Women with endometriosis who suffer from severe deep dyspareunia — pain during sex — have a worse sexual quality of life, regardless of other conditions and types of pain.

The study with that finding, “Deep Dyspareunia and Sexual Quality of Life in Women With Endometriosis,” was published recently in the journal Sexual Medicine.

Dyspareunia is defined as pain associated with vaginal penetration during sexual intercourse. There are two types of dyspareunia — superficial dyspareunia and deep dyspareunia. Superficial dyspareunia refers to pain at the entry of the vagina, while deep dyspareunia refers to pain from with deep penetration.

Endometriosis, which affects 10 percent of reproductive-age women, is one of the most common causes deep dyspareunia.

Multiple studies have shown that women with concurrent endometriosis and deep dyspareunia have decreased sexual quality of life (SQoL), particularly in the domains of sexual functioning and satisfaction.

Women who are affected by both these conditions tend to have reduced frequency and quality of sexual activity, lower self-esteem, and decreased sexual satisfaction.

One of the important things to consider when evaluating SQoL in women with endometriosis is the presence of potential confounding factors because endometriosis tends to be associated with other types of pelvic pain and psychological comorbidities.

For example, one of the variables may be the presence of superficial dyspareunia, which can develop due to vulvodynia — a condition characterized by chronic pain or discomfort around the opening of the vagina. It is possible for a woman with endometriosis to also have vulvodynia, which would skew the SQoL result.

So, researchers conducted a study to investigate whether deep dyspareunia was associated with a worse SQoL in women with endometriosis after controlling for confounding (varying) factors. SQoL was assessed using the Endometriosis Health Profile (EHP-30), a validated tool for QoL measurement.

The study group included 277 women, most of whom had Stage I to II endometriosis (64%), while the rest had Stage III to IV endometriosis (36%).

Through statistical analysis, researchers showed that severe deep dyspareunia was significantly associated with a worse SQoL, even after controlling for other factors, including superficial dyspareunia, pelvic pain, psychological comorbidities, pain conditions, demographics, and behavioral.

“The association between deep dyspareunia and worse SQoL suggests that treatment of deep dyspareunia could be important in improving SQoL in women with endometriosis, independent of superficial dyspareunia or psychological comorbidities,” the authors wrote.

Also, a worse SQoL was associated with increased depression, higher pain catastrophizing (tendency to magnify the threat value of the pain stimulus), bladder pain syndrome, and heterosexual orientation — regardless of varying factors.

The authors concluded: “This study confirms that these latter factors also are important for SQoL. To address these multifactorial factors, a multidisciplinary approach has been proposed for treatment of sexual dysfunction in endometriosis.”