The challenge of endometriosis for female sexual health.

Abstract

The quality of sexual life plays an important role in the overall quality of life,1 representing a primary care priority.2 Sexual health is defined, according to the World Health Organization, as a state of physical, emotional, mental, and social well-being in relation to sexuality.3 Sexual function is a complex phenomenon driven by social, psychological, and biological/hormonal factors4 and may be impaired by medical conditions, especially when gynecologic disorders are involved.5 In the last years, an increasing number of evidences has shown that patients with endometriosis frequently report an impairment in sexual functioning and satisfaction.5,6 Endometriosis is a benign hormone-dependent disorder associated with the presence of endometrial tissue displaced outside the uterine cavity. Its pathophysiology has long been debated and involves estrogen dependency, progesterone resistance, decreased apoptosis, oxidative stress, inflammation, and neuroangiogenesis.7 Global prevalence is estimated to vary from 6% to 10% in women of reproductive age,8 even though the condition is often misdiagnosed or underrated. The main consequences of endometriosis are chronic pain (dysmenorrhea, noncyclic pelvic pain, dyspareunia, dyschezia, dysuria) and subfertility.9 Among pain manifestations, dyspareunia—defined as “recurrent genital pain or discomfort that occurs before, during, or after sexual intercourse, or superficial or deep vaginal penetration”10—is only one of the main sexual symptoms experienced by women with endometriosis.11 Indeed, discomfort during sex and/or difficulties to conceive often lead to poor intimacy and a negative cycle of reduced sexual arousal, desire, ability to orgasm, and satisfaction in affected women.12