These findings highlight that in addition to standard medical treatment, women with endometriosis also should have access to psychotherapy and psychosexual help, investigators noted.
The study, “Influential factors on sexual function in infertile women with endometriosis: a path analysis,” was published in the journal BMC Women’s Health.
Endometriosis is one of the most common gynecological diseases, affecting up to 10% of women of reproductive age.
Pelvic pain, infertility, and mental issues are some of the most prevalent symptoms of endometriosis, and all of them are considered risk factors of sexual dysfunction, which has been reported to be more prevalent among women with endometriosis.
Investigators in Iran, together with colleagues in Australia, tested a conceptual model in an attempt to determine which risk factors could be the most relevant contributors to sexual dysfunction in infertile women with endometriosis.
The team considered and tested several hypotheses, including one claiming that chronic pain in combination with pain during sex were the main predictors of sexual dysfunction, and another stating that mental health issues were the main triggers of sexual dysfunction in women with endometriosis.
To investigate the different hypotheses, researchers conducted a study in which they asked women with endometriosis to complete a series of questionnaires to evaluate their sexual function, sleep quality, levels of anxiety, depression, and pain.
A total of 220 infertile women with a surgically-confirmed diagnosis of endometriosis, followed at the Infertility Clinic of Arash Hospital in Tehran, Iran, from May 2016 to February 2017, participated in the study.
Sexual function was evaluated using the Female Sexual Function Index (FSFI), sleep quality with the Pittsburgh Sleep Quality Index (PSQI), pain intensity with the Visual Analog Scale (VAS), and levels of depression and anxiety with the Hospital Anxiety and Depression Scale (HADS).
Results showed that anxiety, depression, sleep quality, pain during sex, patients’ body mass index (BMI), and education level, all had an impact on sexual function.
Anxiety, depression, sleep quality, and pelvic pain were the four major contributors of sexual dysfunction in women participating in the study.
Analyses also demonstrated that pelvic pain intensity, which was found to have an impact on sleep quality and pain during intercourse, could alter women’s sexual function.
Lower levels of physical activity coupled with higher BMI values, which were found to have an indirect impact on anxiety and sleep quality, also could worsen women’s sexual function.
In addition, researchers found that high levels of anxiety were linked to poor sleep quality and depression, and also had a negative impact on sexual function.
“It is not unlikely that the highest impact of endometriosis on sexual dysfunction is exerted by anxiety, depression, sleep quality, pelvic pain, and dyspareunia [pain during sex],” researchers wrote.
However, they noted that additional factors, including patients’ BMI and levels of physical activity, likely influence women’s sexual function, too.
“In the care of women with endometriosis, not only laparoscopy and medical treatment should be performed but also psychotherapeutic and psychosexual help should be offered,” the researchers concluded.