BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada.
Women's Health Research Institute, Vancouver, BC, Canada.
J Sex Med. 2020 Apr;17(4):761-770. doi: 10.1016/j.jsxm.2019.12.019. Epub 2020 Jan 24.
Deep dyspareunia, a common symptom in endometriosis, has previously been associated with bladder and/or pelvic floor tenderness (BPFT), which suggests a role for central nervous system sensitization. The Central Sensitization Inventory (CSI, 0-100) is a validated self-reported scale for patients with central sensitization.
The objective of this study was to phenotype deep dyspareunia using BPFT and the CSI.
The methods included cross-sectional analysis from a prospective registry from January 2018 to June 2018 at a tertiary center for endometriosis (ClinicalTrials.gov #NCT02911090). Included were women aged 18-50 years with endometriosis (previously surgically diagnosed, current visualized endometrioma on ultrasound, or current palpable or visualized nodule on ultrasound), who were newly or re-referred to the center. Severity of deep dyspareunia was self-reported using an 11-point numeric rating scale (0 = no pain; 10 = worst pain imaginable), categorized as no or low deep dyspareunia (0-4) and high deep dyspareunia (5-10). We identified the subgroup with high deep dyspareunia and presence of BPFT, where we hypothesized a central component of the sexual pain. This subgroup was compared with 2 other subgroups: no or low deep dyspareunia and high deep dyspareunia but no BPFT. The CSI was compared between the groups using analysis of variance, followed by post hoc testing (P < .05).
The main outcome measure was the CSI score ranging from 0 to 100.
Data from 163 women with endometriosis were analyzed. The mean age of this cohort was 36.4 ± 6.8 years, and the mean CSI score was 41.0 ± 18.6. 37 percent (61/163) had high deep dyspareunia and BPFT; 29% (47/163) had high deep dyspareunia and no BPFT; and 34% (55/163) had no or low deep dyspareunia. The CSI significantly differed between the 3 groups (analysis of variance: F = 22.4, P < .001). In post hoc testing, the CSI was higher in women with high deep dyspareunia and BPFT (51.3 ± 16.9), compared with women with no or low deep dyspareunia (30.9 ± 15.4, P < .001) and compared with women with high deep dyspareunia but no BPFT (39.4 ± 17.2, P = .001).
The CSI could be used to classify and phenotype patients with endometriosis-associated sexual pain.
STRENGTH & LIMITATIONS: Strengths include a prospective registry with integrated pain scores, validated questionnaires, and physical examination findings. Limitations include the lack of quantitative sensory testing for central sensitization.
In women with endometriosis, the subgroup with high deep dyspareunia and bladder and/or pelvic floor tenderness had a significantly higher score on the CSI than other subgroups, suggesting that this group may have a central component to their sexual pain. Orr NL, Wahl KJ,Noga H, et al. Phenotyping Sexual Pain in Endometriosis Using the Central Sensitization Inventory. J Sex Med 2020;17:761-770.
深部性交痛是子宫内膜异位症的常见症状，以前与膀胱和/或盆底压痛（BPFT）有关，这表明中枢神经系统敏化起作用。中枢敏化量表（CSI，0-100）是一种用于中枢敏化患者的经过验证的自我报告量表。
本研究的目的是使用 BPFT 和 CSI 对深部性交痛进行表型分析。
该方法包括 2018 年 1 月至 2018 年 6 月在子宫内膜异位症的三级中心进行的前瞻性登记的横断面分析（ClinicalTrials.gov #NCT02911090）。纳入的患者为年龄在 18-50 岁之间的子宫内膜异位症患者（以前通过手术诊断，当前超声可见子宫内膜瘤，或当前超声可见或可触及的结节），他们是新转诊或再次转诊到中心的患者。深部性交痛的严重程度通过 11 点数字评分量表（0=无疼痛；10=可想象到的最严重疼痛）进行自我报告，分为无或低度深部性交痛（0-4）和高度深部性交痛（5-10）。我们确定了具有高度深部性交痛和 BPFT 的亚组，我们假设该亚组存在性疼痛的中枢成分。与另外 2 个亚组进行比较：无或低度深部性交痛和高度深部性交痛但无 BPFT。使用方差分析比较 CSI 评分在各组之间的差异，然后进行事后检验（P <.05）。
主要观察指标是 CSI 评分，范围为 0-100。
对 163 名患有子宫内膜异位症的女性进行了数据分析。该队列的平均年龄为 36.4 ± 6.8 岁，平均 CSI 评分为 41.0 ± 18.6。37%（61/163）有高度深部性交痛和 BPFT；29%（47/163）有高度深部性交痛和无 BPFT；34%（55/163）有无或低度深部性交痛。3 组之间的 CSI 评分差异有统计学意义（方差分析：F = 22.4，P <.001）。在事后检验中，高度深部性交痛和 BPFT 的女性的 CSI 评分明显高于无或低度深部性交痛的女性（51.3 ± 16.9，P <.001）和高度深部性交痛但无 BPFT 的女性（39.4 ± 17.2，P =.001）。
CSI 可用于对子宫内膜异位症相关性疼痛患者进行分类和表型分析。
优势包括前瞻性登记，具有综合疼痛评分、经过验证的问卷和体格检查结果。局限性包括缺乏中枢敏化的定量感觉测试。
在患有子宫内膜异位症的女性中，具有高度深部性交痛和膀胱和/或盆底压痛的亚组在 CSI 上的评分明显高于其他亚组，这表明该组可能存在性疼痛的中枢成分。Orr NL, Wahl KJ, Noga H, et al. 利用中枢敏化量表对子宫内膜异位症相关的性疼痛进行表型分析。J 性医学 2020;17:761-770.
