Dyspareunia and depressive symptoms are associated with impaired sexual functioning in women with endometriosis, whereas sexual functioning in their male partners is not affected
Dyspareunia and depressive symptoms are associated with impaired sexual functioning in women with endometriosis, whereas sexual functioning in their male partners is not affected
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DOI：
10.1093/humrep/dew215
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发表时间：
2016-11-01
影响因子：
6.1
通讯作者：
Dunselman, G. A. J.
中科院分区：
文献类型：
--
作者：
De Graaff, A. A.;Van Lankveld, J.;Dunselman, G. A. J.
子宫内膜异位症及其相关的生理和心理症状在多大程度上与女性及其男性伴侣的性功能感知水平相关？性交困难和抑郁症状与患有子宫内膜异位症的女性性功能受损有关，而其男性伴侣的性功能不受影响。患有子宫内膜异位症的女性有更多的性交困难，性功能下降，生活质量下降。在定性研究中，患有子宫内膜异位症的女性的伴侣报告说，子宫内膜异位症影响了她们的生活质量，并产生了关系困扰。在这项横断面研究中，将子宫内膜异位症女性（n = 83）及其伴侣（n = 74）的性功能与因避孕相关问题到门诊就诊的对照组女性（n = 40）及其伴侣（n = 26）的性功能进行比较。2011年6月至2012年12月期间，马斯特里赫特大学医学中心（MUMC）和文洛维埃库里医学中心招募了妇女及其合作伙伴。所有参与者都被要求完成一套在线问卷。子宫内膜异位症患者的缓解率为59.3%(83/140)，其伴侣的缓解率为52.3%（74/140）。对照组有效率分别为43.2%和27.4%(41/95和27/95)，其中40名女性和26名伴侣可纳入研究。与对照组相比，子宫内膜异位症的女性在性交时疼痛明显更频繁（53%对15%，P < 0.001）；慢性疼痛水平较高（VAS中值2.0 cm vs 0.0 cm, P < 0.001）；性功能障碍加重（女性性功能指数中位数25.4比30.6,P < 0.001）；生活质量受损更严重（短表12中位数为66.3比87.2,P < 0.001）；更多的疼痛灾难化（平均疼痛灾难化量表17.8比8.5,P < 0.001），更多的抑郁和焦虑症状（医院焦虑和抑郁量表中位数抑郁症为7比4，P < 0.001，焦虑为4比1，P < 0.001）。根据国际勃起功能指数，患有子宫内膜异位症的女性的男性伴侣与对照组的男性伴侣的性功能相当。Logistic回归分析显示性交困难（OR 0.54; 95% CI 0.39-0.75）和抑郁症状（OR 0.761; 95% CI 0.58-0.99）是性功能的独立且显著的负向预测因子。慢性盆腔疼痛（OR 0.53; 95% CI 0.35-0.81）和抑郁症状（OR 0.65; 95% CI 0.44-0.96）是生活质量的独立且显著的负向预测因子。患者招募是在一家三级保健中心进行的，在较小程度上是在一家综合医院进行的，这可能导致患有更严重子宫内膜异位症的患者人数过多。所有参与调查的女性都有一个伴侣，因此在关系方面是“幸存者”。这可能导致低估了子宫内膜异位症对性功能的影响。值得进一步探讨抑郁症状在有症状的子宫内膜异位症女性中的作用，并评估抑郁症状治疗对性功能和生活质量的影响。伴侣没有报告性功能受损的事实可能会让女性感到安心，这可能会在咨询室中讨论。这项研究是由MUMC资助的。荷兰身心妇产科学会提供了一笔无条件的研究经费（2011年6月21日）。不适用。
To what extent are endometriosis and its related physical and mental symptoms associated with the perceived level of sexual functioning in women and their male partners?Dyspareunia and depressive symptoms are associated with impaired sexual functioning in women with endometriosis, whereas sexual functioning in their male partners is not affected.Women with endometriosis suffer from more dyspareunia, lower sexual functioning, and lower quality of life. In qualitative studies, partners of women with endometriosis report that endometriosis affected their quality of life and produced relational distress.In this cross-sectional study, sexual functioning in women with endometriosis (n = 83) and their partners (n = 74) was compared with sexual functioning in a control group of women attending the outpatient department for issues related to contraception (n = 40), and their partners (n = 26).Women and partners were recruited in the Maastricht University Medical Centre (MUMC) and the VieCuri Medical Centre Venlo between June 2011 and December 2012. All participants were asked to complete a set of online questionnaires.Response rates were 59.3% (83/140) for women with endometriosis and 52.3% (74/140) for their partners. Response rates in the control group were respectively 43.2% and 27.4% (41/95 and 27/95), of whom 40 women and 26 partners could be included in the study. Women with endometriosis as compared with the control group, reported significantly more frequent pain during intercourse (53% versus 15%, P < 0.001); higher levels of chronic pain (median VAS 2.0 cm versus 0.0 cm, P < 0.001); more impairment of sexual functioning (median Female Sexual Function Index 25.4 versus 30.6, P < 0.001); more impairment of quality of life (median Short Form-12 66.3 versus 87.2, P < 0.001); more pain catastrophizing (mean Pain Catastrophizing Scale 17.8 versus 8.5, P < 0.001), more depression and anxiety symptoms (median Hospital Anxiety and Depression Scale for depression 7 versus 4, P < 0.001 and for anxiety 4 versus 1, P < 0.001). Sexual functioning was comparable between male partners of women with endometriosis and male partners of the control group based on the International Index of Erectile Function. Logistic regression analyses showed that dyspareunia (OR 0.54; 95% CI 0.39-0.75) and depressive symptoms (OR 0.761; 95% CI 0.58-0.99) were independent and significant negative predictors for sexual functioning. Chronic pelvic pain (OR 0.53; 95% CI 0.35-0.81) and depressive symptoms (OR 0.65; 95% CI 0.44-0.96) were independent and significant negative predictors for quality of life.Patient recruitment was performed in one tertiary care centre and to a lesser extent one general hospital, possibly leading to an over-representation of patients with more severe endometriosis. All participating women had a partner and are therefore 'survivors' in relationship terms. This may have led to an underestimation of the impact of endometriosis on sexual functioning.It would be worthwhile to further explore the role of depressive symptoms in women with symptomatic endometriosis and to assess the effect of treatment of depressive symptoms on sexual functioning and quality of life. The fact that the partners did not report impaired sexual functioning could be a reassuring thought to women that might be discussed in the consulting room.The study was funded by the MUMC. An unconditional research grant was given by the Dutch Society of Psychosomatic Obstetrics and Gynaecology (21 June 2011).Not applicable.