Valentina Bertoldo

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.

Question mark form of uterus: a simple sonographic sign associated with the presence of adenomyosis.

Adenomyosis as the presence of ectopic endometrial glands and stroma within the myometrium is an elusive condition that is challenging to diagnose due to the similarity between its clinical symptoms and ultrasound characteristics and those of other frequent benign conditions such as leiomyomatosis1. Over recent years, transvaginal sonography (TVS) has been recommended as an appropriate tool for visualization of adenomyosis, with a sensitivity of 65–81% and a specificity of 65–100%2. We performed a prospective study between January 2012 and January 2014 including 50 symptomatic fertile women who were scheduled to undergo elective hysterectomy because of symptoms of endometriosis/adenomyosis. Adenomyosis was diagnosed on TVS, in accordance with previous studies3,4, in the presence of one or more of the following criteria: heterogeneous myometrium, irregular cystic areas, hypoechoic linear striations, asymmetry of uterine walls and poor definition of the endometrial–myometrial junctional zone (JZ). Moreover, a novel sign, which we called ‘question mark Figure 1 Transvaginal ultrasound image and representative diagram showing the question mark form of the uterus as a marker for adenomyosis.

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.

The Role of Ovarian Suspension in Endometriosis Surgery: A Randomized Controlled Trial

STUDY OBJECTIVE A very high percentage of patients with severe pelvic endometriosis develop adhesions after laparoscopic surgery. The objective of this trial was to evaluate the role of ovarian suspension performed during surgery for severe endometriosis on ovarian adhesions and postoperative pelvic pain. DESIGN A randomized controlled trial (Canadian Task Force classification I). SETTING The tertiary care University Hospital of Bologna, Bologna, Italy. PATIENTS Eighty patients with ovarian and posterior deep infiltrating endometriosis were included in the study. INTERVENTIONS Patients underwent laparoscopic surgery for endometriosis and were randomized sequentially into 2 groups: transient ovarian suspension was performed in the treatment group (n = 40), whereas in the control group (n = 40) ovaries were left free in the pelvis. Symptom intensity (dysmenorrhea, chronic pelvic pain, dyspareunia, dyschezia, and dysuria) were ranked using a visual analog scale. Postsurgical ovarian adhesions were evaluated using transvaginal ultrasonographic scans performed by an ultrasound operator who was blinded to the details of the operative procedure and womens randomization allocation. Complications, lesion localization, endometrioma diameter, and surgery time were recorded. MEASUREMENTS AND MAIN RESULTS At follow-up, a significantly lower rate of ultrasound-detectable ovarian adhesions with the uterus and the bowel was observed in the treatment group, respectively (46.7% vs 77.3%, p = .003 and 26.7% vs 68.2%, p < .0005). Patients in the control group showed a higher percentage of fixed ovaries with moderate and severe adhesions than the treatment group, respectively (56.8% vs 28.9%, p = .003 and 20.5% vs 8.9%, p = .110). No differences between the 2 groups were found regarding complications and pelvic pain. CONCLUSION Ovarian suspension seems to be an additional effective surgical procedure associated with an increased ovarian mobility in women treated for severe endometriosis. Moreover, it is feasible, safe, simple, and fast. Hence, it should be routinely used during laparoscopic surgery for endometriosis.

Do low-dose oral contraceptives have an effect on ovarian endometrioma diameter and endometriosis symptoms?

Purpose To investigate the effect of a low-dose oral contraceptive containing drospirenone/ethinylestradiol 3 mg/20 μg on endometrioma mean diameter. Methods Fifty women with sonographic diagnosis of ovarian endometrioma and at least 12 months of therapy with drospirenone/ethinylestradiol 3 mg/20 μg, without previous adnexal surgery, were selected for this retrospective study. Endometrioma mean diameter measured with transvaginal ultrasonography and endometriosis-associated symptoms evaluated by a visual analogue scale (VAS) score (0-10) were reported at therapy prescription (baseline) and after 6, 12 and 18 months of treatment. Main outcome measures were endometrioma mean diameters and endometriosis-associated symptoms variations during the follow-up; differences between cyclic and continuous regimen were also considered. Results A significant reduction in endometrioma mean diameter was observed during the follow-up. The reductions of mean diameter versus baseline values were significantly higher in continuous users than in cyclic users at 6 and 18 months of follow-up. No new endometriomas occurred. The dysmenorrhea VAS score significantly decreased during the follow-up. Conclusions Drospirenone/ethinylestradiol 3 mg/20 μg seems to be effective in reducing endometrioma mean diameter. The continuous regimen seems to be associated with a greater reduction than the cyclic one.

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.