NIH, Epidemiology Branch, National Institute of Environmental Health Sciences, NC, USA.
J Sex Med. 2014 Mar;11(3):800-8. doi: 10.1111/jsm.12425. Epub 2014 Jan 28.
Despite estimates of a high prevalence of deep dyspareunia (DD) among women in the United States, risk factors for this important area of sexual dysfunction have been largely understudied.
The purpose of this study was to examine the relationship between uterine fibroids and the prevalence of DD.
We used data from the Uterine Fibroid Study (enrollment 1996-1999 in a U.S. metropolitan area). Participating women were ages 35-49 and were randomly selected from the membership rolls of a prepaid health plan. Women were asked to provide detailed health information including a symptom questionnaire with questions about DD and to have a study ultrasound to screen for fibroids ≥ 0.5 cm in diameter. The analysis included 827 women, after restriction to participants who were premenopausal with an intact uterus, sexually active, completed the symptom questionnaire, and had fibroid status adequately assessed. Logistic regression was conducted to estimate the adjusted prevalence odds ratio (aPOR) for the association of DD with presence of fibroids after adjusting for age, ethnicity, education, depression, physical activity, parity, and pelvic pathology.
Our main outcome measures were the presence and severity of DD.
The presence of fibroids was significantly associated with DD (aPOR = 1.7 95% confidence interval [CI] 1.1, 2.5). The aPOR was stronger for severe DD, DD that interfered with normal activity "some" or "a lot" (aPOR = 3.1 95% CI 1.2, 8.2). However, there was not a significant dose response relationship between fibroid burden (measured by uterine volume) and DD. Fundal fibroids were more strongly associated with DD than other fibroids. Additional factors associated with significantly elevated odds of DD were parity, depression, younger age, and pelvic pathology.
Our results suggest that fibroids are associated with DD. The association may not be causal but may reflect shared etiology and/or pathologic pathways.
尽管有研究估计，美国女性中深度性交痛（DD）的患病率很高，但该重要性功能障碍领域的风险因素在很大程度上仍未得到充分研究。
本研究旨在探讨子宫肌瘤与 DD 患病率之间的关系。
我们使用了来自美国大都市地区的子宫肌瘤研究（1996-1999 年入组）的数据。参与研究的女性年龄在 35-49 岁之间，是从一家预付健康计划的会员名单中随机选择的。女性被要求提供详细的健康信息，包括一份关于 DD 的症状问卷，并进行研究性超声检查以筛查直径≥0.5 厘米的肌瘤。该分析包括 827 名女性，这些女性为绝经前、子宫完整、有性生活、完成了症状问卷且肌瘤状况得到充分评估的参与者。采用逻辑回归来估计存在肌瘤与 DD 之间的关联的调整后患病率比值比（aPOR），调整因素包括年龄、种族、教育程度、抑郁、身体活动、生育次数和盆腔病理。
我们的主要观察指标是 DD 的存在和严重程度。
肌瘤的存在与 DD 显著相关（aPOR=1.7，95%置信区间[CI]为 1.1，2.5）。严重 DD、DD 对正常活动“有些”或“很多”造成干扰（aPOR=3.1，95%CI 为 1.2，8.2）的情况下，aPOR 更强。然而，肌瘤负担（通过子宫体积测量）与 DD 之间不存在显著的剂量反应关系。宫底肌瘤与 DD 的相关性比其他肌瘤更强。与 DD 显著相关的其他因素还包括生育次数、抑郁、年龄较小和盆腔病理。
我们的研究结果表明，肌瘤与 DD 相关。这种关联可能不是因果关系，而是可能反映了共同的病因和/或病理途径。
