Sexual Function of Patients with Deep Endometriosis after Surgical Treatment: A Systematic Review

Cervantes, Graziele Vidoto; Ribeiro, Paulo Augusto Ayroza Galvão; Tomasi, Mariana Carpenedo; Farah, Daniela; Ribeiro, Helizabet Salomão Abdalla Ayroza

doi:10.1055/s-0043-1772596

Graziele Vidoto Cervantes Address for correspondence Graziele Vidoto Cervantes, Departamento de Ginecologia, Centro de Endometriose e Cirurgia Laparoscópica, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil (e-mail: gra_cervantes@hotmail.com).

Department of Gynecology, Endometriosis and Laparoscopic Surgery Center, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil

http://orcid.org/0000-0003-3205-9894

Paulo Augusto Ayroza Galvão Ribeiro

Department of Gynecology, Endometriosis and Laparoscopic Surgery Center, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil

http://orcid.org/0000-0001-8196-1898

Mariana Carpenedo Tomasi

Department of Gynecology, Endometriosis and Laparoscopic Surgery Center, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil

http://orcid.org/0000-0003-2779-1087

Daniela Farah

Department of Gynecology, Women's Health Technology Assessment Center, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil

http://orcid.org/0000-0002-9727-9460

Helizabet Salomão Abdalla Ayroza Ribeiro

Department of Gynecology, Endometriosis and Laparoscopic Surgery Center, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil

http://orcid.org/0000-0003-2195-1174

Address for correspondence Graziele Vidoto Cervantes, Departamento de Ginecologia, Centro de Endometriose e Cirurgia Laparoscópica, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil (e-mail: gra_cervantes@hotmail.com).

Conflict of Interests

The authors have no conflict of interests to declare.

Database	Search Strategy	Number Of Studies
PubMed	(deep endometriosis OR deep infiltrating endometriosis OR endometrioma) AND (resection OR excision OR nodulectomy OR cystectomy OR shaving OR rectosigmoidectomy) AND (dyspareunia OR (sexual AND (function OR quality OR behavior) OR (pain OR dysfunction) AND (sexual OR sexual intercourse)	313
EMBASE	(deep endometriosis/exp OR deep endometriosis OR deep infiltrating endometriosis/exp OR deep infiltrating endometriosis OR endometrioma/exp OR endometrioma) AND (resection/exp OR resection OR excision/exp OR excision OR nodulectomy/exp OR nodulectomy OR cystectomy/exp OR cystectomy OR shaving/exp OR shaving OR rectosigmoidectomy/exp OR rectosigmoidectomy) AND dyspareunia OR (sexual AND (function OR quality OR sexual behavior) OR (pain OR dysfunction) AND (sexual OR sexual intercourse) AND (article/it OR article in press/it OR review/it) AND [female]	597
Cochrane Library	(deep endometriosis OR deep infiltrating endometriosis OR endometrioma) AND (resection OR excision OR nodulectomy OR cystectomy OR shaving OR rectosigmoidectomy)AND (dyspareunia OR (sexual AND (function OR quality OR sexual behavior) OR (pain OR dysfunction) AND (sexual OR sexual intercourse)	20
LILACS	(deep endometriosis OR deep infiltrating endometriosis OR endometrioma) AND (resection OR excision OR nodulectomy OR cystectomy OR shaving OR rectosigmoidectomy) AND (dyspareunia OR (sexual AND (function OR quality OR sexual behavior) OR (pain OR dysfunction) AND (sexual OR sexual intercourse)	9
Web of Science	(deep endometriosis OR deep infiltrating endometriosis OR endometrioma) AND (resection OR excision OR nodulectomy OR cystectomy OR shaving OR rectosigmoidectomy) AND (dyspareunia OR (sexual AND (function OR quality OR sexual behavior)) OR (pain OR dysfunction) AND (sexual OR sexual intercourse)	161

