A. Benfenati

Women with deep infiltrating endometriosis: Sexual satisfaction, desire, orgasm, and pelvic problem interference with sex

INTRODUCTION Endometriosis is a chronic and progressive condition of women of reproductive age. It is strongly associated with a significant reduction of quality of life (QOL) and sexual function. AIMS This study aims to objectively evaluate sexual function in women with deep infiltrating endometriosis (DIE) and to study the impact of endometriosis symptoms and type of lesion on patients sexual function. METHODS This is a cross-sectional study in a tertiary care university hospital. It included 182 patients with preoperative clinical and ultrasound diagnosis of DIE who were referred to our center from 2008 to 2011. MAIN OUTCOME MEASURES A sexual activity questionnaire, the Sexual Health Outcomes in Women Questionnaire (SHOW-Q) was used to collect data pertaining to satisfaction, orgasm, desire, and pelvic problem interference with sex. Short Form 36 (SF-36) was used to evaluate QOL. Demographic and clinical characteristics were assessed: age, body mass index, parity, ethnicity, postsecondary education, employment, smoking, history of surgical treatment, and hormonal contraception. Patients were asked about pain symptoms (dysmenorrhea, dyspareunia, dyschezia, chronic pelvic pain, and dysuria) using a visual analog scale. RESULTS The mean values obtained on the different scales of the SHOW-Q showed poor sexual function (mean SHOW-Q total score 56.38 ± 22.74). Satisfaction was the dimension most affected (mean satisfaction score 55.66 ± 34.55), followed by orgasm (mean orgasm score 56.90 ± 33.77). We found a significant correlation between the SF-36 scores and the SHOW-Q scores (P < 0.0001). Sexual dysfunction and deterioration of QOL seem to be correlated. Analyzing the impact of symptoms and lesions on sexual function, we found that dyspareunia and vaginal DIE nodules significantly affect sexual activity (P < 0.05). CONCLUSION The results of this study demonstrated that women with DIE have a sexual function impairment, correlated with the overall well-being decrease. Moreover, the presence of dyspareunia and vaginal endometriotic lesions seems to be involved in sexual dysfunction.

Do women with endometriosis have to worry about sex

OBJECTIVE(S) Sexual function is negatively influenced by endometriosis and women with endometriosis show less sexual and partnership satisfaction compared to patients with other gynaecological disorders. This study aims to compare sexual function between patients with deep infiltrating endometriosis (DIE) and healthy women using Sexual Health Outcomes in Women Questionnaire (SHOW-Q). STUDY DESIGN Case-control study including 182 patients with histological diagnosis of DIE and 182 healthy women, who referred to our tertiary care university hospital from 2010 to 2012. SHOW-Q was used to collect data concerning satisfaction, orgasm, desire and pelvic problem interference with sex. The un-paired t-test was performed to compare the means of a continuous variable between groups when the data were normally distributed; otherwise the Mann-Whitney test was used to check t-test results. Pearsons χ(2) test and Z-test for proportions - independent groups were performed to investigate the difference among grouping variables. RESULTS As described in a previous study, the prevalence of sexual dysfunction in women with endometriosis is around 61% and in women with other gynaecological disorders is 35%. Assuming 5% significance and 95% power, 106 women would be required for the study. Every area of sexual function investigated through the SHOW-Q questionnaire (satisfaction, desire, orgasm and pelvic problem interference) was significantly impaired compared to healthy women. Among patients with DIE, 58% (105/182) reported that pelvic pain severely affected sexual function, while only 1% (2/182) of healthy women (p<0.0001). Moreover, sexual desire was absent or less than one or two times per month in 45% (82/182) of women with DIE compared to 14% (26/182) of healthy women (p<0.0001). CONCLUSION(S) DIE severely affects sexual function. Endometriosis is a global disease, which affects patients physically, psychologically and sexually. The potential sexual consequences of this disease need to be considered.

Prevalence of adenomyosis in women undergoing surgery for endometriosis

OBJECTIVE(S) To evaluate the prevalence of adenomyosis in patients undergoing surgery for endometriosis. STUDY DESIGN Retrospective study including 1618 women with preoperative clinical and ultrasound diagnosis of endometriosis. As preoperative assessment, all patients underwent ultrasound to assess endometriosis and all features associated with adenomyosis (heterogeneous myometrial echotexture, globular-appearing uterus, asymmetrical thickness of anteroposterior wall of the myometrium, subendometrial myometrial cysts, subendometrial echogenic linear striations or poor definition of the endometrial-myometrial junction). RESULTS Adenomyosis was present in 353/1618 (21.8%) women included in the study. Multivariate analysis showed that the prevalence of adenomyosis was significantly associated with deep infiltrating endometriosis, parity, dysmenorrhea intensity and womens age (P<0.0001). CONCLUSION(S) Adenomyosis is a common condition but its aetiology and natural history are still unknown. Our experience showed a 21.8% of prevalence of adenomyosis in patients affected by endometriosis and its association with parous women, increasing age, dysmenorrhea intensity and with the presence of deep infiltrating endometriosis.

