproduction.

[46]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement , 2009, BMJ.

[47]  D. Moher,et al.  Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement , 2009, BMJ : British Medical Journal.

[48]  P. Vercellini,et al.  The effect of surgery for symptomatic endometriosis: the other side of the story. , 2009, Human reproduction update.

[49]  C. Johannes,et al.  Sexual Problems and Distress in United States Women: Prevalence and Correlates , 2008, Obstetrics and gynecology.

[50]  N. Ragni,et al.  Deep dyspareunia: causes, treatments, and results , 2008, Current opinion in obstetrics & gynecology.

[51]  S. Gregorich,et al.  Development and validation of a sexual functioning measure for use in diverse women's health outcome studies. , 2008, American journal of obstetrics and gynecology.

[52]  J. Kristensen,et al.  Laparoscopic laser resection of rectovaginal pouch and rectovaginal septum endometriosis: the impact on pelvic pain and quality of life , 2007, Acta obstetricia et gynecologica Scandinavica.

[53]  N. Ragni,et al.  Letrozole and norethisterone acetate in rectovaginal endometriosis. , 2007, Fertility and sterility.

[54]  E. Denny,et al.  Endometriosis-associated dyspareunia: the impact on women's lives , 2007, Journal of Family Planning and Reproductive Health Care.

[55]  N. Ragni,et al.  Deep dyspareunia and sex life after laparoscopic excision of endometriosis. , 2007, Human reproduction.

[56]  S. Dziurawiec,et al.  Living with endometriosis: the perspective of male partners. , 2006, Journal of psychosomatic research.

[57]  J. Abbott,et al.  Clinical and quality-of-life outcomes after fertility-sparing laparoscopic surgery with bowel resection for severe endometriosis. , 2006, Journal of minimally invasive gynecology.

[58]  G. Melis,et al.  Laparoscopic excision of posterior vaginal fornix in the treatment of patients with deep endometriosis without rectum involvement: surgical treatment and long-term follow-up. , 2006, Human reproduction.

[59]  E. Darai,et al.  Quality of life after laparoscopic colorectal resection for endometriosis. , 2006, Human reproduction.

[60]  S. Landi,et al.  Laparoscopic nerve-sparing complete excision of deep endometriosis: is it feasible? , 2006, Human reproduction.

[61]  P. Vercellini,et al.  Treatment of symptomatic rectovaginal endometriosis with an estrogen-progestogen combination versus low-dose norethindrone acetate. , 2005, Fertility and sterility.

[62]  N. Ragni,et al.  Dyspareunia and quality of sex life after laparoscopic excision of endometriosis and postoperative administration of triptorelin. , 2005, Fertility and sterility.

[63]  Francesca Esposito,et al.  Quality of sex life in women with endometriosis and deep dyspareunia. , 2005, Fertility and sterility.

[64]  R. Garry,et al.  The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up. , 2004, Human reproduction.

[65]  R. Garry,et al.  The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2–5 year follow‐up , 2003 .

[66]  L. Derogatis,et al.  The Female Sexual Distress Scale (FSDS): Initial Validation of a Standardized Scale for Assessment of Sexually Related Personal Distress in Women , 2002, Journal of sex & marital therapy.

[67]  I. Nakadi,et al.  Impact of surgical resection of rectovaginal pouch of douglas endometriotic nodules on pelvic pain and some elements of patients' sex life. , 2001, The Journal of the American Association of Gynecologic Laparoscopists.

[68]  R. Garry,et al.  The effect of endometriosis and its radical laparoscopic excision on quality of life indicators , 2000, BJOG : an international journal of obstetrics and gynaecology.

[69]  E. Laumann,et al.  Sexual dysfunction in the United States: prevalence and predictors. , 1999, JAMA.

[70]  Y. Binik,et al.  Biopsychosocial Profile of Women With Dyspareunia , 1997, Obstetrics and gynecology.

[71]  I. Osterloh,et al.  The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. , 1997, Urology.

[72]  M. Canis,et al.  Revised American Society for Reproductive Medicine classification of endometriosis: 1996. , 1997, Fertility and sterility.

[73]  D. Torgerson,et al.  Measuring sexual functioning in premenopausal women , 1995, British journal of obstetrics and gynaecology.

[74]  J. Rust,et al.  The GRISS: A psychometric instrument for the assessment of sexual dysfunction , 1986, Archives of sexual behavior.

[75]  R. Seracchioli,et al.  Sexual function in women undergoing surgery for deep infiltrating endometriosis: a comparison with healthy women. , 2015, The journal of family planning and reproductive health care.

[76]  M. A. Oliveira,et al.  Sexual function in patients with deep infiltrating endometriosis. , 2014, The journal of sexual medicine.

[77]  F. Golfier,et al.  Sexualité féminine après chirurgie pour endométriose pelvienne profonde , 2013 .

[78]  G. Camerini,et al.  Norethisterone acetate in the treatment of colorectal endometriosis: a pilot study. , 2010, Human reproduction.

[79]  C. Meuleman,et al.  Outcome after multidisciplinary CO2 laser laparoscopic excision of deep infiltrating colorectal endometriosis. , 2009, Reproductive biomedicine online.

[80]  G. Apolone,et al.  Laparoscopic uterosacral ligament resection for dysmenorrhea associated with endometriosis: results of a randomized, controlled trial. , 2003, Fertility and sterility.

[81]  P. Vercellini,et al.  Cyproterone acetate versus a continuous monophasic oral contraceptive in the treatment of recurrent pelvic pain after conservative surgery for symptomatic endometriosis. , 2002, Fertility and sterility.

[82]  Candace S. Brown,et al.  The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. , 2000, Journal of sex & marital therapy.

[83]  L. Derogatis.  The Derogatis Interview for Sexual Functioning (DISF/DISF-SR): an introductory report. , 1997, Journal of sex & marital therapy.

[84]  L. Derogatis,et al.  The DSFI: a multidimensional measure of sexual functioning. , 1979, Journal of sex & marital therapy.

[85]  M. Scheier,et al.  Public and private self-consciousness: Assessment and theory. , 1975 .