Deep Dyspareunia, Superficial Dyspareunia, and Infertility Concerns Among Women With Endometriosis: A Cross-Sectional Study

Kate J. Wahl, MSc; Natasha L. Orr, MSc; Michelle Lisonek; Heather Noga, MA; Mohamed A. Bedaiwy, PhD; Christina Williams, MD; Catherine Allaire, MD; Arianne Y. Albert, PhD; Kelly B. Smith, PhD; Susan Cox, PhD; Paul J. Yong, PhD

Sexual Medicine (Jun 2020)

Deep Dyspareunia, Superficial Dyspareunia, and Infertility Concerns Among Women With Endometriosis: A Cross-Sectional Study

Kate J. Wahl, MSc,
Natasha L. Orr, MSc,
Michelle Lisonek,
Heather Noga, MA,
Mohamed A. Bedaiwy, PhD,
Christina Williams, MD,
Catherine Allaire, MD,
Arianne Y. Albert, PhD,
Kelly B. Smith, PhD,
Susan Cox, PhD,
Paul J. Yong, PhD

Affiliations

Kate J. Wahl, MSc: Center for Pelvic Pain and Endometriosis, BC Women’s Hospital, Vancouver, BC, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Natasha L. Orr, MSc: Center for Pelvic Pain and Endometriosis, BC Women’s Hospital, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
Michelle Lisonek: Center for Pelvic Pain and Endometriosis, BC Women’s Hospital, Vancouver, BC, Canada
Heather Noga, MA: Women's Health Research Institute, Vancouver, BC, Canada
Mohamed A. Bedaiwy, PhD: Center for Pelvic Pain and Endometriosis, BC Women’s Hospital, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
Christina Williams, MD: Center for Pelvic Pain and Endometriosis, BC Women’s Hospital, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
Catherine Allaire, MD: Center for Pelvic Pain and Endometriosis, BC Women’s Hospital, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
Arianne Y. Albert, PhD: Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada
Kelly B. Smith, PhD: BC Center for Vulvar Health, Gordon and Leslie Diamond Health Care Center, Vancouver, BC, Canada
Susan Cox, PhD: School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Paul J. Yong, PhD: Center for Pelvic Pain and Endometriosis, BC Women’s Hospital, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada; BC Center for Vulvar Health, Gordon and Leslie Diamond Health Care Center, Vancouver, BC, Canada; Corresponding Author: Paul J. Yong, PhD, Department of Obstetrics & Gynecology, University of British Columbia, BC Women's Center for Pelvic Pain and Endometriosis, F2-4500 Oak Street, Vancouver, British Columbia V6H 3N1, Canada. Tel: +1-604-875-2534; Fax: +1-604-875-2569

Journal volume & issue: Vol. 8, no. 2
pp. 274 – 281

Abstract

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Introduction: Deep dyspareunia is a cardinal symptom of endometriosis, and as many as 40% of people with this condition experience comorbid superficial dyspareunia. Aim: To evaluate the relationship between sexual pain and infertility concerns among women with endometriosis. Methods: This is a cross-sectional study conducted at a university-based tertiary center for endometriosis. 300 reproductive-aged participants in the prospective Endometriosis Pelvic Pain Interdisciplinary Cohort (ClinicalTrials.gov Identifier: NCT02911090) with histologically confirmed endometriosis were included (2013–2017). Main Outcome Measure: The total score on the infertility concerns module of the Endometriosis Health Profile-30 categorized into 5 groups (0, 1–4, 5–8, 9–12, 13–16). Results: The odds of infertility concerns did not increase with severity of deep dyspareunia (odds ratio = 1.02, 95% CI: 0.95–1.09, P = .58). However, the odds of infertility concerns increased with severity of superficial dyspareunia (odds ratio = 1.09, 95% CI: 1.02–1.16, P = .011); this relationship persisted after adjusting for endometriosis-specific factors, infertility risk factors, reproductive history, and demographic characteristics (adjusted odds ratio [AOR] = 1.14, 95% CI: 1.06–1.24, P < .001). Other factors in the model independently associated with increased infertility concerns were previous difficulty conceiving (AOR = 2.09, 95% CI 1.04–4.19, P = .038), currently trying to conceive (AOR = 5.23, 95% CI 2.77–9.98, P < .001), nulliparity (AOR = 3.21, 95% CI 1.63–6.41, P < .001), and younger age (AOR = 0.94, 95% CI: 0.89–0.98, P = .005). Conclusion: Severity of superficial dyspareunia, but not deep dyspareunia, was associated with increased odds of infertility concerns among women with endometriosis. Strengths of the study included the use of a validated measure of infertility concerns and disaggregation of sexual pain into deep and superficial dyspareunia. Limitations included the setting of a tertiary center for pelvic pain, which affects generalizability to fertility clinic and primary care settings. Women experiencing introital dyspareunia, who can have difficulties with achieving penetrative intercourse, may be concerned about their future fertility and should be counselled appropriately.Wahl KJ, Orr NL, Lisonek M, et al. Deep Dyspareunia, Superficial Dyspareunia, and Infertility Concerns Among Women With Endometriosis: A Cross-Sectional Study. Sex Med 2020;8:274–281.

Published in Sexual Medicine

ISSN: 2050-1161 (Online)
Publisher: Oxford University Press
Country of publisher: United Kingdom
LCC subjects: Medicine
Website: https://academic.oup.com/smoa

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