Author, year	Country	Type of study	N	Type of surgery	Age in years	Sexual function questionnaire	Dyspareunia questionnaire
Garry et al., ²⁷27 Garry R, Clayton R, Hawe J. The effect of endometriosis and its radical laparoscopic excision on quality of life indicators. BJOG. 2000;107(01):44–54 2000	United Kingdom	Prospective	57	Laparoscopic excision surgery	–	SAQ	NRS
Abbot et al., ²⁴24 Abbott JA, Hawe J, Clayton RD, Garry R. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up. Hum Reprod. 2003;18(09): 1922–1927 2003	Australia	Prospective	254	Laparoscopic excision surgery	Median: 31 (range 20–48)	SAQ	VAS
Vercellini et al., ³²32 Vercellini P, Aimi G, Busacca M, Apolone G, Uglietti A, Crosignani PG. Laparoscopic uterosacral ligament resection for dysmenorrhea associated with endometriosis: results of a randomized, controlled trial. Fertil Steril. 2003;80(02):310–319 2003	Italy	Randomized controlled trial	180	Laparoscopic excision surgery	Mean 30 ± 5	SSRS	VAS
Ferrero et al., ²⁶26 Ferrero S, Abbamonte LH, Parisi M, Ragni N, Remorgida V. Dyspareunia and quality of sex life after laparoscopic excision of endometriosis and postoperative administration of triptorelin. Fertil Steril. 2007;87(01):227–229 2007	Italy	Prospective	98	Laparoscopic excision surgery	Mean 34.6 ± 3.4	DSFI; GSSI	–
Ferrero et al., ²⁵25 Ferrero S, Abbamonte LH, Giordano M, Ragni N, Remorgida V. Deep dyspareunia and sex life after laparoscopic excision of endometriosis. Hum Reprod. 2007;22(04):1142–1148. Doi: 10.1093/humrep/del465 https://doi.org/10.1093/humrep/del465... 2007	Italy	Prospective	73	Laparoscopic excision surgery	Mean 34.7 ± 4.3	DSFI; GSSI	VAS
Meuleman et al., ¹⁵15 Meuleman C, D'Hoore A, Van Cleynenbreugel B, Beks N, D'Hooghe T. Outcome after multidisciplinary CO2 laser laparoscopic excision of deep infiltrating colorectal endometriosis. Reprod Biomed Online. 2009;18(02):282–289 2009	Belgium	Retrospective	56	Laparoscopic excision surgery with CO₂ laser	Median:32 (range: 24–42)	SAQ	VAS
Meuleman et al., ¹³13 Meuleman C, Tomassetti C, D'Hooghe TM. Clinical outcome after laparoscopic radical excision of endometriosis and laparoscopic segmental bowel resection. Curr Opin Obstet Gynecol. 2012;24 (04):245–252 2012	Belgium	Retrospective	45	Laparoscopic excision surgery with CO₂ laser	Median 30 (range: 18–42)	SAQ	VAS
Mabrouk et al., ³³33 Mabrouk M, Montanari G, Di Donato N, Del Forno S, Frascà C, Geraci E, et al. What is the impact on sexual function of laparoscopic treatment and subsequent combined oral contraceptive therapy in women with deep infiltrating endometriosis? J Sex Med. 2012;9(03):770–778 2012	Italy	Prospective	125	Laparoscopic excision surgery	Mean 35.4 ± 5.5	SHOW-Q	VAS
Setälä et al., ¹⁶16 Setälä M, Härkki P, Matomäki J, Mäkinen J, Kössi J. Sexual functioning, quality of life and pelvic pain 12 months after endometriosis surgery including vaginal resection. Acta Obstet Gynecol Scand. 2012;91(06):692–698 2012	Finland	Prospective	22	Laparoscopic excision surgery or combined laparoscopic vaginal surgery	Median: 29 (range: 19–40)	MFSQ	VAS
Kossi et al., ²¹21 Kössi J, Setälä M, Mäkinen J, Härkki P, Luostarinen M. Quality of life and sexual function 1 year after laparoscopic rectosigmoid resection for endometriosis. Colorectal Dis. 2013;15(01): 102–108 2013	Finland	Prospective	26	Laparoscopic excision surgery	Median: 33.5 (range: 22–46)	MFSQ	–
Van den Broeck et al., ¹⁴14 Van den Broeck U, Meuleman C, Tomassetti C, D'Hoore A, Wolthuis A, Van Cleynenbreugel B, et al. Effect of laparoscopic surgery for moderate and severe endometriosis on depression, relationship satisfaction and sexual functioning: comparison of patients with and without bowel resection. Hum Reprod. 2013;28(09): 2389–2397 2013	Belgium	Prospective	203 (total); 76 WB; 127 WOB	Laparoscopic excision surgery with CO₂ laser	–	SSFS	–
