Impact of endometriosis on female sexual function: an updated systematic review and meta-analysis

INTRODUCTION: Endometriosis can lead to a state of chronic inflammation marked by the presence of scarring and adhesions within the pelvis and/or other parts of the body. Recent estimates suggest that globally this condition affects approximately 10% of women in the reproductive age group. AIMS: In this study we sought updated evidence on the association between endometriosis and sexual function in female patients. METHODS: We used standard assessment tools to conduct a systematic search of the PubMed, EMBASE, and Scopus databases for observational studies that documented the association of endometriosis with female sexual function. A random-effects model was used for the analysis, and effect sizes were reported as the weighted mean difference (WMD) or OR with 95% CIs. RESULTS: A total of 13 studies were selected for inclusion in our investigation. All of the included studies were cross-sectional in design. The data on sexual function in most of the studies were collected by using the Female Sexual Function Index (FSFI) tool, for which higher scores suggest better sexual function. The risk of sexual dysfunction (based on specific cutoffs for the FSFI score) was higher in women with than in women without endometriosis (OR 1.71; 95% CI, 1.21-2.43). In addition, when we used continuous scores to examine the risk of sexual dysfunction, diagnosis of endometriosis was associated with significantly lower overall FSFI scores (WMD, −3.40; 95% CI, −5.13 to −1.66) and lower scores on all of its 6 domains, ie, desire (WMD, −0.27; 95% CI, −0.53 to −0.02), arousal (WMD, −0.43; 95% CI, −0.79 to −0.07), lubrication (WMD, −0.49; 95% CI, −0.66 to −0.31), orgasm (WMD, −0.65; 95% CI, −1.07 to −0.23), satisfaction (WMD, −0.52; 95% CI, −0.77 to −0.26), and pain (WMD, −1.06; 95% CI, −1.57 to −0.55). CONCLUSION: The findings of this study suggest that female patients with endometriosis have suboptimal sexual function compared with healthy female subjects. Patients with endometriosis should be offered sexual counseling and supportive care by a multidisciplinary team of gynecologists, psychologists, and sexual therapists.