Urodynamic evaluation and anorectal manometry pre- and post-operative bowel shaving surgical procedure for posterior deep infiltrating endometriosis: a pilot study.

STUDY OBJECTIVE To analyze bowel and urinary function in patients with posterior deep infiltrating endometriosis (DIE) >30 mm in largest diameter at transvaginal ultrasound before and after surgical nerve-sparing excision. DESIGN Prospective observational study (Canadian Task Force classification III). SETTING Tertiary care university hospital in Bologna, Italy. PATIENTS Twenty-five patients with posterior DIE were included in the study between June 2011 and December 2012. Patients did not receive hormone therapy for at least 3 months before and 6 months after surgery. INTERVENTIONS Patients underwent urodynamic studies and anorectal manometry before and after nerve-sparing laparoscopic excision of the posterior DIE nodule. MEASUREMENTS AND MAIN RESULTS Intestinal and urinary function was evaluated in patients with bulky posterior DIE using urodynamic and anorectal manometry. Results of urodynamic studies and anorectal manometry were similar before and after nerve-sparing surgical excision of the posterior DIE nodule. Urodynamic studies demonstrated a high prevalence of voiding dysfunction, whereas anorectal manometry showed no reduction in rectoanal inhibitory reflex and hypertone of the internal anal sphincter. CONCLUSIONS Patients with posterior DIE >30 mm in greatest diameter demonstrate preoperative dysfunction at urodynamic study and anorectal manometry, probably due to DIE per se. The nerve-sparing surgical approach seems not to influence the motility or sensory capacity of the bladder and the rectosigmoid colon.

Sexual function in women undergoing surgery for deep infiltrating endometriosis: a comparison with healthy women

Background Endometriosis is a chronic and progressive condition of women of reproductive age. It is strongly associated with significant impairment of sexual function. Aim To objectively evaluate the impact of laparoscopic excision of endometriosis on sexual function in patients with deep infiltrating endometriosis (DIE) compared to healthy women. Setting and design Prospective study, including 250 patients with a diagnosis of DIE scheduled for laparoscopic surgery and 250 healthy women. Methods A sexual activity questionnaire, SHOW-Q (Sexual Health Outcomes in Women Questionnaire), was used to collect data pertaining to womens satisfaction, orgasm, desire and pelvic problem interference with sexual function. Women with DIE underwent complete excision of endometriotic lesions. All participants were asked to complete the SHOW-Q questionnaire before and after surgery. Results SHOW-Q scores in the endometriosis group before and 6 months after surgery were compared with the healthy group scores. A significant improvement was found between pre- and post-treatment in the scores of the satisfaction scale, desire scale and pelvic problem interference scale of SHOW-Q. The distribution of post-surgery SHOW-Q scores was comparable to healthy womens scores apart from the orgasm scale score, which was unchanged in the post-surgery group. Conclusions The surgical approach to treatment has a positive impact not only on organ impairment but also on sexual function in women affected by DIE.

Severe ureteral endometriosis: frequency and risk factors

Abstract Ureteral endometriosis (UE) can be classified as severe when there is obstruction to urinary flow (ureteral compression (UC)). In this retrospective study on 205 patients, we evaluated intraoperatively the frequency of severe ureteral endometriosis (UE) in women with UE and, secondarily, risk factors associated with UC. We documented intraoperatively ureteral UC in 124 (60.5%) patients with UE. A significantly lower body mass index (BMI) was observed in women with UC than in women without UC (p = .02). A significant association was found between UC and parametrial endometriosis (p = .001). In multivariable analysis, these variables remained significantly associated with UC. Ureteral compression is common in patients with UE, especially in women with parametrial infiltration and a low BMI.

Pelvic floor muscle assessment at 3-and 4-dimensional transperineal ultrasound in women with endometriosis, with or without retroperitoneal infiltration: a step towards complete functional assessment

Previous studies comparing women with deep infiltrating endometriosis (DIE) and healthy controls have underlined an association between pelvic floor muscle (PFM) hypertonic dysfunction and deep lesions. The aim of this study was to compare the morphometry of PFM in women affected by ovarian endometriosis with DIE vs those without DIE in order to assess the impact of retroperitoneal infiltration by the disease on PFM function.