Di Donato et al., ³¹31 Di Donato N, Montanari G, Benfenati A, Monti G, Leonardi D, Bertoldo V, et al. Sexual function in women undergoing surgery for deep infiltrating endometriosis: a comparison with healthy women. J Fam Plann Reprod Health Care. 2015;41(04):278–283 2015	Italy	Prospective	250 DIE; 250 HG	Laparoscopic excision surgery	DIE: mean 34 ± 5 HG: mean 32 ± 6	SHOW-Q	–
Fritzer et al., ¹⁷17 Fritzer N, Tammaa A, Haas D, Oppelt P, Renner S, Hornung D, et al. When sex is not on fire: a prospective multicentre study evaluating the short-term effects of radical resection of endometriosis on quality of sex life and dyspareunia. Eur J Obstet Gynecol Reprod Biol. 2016;197:36–40 2016	Germany	Prospective	96	Laparoscopic excision surgery or combined laparoscopic vaginal surgery	Median: 30.8 (range: 18–45)	FSDS; FSFI	NRS
Pontis et al., ¹⁸18 Pontis A, Nappi L, Sedda F, Multinu F, Litta P, Angioni S. Management of bladder endometriosis with combined transurethral and laparoscopic approach. Follow-up of pain control, quality of life, and sexual function at 12 months after surgery. Clin Exp Obstet Gynecol. 2016;43(06):836–839 2016	Italy	Prospective	16	Combined transurethral and laparoscopicd surgeries	Mean: 29.12 ± 4.33	FSFI	–
Riiskjaer et al., ²⁰20 Riiskjaer M, Greisen S, Glavind-Kristensen M, Kesmodel US Forman A, Seyer-Hansen M. Pelvic organ function before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective, observational study. BJOG. 2016;123(08): 1360–1367 2016	Denmark	Prospective	128	Laparoscopic excision surgery	Mean: 33.8 ± 5.3	SVQ	1: never; 2: a little; 3: often; 4: very often
Uccella et al., ²⁹29 Uccella S, Gisone B, Serati M, Biasoli S, Marconi N, Angeretti G, et al. Functional outcomes of nerve-sparing laparoscopic eradication of deep infiltrating endometriosis: a prospective analysis using validated questionnaires. Arch Gynecol Obstet. 2018;298 (03):639–647 2018	Italy	Prospective	34	Laparoscopic excision surgery	Median 39 (range: 27–51)	FSFI	–
Lermann et al., ¹⁹19 Lermann J, Topal N, Renner SP, Beckmann MW, Burghaus S, Adler W, Heindl F. Comparison of preoperative and postoperative sexual function in patients with deeply infiltrating endometriosis with and without bowel resection. Eur J Obstet Gynecol Reprod Biol. 2019;239:21–29 2019	Germany	Retrospective	134 WOB; 113 WB; 100 CG	Laparoscopic excision surgery	WOB: mean 34.3 ± 6; WB: mean – 37.7 ± 6.	KFSP	–
Ianieri et al., ²⁸28 Ianieri MM, Raimondo D, Rosati A, Cocchi L, Trozzi R, Maletta M, et al. Impact of nerve-sparing posterolateral parametrial excision for deep infiltrating endometriosis on postoperative bowel, urinary, and sexual function. Int J Gynaecol Obstet. 2022;159(01): 152–159 2022	Italy	Retrospective	100	Laparoscopic Excision Surgery	Mediana:38 (32,5–43)	FSFI	VAS
Martínez-Zamora et al., ³⁴34 Martínez-Zamora MA, Coloma JL, Gracia M, Rius M, Castelo-Branco C, Carmona F. Long-term Follow-up of Sexual Quality of Life after Laparoscopic Surgery in Patients with Deep Infiltrating Endometriosis. J Minim Invasive Gynecol. 2021;28(11): 1912–1919 2021	Spain	Prospective	193 (total); 129 DIE; 64 CG	Laparoscopic excision surgery	DIE: mean 33.5 ± 6.04; CG: mean 34.7 ± 4.5	SQoL-F; FSDS; B-PFSF	–
Zhang et al., ³⁰30 Zhang N, Sun S, Zheng Y, Yi X, Qiu J, Zhang X, et al. Reproductive and postsurgical outcomes of infertile women with deep infiltrating endometriosis. BMC Womens Health. 2022;22(01):83 2022	China	Retrospective	55	Laparoscopic excision surgery	Mean: 30 ± 3	FSFI	–

