An evaluation of sexual function and health-related quality of life following laparoscopic surgery in individuals living with endometriosis

Abstract STUDY QUESTION What is the relationship between sexual function, health-related quality of life (HRQoL), and laparoscopic surgery in individuals living with endometriosis? SUMMARY ANSWER A higher number of laparoscopic surgeries is significantly associated with poorer HRQoL and greater levels of sexual dysfunction in individuals with endometriosis. WHAT IS KNOWN ALREADY Prior research indicates that endometriosis is associated with lowered HRQoL and sexual function and that these outcomes are influenced by endometriosis-related symptom profiles, medical, and surgical management. A limited number of studies have examined changes in sexual function in individuals with endometriosis following laparoscopic surgery or following repeated surgeries. STUDY DESIGN, SIZE, DURATION A cross-sectional community-based online survey was used to examine the relationships between sexual function, HRQoL, and laparoscopic surgery (n = 210). PARTICIPANTS/MATERIALS, SETTING, METHODS Individuals with a self-reported diagnosis of endometriosis were recruited via online advertising through social media and gynaecology clinics. Endometriosis-specific data (e.g. diagnostic delay, symptom experience) was collected in addition to engagement with laparoscopic surgery, level of HRQoL (EuroQol-5 Dimension: EQ-5D-5L), and sexual function (Female Sexual Function Index: FSFI). Bivariate correlational analyses and hierarchical multiple regression were used to determine the associations between the variables of interest. MAIN RESULTS AND THE ROLE OF CHANCE Individuals with endometriosis have substantially poorer HRQoL in comparison to Australian normative samples, with greater levels of endometriosis-related symptom burden, distress, and pain significantly associated with lower levels of HRQoL. The mean FSFI score was suggestive of clinically significant female sexual dysfunction, with the lowest level of function noted in the domain of sexual pain and the highest level of function noted in the sexual satisfaction domain. A greater number of laparoscopic surgeries was significantly associated with poorer overall HRQoL and greater levels of sexual dysfunction. LIMITATIONS, REASONS FOR CAUTION The cross-sectional nature of the data precludes direct findings of causality and further longitudinal research is recommended. The information pertaining to engagement in laparoscopic surgery was self-report in nature and was not medically verified. WIDER IMPLICATIONS OF THE FINDINGS The study’s findings highlight the pervasive impact of endometriosis on all domains of living, emphasizing the need to extend treatment planning beyond that of physical pain management alone. Early referral for assessment and management of sexual wellbeing is recommended prior to, and post-surgical intervention, with a focus on maintaining post-surgical changes, potentially reducing the need for multiple surgeries. STUDY FUNDING, COMPETING INTEREST(S) The study was not associated with research funding. Author CN reports grant funding from the Australian Government and Medical Research Future Fund (MRFF) and was a previous employee of CSL Vifor (formerly Vifor Pharma Pty Ltd). TRIAL REGISTRATION NUMBER N/A.

As can be seen in Table 5, when the absence/presence of certain endometriosis-related symptoms were entered on Step 1, dysmenorrhea, dyspareunia, and intermenstrual bleeding were significant correlates of sexual desire.When treatment factors were added at Step 2, dysmenorrhea, dyspareunia, and intermenstrual bleeding were significant correlates of sexual desire.The significant positive correlate of sexual desire in the final model was Health VAS (Visual Analogue Scale) with higher selfreported health associated with greater function in the domain of sexual desire.The significant negative predictors of sexual desire in the final model were dysmenorrhea, intermenstrual bleeding, and length of time since the most recent laparoscopic surgery, with the presence of intermenstrual bleeding and dysmenorrhea and greater duration post-surgery associated with poorer function in the domain of sexual desire.
Sexual Arousal.On Step 1 of the hierarchical MRA, the absence/presence of individual endometriosis-related symptoms accounted for a significant 19.8% of the variance in sexual arousal, R 2 ¼ 0.198, F(11, 190)  As can be seen in Table 5, when the absence/presence of certain endometriosis-related symptoms were entered on Step 1, dysmenorrhea, dyspareunia, and intermenstrual bleeding were significant correlates of sexual arousal.When treatment factors were added at Step 2, dysmenorrhea, dyspareunia, intermenstrual bleeding, and undertaking hormonal therapy were significant correlates of sexual arousal.The significant positive correlate of sexual arousal in the final model was the Health VAS with higher self-reported health associated with greater function in the domain of sexual arousal.The significant negative correlates of sexual arousal in the final model were dysmenorrhea, dyspareunia, intermenstrual bleeding, and hormonal therapy with the presence of dysmenorrhea, dyspareunia, intermenstrual bleeding, and undertaking hormonal therapy associated with poorer function in the domain of sexual arousal.
As can be seen in Table 5, when the absence/presence of certain endometriosis-related symptoms were entered on Step 1, dysmenorrhea was the only significant correlate of sexual lubrication.When treatment factors were added at Step 2, dysmenorrhea, and hormonal therapy were significant correlates of sexual lubrication.The significant positive correlate of sexual lubrication in the final model was the Health VAS with higher selfreported health associated with greater function in the domain of sexual lubrication.The significant negative correlates of sexual lubrication in the final model were dysmenorrhea, intermenstrual bleeding, and hormonal therapy with the presence of dysmenorrhea, intermenstrual bleeding, and undertaking hormonal therapy associated with poorer function in the domain of sexual lubrication.
As can be seen in Table 6, when the absence/presence of endometriosis-related symptoms were entered on Step 1, endometriosis-related pain, dysmenorrhea, dyspareunia, and intermenstrual bleeding were the significant correlates of orgasmic function.When treatment factors were added at Step 2, endometriosis-related pain, dysmenorrhea, dyspareunia, and intermenstrual bleeding were significant correlates of orgasmic function.The significant positive correlate of orgasmic function in the final model was the Health VAS with higher self-reported health associated with greater function in the domain of orgasmic function.The significant negative correlates of orgasmic function in the final model were dysmenorrhea, dyspareunia, and intermenstrual bleeding, with the presence of dysmenorrhea, dyspareunia, and intermenstrual bleeding associated with poorer function in the domain of orgasmic function.
As can be seen in Table 6, when the absence/presence of endometriosis-related symptoms were entered on Step 1, endometriosis-related pain, dysmenorrhea, and dyspareunia were the significant correlates of sexual satisfaction.When treatment factors were added at Step 2, endometriosis-related pain, dysmenorrhea, dyspareunia, and hormonal therapy were significant correlates of sexual satisfaction.The significant positive correlate of sexual satisfaction in the final model was the Health VAS with higher self-reported health associated with greater function in the domain of sexual satisfaction.The significant negative correlates of sexual satisfaction in the final model were dysmenorrhea, dyspareunia, and hormonal therapy with the presence of dysmenorrhea and dyspareunia and use of hormonal therapy associated with poorer function in the domain of sexual satisfaction.
As can be seen in Table 6, when the absence/presence of endometriosis-related symptoms were entered on Step 1, endometriosis-related pain, intermenstrual bleeding, nausea, and vulval pain were the significant correlates of sexual pain.When treatment factors were added at Step 2, endometriosis-related pain, intermenstrual bleeding, nausea, and vulval pain were significant correlates of sexual pain.The significant positive correlate of sexual pain in the final model was the Health VAS with higher self-reported health associated with lower levels of sexual pain.The significant negative correlates of sexual pain in the final model were intermenstrual bleeding, nausea, and hormonal treatment, with the presence of intermenstrual bleeding and nausea and use of hormonal therapy associated with greater sexual pain.