OP31.03: Pelvic floor morphometry at three- and four-dimensional transperineal ultrasound in women with ovarian endometriosis or deep infiltrating endometriosis

Objectives: To assess the changes in the volume of endometriomas and rectovaginal endometriotic nodules (RVE) during 12-month treatment with norethindrone acetate (NETA) versus extended-cycle oral contraceptive. Methods: This patient preference prospective study included women of reproductive age with endometriosis. Patients received either continuous oral treatment with NETA (2.5 mg/day, Primolut-Nor® Schering, Milan, Italy; group A) or a 91-day extended-cycle oral contraceptive (LNG/EE 150/30 mcg for 84 days and EE 10 mcg for 7 days, Seasonique® Teva, Assago, Italy; group B) for 12 months. The volume of the lesions was assessed by virtual organ computer-aided analysis (VOCAL, GE Healthcare, USA). The changes in the volume of endometriomas and RVE were compared between baseline, after 6 and 12 months of treatment. The echogenicity of the endometriomas was subjectively evaluated by the ultrasonographer using a Likert scale. Results: 100 patients were enrolled in the study (50 in each group). 45 patients completed the treatment in group A and 38 in group B. In both study groups, the volume of the cysts significantly decreased at 6 (p<0.05) and 12 months of treatment (p<0.05; percentage reduction: 56.5% in group A and 55.7% in group B) compared with baseline. The decrease in the volume of the cyst between 6-month and 12-month treatment reached statistical significance in both study groups (p < 0.05). After 12 months of treatment, the echogenicity of the endometriomas significantly changed in both study groups (p<0.05). After 6 and 12 months of treatment, the volume of the RVE significantly decreased in both groups compared to baseline. There was a significant reduction in the volume of the RVE between the 6 and 12 months of treatment (p<0.05 for both study groups). Conclusions: Both NETA and Seasonique® are effective in reducing the volume of the endometriomas and RVE.

The impact of socioeconomic and anamnestic characteristics on quality of life and sexual function in women with endometriosis

Purpose The aim of this study is to evaluate the impact of sociodemographic and anamnestic characteristics of women with deep infiltrating endometriosis (DIE) on the quality of life and sexual function. Methods It is a prospective cohort study including 200 women with pre-operative clinical and ultrasound diagnosis of DIE. They completed a pre-operative questionnaire regarding sociodemographic and anamnestic characteristics, a sexual activity questionnaire (Sexual Health Outcomes in Women Questionnaire [SHOW-Q]) and a quality of life questionnaire (Short Form-36 Health Survey [SF-36]). Results The mean values obtained for the SF-36 (50.7 ± 21.1) and SHOW-Q (56.4 ± 21.1) questionnaire showed an impairment of quality of life and sexual function. Women with a history of previous surgery had significantly lower scores of SF-36 and SHOW-Q questionnaires than women without (p< 0.05). The increase of body mass index (BMI) was positively correlated with an improvement of sexual function (p = 0.008). Postsecondary education was significantly associated with a better quality of life (p = 0.001). Conclusions Patients with DIE have an impairment of quality of life and sexual function. Educational level, BMI and previous surgery may influence quality of life and sexual function of women affected by DIE.

M059 DO WOMEN WITH BILATERAL OVARIAN ENDOMETRIOSIS HAVE MORE TUBAL ALTERATION THAN THOSE WITH MONOLATERAL DISEASE? OBJECTIVE EVALUATION OF PATIENTS

was made and this time at cystoscopy, a full thickness resection of the nodule was performed. Histology revealed florid endometriosis within the detrusor muscle with no evidence of mucosal involvement. Results: Three months following the bladder resection, symptoms had significantly improved. The patient received appropriate counseling and was commenced on six months of leuprorelin with Tibolone as “add back” therapy. The patient remained asymptomatic, 18 months following the bladder resection. Conclusions: The national caesarean section rate currently exceeds 24% and is rising due to factors such as advancing maternal age and increasing maternal BMI. The increase in Caesarean section rate may become even more problematic following publication of the new NICE Caesarean section guideline. The intense media scrutiny of the guideline has been misinterpreted and thus misinformed the public, that maternal request of caesarean section is acceptable. As a result, the number of recognized complications at caesarean sections may rise. We would therefore suggest that bladder endometriosis and menstrual dysfunction should be mentioned as potential complications when consenting for caesarean section.