		Sexual Function			Dyspareunia
Autor, year	Follow-up (months)	Preoperatively	Postoperatively	Significance	Preoperatively	Postoperatively	Significance
Questionnaire: SAQ
Garry et al.,²⁷27 Garry R, Clayton R, Hawe J. The effect of endometriosis and its radical laparoscopic excision on quality of life indicators. BJOG. 2000;107(01):44–54 2000	4	Pleasure: 11 (6 ± 13)	Pleasure: 13 (9 ± 16)	Pleasure: 0.002	7 (5.5 ± 9)	0 (0 ± 4)	0.0001
		Discomfort: 3 (1.5 ± 5)	Discomfort: 1 (0 ± 3)	Discomfort: < 0.05
		Habit:1 (0 ± 1)	Habit:1 (1 ± 2)	Habit: < 0.002
Abbott, et al.,²⁴24 Abbott JA, Hawe J, Clayton RD, Garry R. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up. Hum Reprod. 2003;18(09): 1922–1927 2003	60	Pleasure:10 (5 ± 12)	Pleasure:12 (9 ± 16)	Pleasure: 0.001	Median: 6.0 (0.0–9.0)	0.0 (0.0–4.0)	< 0.001
		Discomfort: 3 (1 ± 5)	Discomfort: 2 (1.5 ± 3)	Discomfort: < 0.012
		Habit:1 (0 ± 1)	Habit:1(1 ± 1)	Habit:0.001
Meuleman et al.,¹⁵15 Meuleman C, D'Hoore A, Van Cleynenbreugel B, Beks N, D'Hooghe T. Outcome after multidisciplinary CO2 laser laparoscopic excision of deep infiltrating colorectal endometriosis. Reprod Biomed Online. 2009;18(02):282–289 2009	29	–	–	Pleasure: < 0.0001	5 (0–10)	1 (0–10)	< 0.0001
				Discomfort: < 0.0001
				Habit< 0.0001
Meuleman et al.,¹³13 Meuleman C, Tomassetti C, D'Hooghe TM. Clinical outcome after laparoscopic radical excision of endometriosis and laparoscopic segmental bowel resection. Curr Opin Obstet Gynecol. 2012;24 (04):245–252 2012	27	–	–	Pleasure: 0.009	28 (0–95)	1 (0–63)	< 0.0001
				Discomfort: 0.026
				Habit: 0.0003
Questionnaire: FSFI
Pontis et al.,¹⁸18 Pontis A, Nappi L, Sedda F, Multinu F, Litta P, Angioni S. Management of bladder endometriosis with combined transurethral and laparoscopic approach. Follow-up of pain control, quality of life, and sexual function at 12 months after surgery. Clin Exp Obstet Gynecol. 2016;43(06):836–839 2016	12	26 ± 2.5	28 ± 1.7	< 0.001	–	–	–
Uccella et al.,²⁹29 Uccella S, Gisone B, Serati M, Biasoli S, Marconi N, Angeretti G, et al. Functional outcomes of nerve-sparing laparoscopic eradication of deep infiltrating endometriosis: a prospective analysis using validated questionnaires. Arch Gynecol Obstet. 2018;298 (03):639–647 2018	6	19.1 (1.2–28.9)	22.7 (12.2–31)	0.004	–	–	–
Ianieri et al.,²⁸28 Ianieri MM, Raimondo D, Rosati A, Cocchi L, Trozzi R, Maletta M, et al. Impact of nerve-sparing posterolateral parametrial excision for deep infiltrating endometriosis on postoperative bowel, urinary, and sexual function. Int J Gynaecol Obstet. 2022;159(01): 152–159 2022	3	P: 19.4 ± 9.8	P: 21.6 ± 10.8	0.34	P: 5.2 ± 3.6	P: 0.9 ± 2.2	< 0.001
	3	NP 23.8 ± 3.7	NP: 23.7 ± 8.1	0.34	NP: 3.7 ± 3.5	NP: 0.1 ± 0.5	< 0.001
Zhang et al.,³⁰30 Zhang N, Sun S, Zheng Y, Yi X, Qiu J, Zhang X, et al. Reproductive and postsurgical outcomes of infertile women with deep infiltrating endometriosis. BMC Womens Health. 2022;22(01):83 2022	26	26.1 ± 3	26.8 ± 3	0.25	–	–	–
Questionnaire: FSFI and FSDS
Fritzer et al.,¹⁷17 Fritzer N, Tammaa A, Haas D, Oppelt P, Renner S, Hornung D, et al. When sex is not on fire: a prospective multicentre study evaluating the short-term effects of radical resection of endometriosis on quality of sex life and dyspareunia. Eur J Obstet Gynecol Reprod Biol. 2016;197:36–40 2016	10 FSFI	–	–	DIE: 0.21	DIE: 6.18	DIE: 2.49	< 0.001
