Prevalence and Predictors of Sexual Dysfunction Among Women with Endometriosis: A Cross-Sectional Study

Abstract

Background: Endometriosis is a chronic inflammatory gynecological disorder that may impair sexual functioning through dyspareunia, pelvic pain, psychological distress, and infertility. This study determined the prevalence of sexual dysfunction and its predictors among women with endometriosis.

Methods: This analytical cross-sectional research encompassed 80 sexually active females aged 18 to 45 years diagnosed with endometriosis, who visited the Department of Gynecology and Obstetrics at Nishtar Medical University, Multan, Pakistan, between March 2022 and March 2023. Sexual performance was evaluated with the 19-item Female Sexual Function Index, where a cumulative score of ≤26.55 signifies dysfunction. The intensity of pain was assessed by a numerical rating scale, whilst depressed symptoms were gauged using the Patient Health Questionnaire-9. Binary logistic regression determined autonomous predictors.

Results: Sexual dysfunction was present in 57 women, giving a prevalence of 71.3% (95% confidence interval, 60.5%–80.0%). Mean total Female Sexual Function Index score was 22.8 ± 5.8, with significant impairment across all domains. Severe deep dyspareunia, stage III–IV endometriosis, severe chronic pelvic pain, infertility, and depressive symptoms were more frequent among women with dysfunction. On multivariable analysis, severe deep dyspareunia (adjusted odds ratio 4.21), stage III–IV disease (adjusted odds ratio 3.32), and moderate-to-severe depressive symptoms (adjusted odds ratio 4.33) remained independent predictors. The model showed good discrimination and acceptable calibration for predicting dysfunction.

Conclusion: Sexual dysfunction was highly prevalent among women with endometriosis. Severe dyspareunia, advanced disease, and depressive symptoms were important predictors, supporting routine sexual-health and psychological assessment as part of multidisciplinary endometriosis care.

Keywords: depressive symptoms; dyspareunia; endometriosis; Female Sexual Function Index; sexual dysfunction