子宫内膜异位症与性功能障碍：手术与药物治疗的影响，一项多中心横断面研究。
Endometriosis and sexual disorders: the effect of surgical and medical treatment, a multicentre cross-sectional study.
机构信息
Department of Experimental, Clinical and Biomedical Sciences, Division of Obstetrics and Gynecology, Careggi University Hospital, University of Florence, Florence, Tuscany, Italy.
Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, University of Florence, Florence, Tuscany, Italy.
出版信息
F1000Res. 2023 Oct 31;12:1424. doi: 10.12688/f1000research.141537.1. eCollection 2023.
BACKGROUND
Sexual health is a major concern in women with endometriosis, however only a few controlled studies have examined this with validated instruments. The effect of hormonal treatments on sexual function in endometriosis is also an underrated topic. The aim of this study was to investigate sexual function of patients with endometriosis by a specific tool to better evaluate their sexual function (including different domains), and the influence of hormonal treatment or surgery on these parameters.
METHODS
An observational, cross-sectional, multicentre study was conducted in a group (n=194) of sexually active, women aged 25-45 years old, with surgical or ultrasonographic diagnosis of endometriosis, referred to the Endometriosis Center of Careggi University Hospital or Negrar di Valpolicella. Sexual function was assessed by administering the Female Sexual Function Index (FSFI), which assesses the domains of desire, arousal, lubrication, orgasm, satisfaction and pain. FSFI scores were compared to those of a control group (n=58) and according to the treatment received by patients with endometriosis.
RESULTS
Ovarian endometriosis was present in 50 patients (25.8%), deep infiltrating endometriosis in 65 patients (33.5%) and both in 79 patients (40.7%). Adenomyosis coexisted in 102 patients (52.6%). Women with endometriosis reported a mean total FSFI score of 18.3 [4.2-25.8] (< 26.55), indicating female sexual dysfunction (FSD) in all patients. At multivariate analysis, after adjusting for confounders (BMI and hormonal therapy), women with endometriosis presented significantly lower scores than controls in all the FSFI (p<0.001). Patients with endometriosis under hormonal treatments (n=124; 64%), regardless of the type, had significantly lower scores in all FSFI subscales and total score, even after adjusting for confounders-age, BMI and history of surgery.
CONCLUSIONS
Patients with endometriosis are at risk for FSD, encompassing not only dyspareunia, but all domains of sexual function. Hormonal treatments do not result in improvement in sexual symptoms.
背景
性健康是子宫内膜异位症患者的主要关注点，但只有少数对照研究使用经过验证的工具对此进行了检查。激素治疗对子宫内膜异位症患者性功能的影响也是一个被低估的话题。本研究旨在通过特定工具评估子宫内膜异位症患者的性功能，以更好地评估其性功能（包括不同领域），并研究激素治疗或手术对这些参数的影响。
方法
这是一项观察性、横断面、多中心研究，共纳入了 194 名年龄在 25-45 岁之间、有性生活的、经手术或超声诊断为子宫内膜异位症的女性患者，她们均来自 Careggi 大学医院或 Negrar di Valpolicella 的子宫内膜异位症中心。通过女性性功能指数（FSFI）评估性功能，该指数评估了欲望、唤起、润滑、性高潮、满意度和疼痛等领域。将 FSFI 评分与对照组（n=58）进行比较，并根据子宫内膜异位症患者接受的治疗进行比较。
结果
50 名患者（25.8%）患有卵巢子宫内膜异位症，65 名患者（33.5%）患有深部浸润性子宫内膜异位症，79 名患者（40.7%）同时患有这两种疾病。102 名患者（52.6%）同时患有子宫腺肌病。子宫内膜异位症患者的平均总 FSFI 评分为 18.3[4.2-25.8]（<26.55），表明所有患者均存在女性性功能障碍（FSD）。多变量分析显示，在校正混杂因素（BMI 和激素治疗）后，子宫内膜异位症患者在所有 FSFI 评分上的得分均明显低于对照组（p<0.001）。接受激素治疗的子宫内膜异位症患者（n=124；64%），无论激素治疗类型如何，在所有 FSFI 亚量表和总分上的得分均明显较低，即使在校正混杂因素（年龄、BMI 和手术史）后也是如此。
结论
子宫内膜异位症患者存在 FSD 风险，不仅包括性交痛，还包括性功能的所有领域。激素治疗并不能改善性功能症状。
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