				Vaginal: 0.98	DIE: 6.18	DIE: 2.49	< 0.001
				Peritoneal: 0.11	Vaginal: 6.64	Vaginal: 2.18	< 0.001
	FSDS	–	–	DIE: 0.04	Vaginal: 6.64	Vaginal: 2.18	< 0.001
				Vaginal: 0.25	Peritoneal: 5.05	Peritoneal: 2.85	< 0.001
				Peritoneal: 0.34	Peritoneal: 5.05	Peritoneal: 2.85	< 0.001
Questionnaire: SHOW-Q
Mabrouk et al.,³³33 Mabrouk M, Montanari G, Di Donato N, Del Forno S, Frascà C, Geraci E, et al. What is the impact on sexual function of laparoscopic treatment and subsequent combined oral contraceptive therapy in women with deep infiltrating endometriosis? J Sex Med. 2012;9(03):770–778 2012	6	Satisfaction: 51	Satisfaction: 65	< 0.0005	7 ± 3	1 ± 3	< 0.0001
		Orgasm: 57	Orgasm: 59	0.7
		Desire: 55	Desire: 64	< 0.0004
Di Donato et al.,³¹31 Di Donato N, Montanari G, Benfenati A, Monti G, Leonardi D, Bertoldo V, et al. Sexual function in women undergoing surgery for deep infiltrating endometriosis: a comparison with healthy women. J Fam Plann Reprod Health Care. 2015;41(04):278–283 2015	12	Satisfaction: 50	Satisfaction: 75	< 0.001	–	–	–
		Orgasm:63	Orgasm:62	Not significant
		Desire: 58	Desire: 72	< 0.001
Questionnaire: DSFI and GSSI
Ferrero et al.,²⁶26 Ferrero S, Abbamonte LH, Parisi M, Ragni N, Remorgida V. Dyspareunia and quality of sex life after laparoscopic excision of endometriosis and postoperative administration of triptorelin. Fertil Steril. 2007;87(01):227–229 2007	3 DSFI	Frequency with USL: 1.3 ± 0.7; without USLE: 1.6 ± 0.7	Frequency with USL: 2.3 ± 0.7; without USL: 2.2 ± 0.8	Frequency ith USL: < 0.001; without USL: 0.004	–	–	–
	3 DSFI	Orgasm with USL: 2.3 ± 1.0; without USL: 2.9 ± 1.0	Orgasm with USL: 4.4 ± 1.1; without USL: 3.1 ± 1.5	Orgasm with USL: 0.001; without USL: 0.003
	3 GSSI	With USL: 3.4 ± 1.7; without USL: 4.1 +/− 1.7	With USL: 5.5 ± 1.9; without USL: 5.3 +/− 1.8	With USL: 0.001; without USL: 0.003
Ferrero et al.,²⁵25 Ferrero S, Abbamonte LH, Giordano M, Ragni N, Remorgida V. Deep dyspareunia and sex life after laparoscopic excision of endometriosis. Hum Reprod. 2007;22(04):1142–1148. Doi: 10.1093/humrep/del465 https://doi.org/10.1093/humrep/del465... 2007	6 DSFI	Frequency with USL: 1.1 ± 0.6; without USL: 1.3 ± 0.9	Frequency with USL: 1.8 ± 0.8; without USL: 2.2 ± 1.1	Frequency with USL: < 0.001; without USL:< 0.001	With USL: 7.6 ± 1.1; without USL: 7.1 ± 1.0	With USL: 2.8 ± 1.9; without USL: 2.4 ± 1.8	< 0.001
	6 DSFI	Orgasm with USL: 2.3 ± 1.2; without USL: 3.1 ± 1.0	Orgasm with USL: 1.3 ± 0.9; without USL: 4.2 ± 1.3	Orgasm with USL: < 0.001; without ULSE: < 0.003
	6 GSSI	With USL: 3.2; without USL: 3	With USL: 5; without USL: 5.8	< 0.001 < 0.001
	12 DSFI	Frequency with USL: 1.1 ± 0.6; without USL: 1.3 ± 0.9	Frequency with USL: 1.9 ± 0.7; without USL: 2.2 ± 1.1	Frequency with USL: < 0.001; without USL: < 0.027	With USL: 7.6 ± 1.1; without USL: 7.1 ± 1.0	With USL: 2.8 ± 2.2; without USL: 2.2 ± 1.8	< 0.001
	12 DSFI	Orgasm with USL: 2.3 ± 1.2; without USL: 3.1 ± 1.0	Orgasm with USL: 1.9 ± 0.7; without USL: 4.0 ± 1.0	Orgasm with USL: < 0.001; without USL: < 0.118
	12 GSSI	With USL: 3.2; without USL: 3	With USL: 5.2; without USL: 5.6	< 0.001 < 0.001
Questionnaire: MFSQ
