Background

It is a truth universally acknowledged that the main symptoms of endometriosis are pelvic pain and, to a lesser extent, infertility and fatigue.1 ,2 These symptoms affect an estimated 176 million women worldwide.3

What is less frequently acknowledged, however, are the different types of pains associated with symptomatic endometriosis, a disease which constitutes the most frequent origin of the ‘3D Syndrome’4:

• Dysmenorrhoea (defined according to loss of work productivity and need for bed rest)

• Dyschezia (defined according to frequency of the complaint) and

• Dyspareunia (defined according to limitation of sexual activity).

Dyspareunia is generally described as deep (pain experienced inside the vaginal canal, at the level of the cervix, or in the pelvic/uterine/abdominal region) or superficial (pain in the vulvar region and/or the vaginal introitus).5 However, if sex hurts it is a problem for the woman and the couple regardless of whether the pain is deep or superficial. If something is painful, it is painful, and one will typically wish to avoid it.

Frequency of dyspareunia in women with endometriosis

Women with endometriosis have a nine-fold increase in risk of deep dyspareunia in comparison to the general female population of corresponding age.6 In two groups of women with recto-vaginal endometriosis (n=100) and peritoneal and/or ovarian endometriosis (n = 100) compared to healthy controls (n=100), 67% and 53%, respectively, reported deep dyspareunia compared with 26% of controls.7

Whilst recognising that dyspareunia is found in populations without endometriosis, this study demonstrated that women with endometriosis experience more frequent and severe deep dyspareunia and worse sexual functioning compared with women without endometriosis. Differences between women with diverse endometriosis forms are, however, marginal.7

In a market research survey of 2753 women, with symptomatic endometriosis or suspected (symptomatic of) endometriosis, 50% responded …