Dyspareunia in women with endometriosis – What characterizes women with dyspareunia and endometriosis?

Endometriosis is a chronic, often progressive disease characterized by symptoms as pelvic pain, dyspareunia (DP), dysmenorrhea, disturbed bleeding patterns or reduced fertility. Current research supports the hypothesis, that specific locations of endometriosis, i.e. those of the uterosacral ligaments (USL) are associated with a higher prevalence of DP.

Retrospective data from 476 women with confirmed endometriosis was collected from different Swiss and German hospitals. In a self-administered questionnaire designed to investigate quality of life in endometriosis, socio-demographic data, medical, gynaecologic and obstetric history, and different aspects of quality of life were inquired.

A total of 90.1% (429) women answered the question about the frequence of DP. Out of these 19.8% (85) women reported to suffer from pain in every or almost every intercourse, 35.2% (151) suffered from moderate, 45% (193) from rare DP. Age and BMI did not differ with the frequency of DP, whereas there was a highly significant difference for the education. Women with a university degree suffered less frequent from DP (p = 0.002). The frequence of DP was independent from the ASRM stages, p = 0.574. (i.e. 20% in ASRM I, 16.9% in ASRM II, 21.9% in ASRM III and 21.4% in ASRM IV.) Women with frequent DP were not significantly more often treated for lesions on the USL (62.3%), an obliterated Douglas (29.4%) or a resection in the vaginal fornix (15.3%) than women reporting moderate or rare DP. Women with frequent DP were significantly less sexually active (p < 0.001) and more often avoiding intercourse because of pain (p < 0.001). Discussion/Conclusion: Women with a higher education have less DP, they might have better coping strategies. Women should be asked about DP. Not only women with lesions of the USL suffer from DP. Therefore, any women suffering from endometriosis should systematically be counselled, to reduce potential consequences on sexual activity.