Setälä et al.,¹⁶16 Setälä M, Härkki P, Matomäki J, Mäkinen J, Kössi J. Sexual functioning, quality of life and pelvic pain 12 months after endometriosis surgery including vaginal resection. Acta Obstet Gynecol Scand. 2012;91(06):692–698 2012	12	Sexual satisfaction: 21.1	Sexual satisfaction: 2.1	< 0.05	4.3	1.7	< 0.05
		Sexual problem: 6.3	Sexual problem: 1.4	< 0.05
		Partner satisfaction: 12.1	Partner satisfaction: 0.8	Not significant
Kossi et al.,²¹21 Kössi J, Setälä M, Mäkinen J, Härkki P, Luostarinen M. Quality of life and sexual function 1 year after laparoscopic rectosigmoid resection for endometriosis. Colorectal Dis. 2013;15(01): 102–108 2013	12	Sexual satisfaction: 20.1	Sexual satisfaction: 2.8	< 0.01	–	–	–
		Sexual problem: 7	Sexual problem: 1.1	< 0.10
		Partner satisfaction: 12.1	Partner satisfaction: 0.7	< 0.10
Questionnaire: KFSP
Lermann et al.,¹⁹19 Lermann J, Topal N, Renner SP, Beckmann MW, Burghaus S, Adler W, Heindl F. Comparison of preoperative and postoperative sexual function in patients with deeply infiltrating endometriosis with and without bowel resection. Eur J Obstet Gynecol Reprod Biol. 2019;239:21–29 2019	69	WB: 24	WB: 25	0.416	–	–	–
	69	WOB: 27.5	WOB: 19.5	0.001	–	–	–
Questionnaires: SQOL, FSDS and B-PFSF
Martínez-Zamora et al.,³⁴34 Martínez-Zamora MA, Coloma JL, Gracia M, Rius M, Castelo-Branco C, Carmona F. Long-term Follow-up of Sexual Quality of Life after Laparoscopic Surgery in Patients with Deep Infiltrating Endometriosis. J Minim Invasive Gynecol. 2021;28(11): 1912–1919 2021	36	SQOL-F: 70	SQOL-F: 77	< 0.001	–	–	–
		FSDS: 17	FSDS: 10	< 0.001
		B-PFSF: 18	B-PFSF: 25	< 0.001
Questionnaire: SQV
Riiskjaer et al.,²⁰20 Riiskjaer M, Greisen S, Glavind-Kristensen M, Kesmodel US Forman A, Seyer-Hansen M. Pelvic organ function before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective, observational study. BJOG. 2016;123(08): 1360–1367 2016	12	Satisfaction: 3 (1–7)	Satisfaction: 4 (1–7)	0.0001	3 (1–4)	2 (1–4)	< 0.0001
		Frequency: 2 (1–5)	Frequency: 3(1–5)	0.0004
		Desire: 2 (1–4)	Desire: 2 (1–4)	0.0003
Questionnaire: SFSS
Van den Broeck et al.,¹⁴14 Van den Broeck U, Meuleman C, Tomassetti C, D'Hoore A, Wolthuis A, Van Cleynenbreugel B, et al. Effect of laparoscopic surgery for moderate and severe endometriosis on depression, relationship satisfaction and sexual functioning: comparison of patients with and without bowel resection. Hum Reprod. 2013;28(09): 2389–2397 2013	6	Orgasm – WB:10.5%; WOB:16.3%	Orgasm – WB: 0%; WOB: 10%	< 0.01	WB: 44.8%; WOB: 31.3%	WB: 10.4%; WOB: 12.7%	> 0.05
		Excitation – WB:21.6%; WOB:11.5%	Excitation – WB:7.4%; WOB:13%%	> 0.05
		Desire – WB:31.7%; WOB: 28.4%	Desire – WB:9.4%; WOB:19.4%	> 0.05
	18	Orgasm – WB:16.3%; WOB:10,5%	Orgasm – WB: 6.3%; WOB: 2.9%	> 0.05	WB: 44.8%; WOB: 31.3%	WB: 6.3%; WOB: 20%	> 0.05
		Excitation – WB: 21.6%; WOB: 11.5%	Excitation – WB: 6.3%; WOB: 2.9%	> 0.05
		Desire – WB: 28.4%; WOB: 31.7%	Desire – WB: 12.1%; WOB: 5.7%	> 0.05
Questionnaire: SSRS
Vercellini et al.,³²32 Vercellini P, Aimi G, Busacca M, Apolone G, Uglietti A, Crosignani PG. Laparoscopic uterosacral ligament resection for dysmenorrhea associated with endometriosis: results of a randomized, controlled trial. Fertil Steril. 2003;80(02):310–319 2003	18	USL:45.4 ± 19.9	USL:53.8 ± 18.8	0.763	USL: 58 (45–72)	USL: 22 (0–35)	0.0001
	18	CG: 44.7 ± 20.8	CG: 55.4 ± 15.6	0.763	CG: 54 (26–67)	CG: 18 (0–30)	0.0001

