031 Bladder and Pelvic Floor Tenderness in Endometriosis Deep Dyspareunia

Abstract

The etiology of endometriosis-associated deep dyspareunia (DD) may be due to direct disease-specific factors (e.g. location or invasiveness of disease) and/or to indirect contributors such as bladder/pelvic floor dysfunction. We aimed to determine if bladder/pelvic floor tenderness was associated with severity of DD in women with endometriosis, independent of disease-specific factors and other factors (e.g. demographics). Prospective patient registry (January 2014–December 2016) at an endometriosis tertiary centre. Primary outcome: severity of DD categorized as none-mild (0-3), moderate (4-6), and severe (7-10). Inclusion criteria: surgical removal and histopathological confirmation of endometriosis and 18-50 years old. Exclusion criteria: never sexually active, post-menopausal, no dyspareunia score/physical exam. Bivariate associations with the primary outcome were tested for bladder/pelvic floor tenderness, as well as disease-specific factors and other factors. Ordinal regression determined independent associations with the primary outcome. Total sample size was 424. At surgery, 263 had Stage I/II endometriosis while 148 had Stage III/IV endometriosis. On ordinal regression, in women with Stage I/II, severity of DD was independently associated with tenderness of the bladder/pelvic floor and painful bladder syndrome: (OR=1.99, 95% CI: 1.15-3.44, p=0.013 and OR=1.94, 95% CI: 1.11–3.38, p=0.019, respectively). Similar results were found for women with Stage III/IV (OR=1.90, 95% CI: 1.01 – 3.57, p=0.048 and OR=2.51, 95% CI: 1.25 – 5.02, p=0.01, respectively). These associations were independent of disease-specific factors or other factors. In addition, in women with Stage I/II, depression and pain catastrophizing were independently associated with bladder/pelvic floor tenderness (OR=2.23, 95% CI: 1.29 – 3.86, p=0.0040 and OR=2.13, 95% CI: 1.17 – 3.88, p=0.013, respectively). In contrast, in women with Stage III/IV, anxiety was independently associated with bladder/pelvic floor tenderness (OR=3.41, 95% CI: 1.62 – 7.18, p=0.0010).