What is the impact on sexual function of laparoscopic treatment and subsequent combined oral contraceptive therapy in women with deep infiltrating endometriosis?
BACKGROUND
Deep infiltrating endometriosis (DIE) is a form of endometriosis in which the lesion penetrates for more than 5 mm under the peritoneal surface. It is a chronic disease which can impair women's sexual function. There is a growing body of evidence supporting combined surgical/medical treatment in the management of DIE.


OBJECTIVE
The aims of this article are to evaluate the impact of the laparoscopic full excision of endometriosis and postoperative combined oral contraceptives (COC) administration on sexual function in patients with DIE and to compare sexual function outcomes of women submitted to intestinal resection and nodule excision.


METHODS
It is a prospective cohort study in a tertiary care university hospital on 106 sexually active women, with histologically confirmed DIE, managed by laparoscopy and subsequent COC therapy for 6 months. Patients filled preoperatively and 6-month postoperatively a quality of sexual life questionnaire, the Sexual Health Outcomes in Women Questionnaire (SHOW-Q) and they ranked their symptom intensity using a 10-point visual analogue scale (VAS).


METHODS
Sexual function was measured through the SHOW-Q scores and pain symptoms through VAS scores. Intraoperative details, type of intervention and perioperative complications were noted.


RESULTS
Six months after surgery and postoperative COC treatment, a significant improvement was observed in the SHOW-Q domains of pelvic problem interference, sexual satisfaction and desire (P<0.05). Laparoscopic management of DIE did not change significantly the orgasm area of the sexual functioning (P=0.7). No significant difference was found in SHOW-Q scores between patients submitted to intestinal resection and patients submitted to intestinal nodule excision (P>0.05).


CONCLUSIONS
Sexual desire, satisfaction with sex and pelvic problem interference with intercourse are significantly improved after 6 months from laparoscopic excision of DIE combined with postoperative COC therapy. No difference in sexual outcomes was detected between patients submitted to intestinal resection and nodule excision.
Minimally Invasive Gynecological Surgery Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy.
Mohamed
M
Mabrouk
Giulia
G
Montanari
Nadine
N
Di Donato
Simona
S
Del Forno
Clarissa
C
Frascà
Elisa
E
Geraci
Giulia
G
Ferrini
Claudia
C
Vicenzi
Diego
D
Raimondo
Gioia
G
Villa
Ziv
Z
Zukerman
Stefania
S
Alvisi
Renato
R
Seracchioli
D000328:Adult; D003131:Combined Modality Therapy; D003277:Contraceptives, Oral, Combined / Q000627:therapeutic use*; D004715:Endometriosis / Q000150:complications / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D011446:Prospective Studies; D012725:Sexual Behavior; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000628:therapy*; D020018:Sexual Dysfunctions, Psychological / Q000209:etiology / Q000628:therapy*; D055815:Young Adult
D003277:Contraceptives, Oral, Combined