Author, year	Histological analysis	Endometriosis classification	Intraoperative classification	Nerve-sparing technique	Procedures	Other endometriosis location (%)	Retro cervical (%)	USL (%)	Rectovaginal septum (%)	Vagina (%)	Bowel (%)
Garry et al., ²⁷27 Garry R, Clayton R, Hawe J. The effect of endometriosis and its radical laparoscopic excision on quality of life indicators. BJOG. 2000;107(01):44–54 2000	No	rAFS	III: 63.2%	No	Complication: 1,9% – bruises	Ovaries: 40.3%; total pouch of Douglas obliteration: 30.4%; partial pouch of Douglas obliteration: 33.3%	33.3%	No Specific side: 77.2%	59.6%	38.52%	56.1%
Abbot et al., ²⁴24 Abbott JA, Hawe J, Clayton RD, Garry R. The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up. Hum Reprod. 2003;18(09): 1922–1927 2003	Yes	rAFS	I:14%; II: 28%; III: 17%; IV: 41%	No	Complication: 0.3% – iatrogenic bowel injury; 0.6% – transfusion; 0.3% –vaginal deiscense	Total pouch of Douglas obliteration: 32%; partial pouch of Douglas obliteration: 18%; bilateral endometrioma: 12%; right: 18%; left: 12%	–	Unilateral 88%; bilateral: 57%	–	6%	–
Vercellini et al., ³²32 Vercellini P, Aimi G, Busacca M, Apolone G, Uglietti A, Crosignani PG. Laparoscopic uterosacral ligament resection for dysmenorrhea associated with endometriosis: results of a randomized, controlled trial. Fertil Steril. 2003;80(02):310–319 2003	No	rAFS	I: 39%; II: 22%; III: 20%; IV: 19%	No	–	–	–	No specific side: 100%	–	–	–
Ferrero et al., ²⁶26 Ferrero S, Abbamonte LH, Parisi M, Ragni N, Remorgida V. Dyspareunia and quality of sex life after laparoscopic excision of endometriosis and postoperative administration of triptorelin. Fertil Steril. 2007;87(01):227–229 2007	Yes	–	–	No	–	–	–	No specific side: 65.3%	–	–	–
Ferrero et al., ²⁶26 Ferrero S, Abbamonte LH, Parisi M, Ragni N, Remorgida V. Dyspareunia and quality of sex life after laparoscopic excision of endometriosis and postoperative administration of triptorelin. Fertil Steril. 2007;87(01):227–229 2007	Yes	rAFS	IV-III: 86.9%; II-I: 12.32%	No	–	–	–	No specific side: 64.7%	–	–	–
Meuleman et al., ¹⁵15 Meuleman C, D'Hoore A, Van Cleynenbreugel B, Beks N, D'Hooghe T. Outcome after multidisciplinary CO2 laser laparoscopic excision of deep infiltrating colorectal endometriosis. Reprod Biomed Online. 2009;18(02):282–289 2009	Yes	rAFS	II: 2.22%; III: 4.44%; IV: 95%	Yes	Oophorectomy: 9%; appendectomy: 14%; salpingectomy: 30%; cystectomy: 39%; ureterolysis: 86%; adhesiolysis: 100%; complication: 3.5% – vascular anastomosis; 5.3% – compartmental syndrome	–	11%	–	–	–	Anterior bowel resection: 36%; sigmoid resection: 39%
Meuleman et al., ¹³13 Meuleman C, Tomassetti C, D'Hooghe TM. Clinical outcome after laparoscopic radical excision of endometriosis and laparoscopic segmental bowel resection. Curr Opin Obstet Gynecol. 2012;24 (04):245–252 2012	Yes	rAFS	III: 2%; IV: 98%	Yes	Oophorectomy 2%; bladder suture: 7%; appendectomy: 9%; salpingectomy: 38%; cystectomy: 42%; ureterolysis: 91%; complication: 2.2% – transitory urinary retention	–	16%	–	–	–	Sigmoid resection: 90%
Mabrouk et al., ³³33 Mabrouk M, Montanari G, Di Donato N, Del Forno S, Frascà C, Geraci E, et al. What is the impact on sexual function of laparoscopic treatment and subsequent combined oral contraceptive therapy in women with deep infiltrating endometriosis? J Sex Med. 2012;9(03):770–778 2012	Yes	–	–	Yes	Complications: 0.8% – vascular injury; 1.6% –transfusion; 4% – transitory urinary retention; 1.6% – retovaginal fistula; 0.8% – ureterovaginal fistula	55%	–	72%	–	25%	Sigmoid resection: 17%; shaving: 30%
Setälä et al., ¹⁶16 Setälä M, Härkki P, Matomäki J, Mäkinen J, Kössi J. Sexual functioning, quality of life and pelvic pain 12 months after endometriosis surgery including vaginal resection. Acta Obstet Gynecol Scand. 2012;91(06):692–698 2012	No	rAFS	–	No	Appendicectomy: 14%; urinary bladder resection: 14%; salpingectomy: 14%; adhesiolysis: 100%; complications: 14% – transitory urinary retention; 4.5% – anemia; 4% – vaginal deiscense	Pouch of Douglas obstruction 7%; peritoneal lesions: 68%	95%	14%	86%	100%	50%
Kossi et al., ²¹21 Kössi J, Setälä M, Mäkinen J, Härkki P, Luostarinen M. Quality of life and sexual function 1 year after laparoscopic rectosigmoid resection for endometriosis. Colorectal Dis. 2013;15(01): 102–108 2013	Yes	–	–	No	Resection of urinary bladder: 7%; appendectomymy: 11%; salpingectomy: 26%; ureterolysis 80%; adhesiolysis: 100%; complications:11.5% – transitory urinary retention; 3.8% – bowel bleeding	Peritoneal lesions: 53%	–	No specific side: 88%	–	61%	100%
Van den Broeck et al., ¹⁴14 Van den Broeck U, Meuleman C, Tomassetti C, D'Hoore A, Wolthuis A, Van Cleynenbreugel B, et al. Effect of laparoscopic surgery for moderate and severe endometriosis on depression, relationship satisfaction and sexual functioning: comparison of patients with and without bowel resection. Hum Reprod. 2013;28(09): 2389–2397 2013	Yes	rAFS	III: 33%; IV: 66%	Yes	–	–	–	–	–	–	100%
Di Donato et al., ³¹31 Di Donato N, Montanari G, Benfenati A, Monti G, Leonardi D, Bertoldo V, et al. Sexual function in women undergoing surgery for deep infiltrating endometriosis: a comparison with healthy women. J Fam Plann Reprod Health Care. 2015;41(04):278–283 2015	Yes	–	–	No	–	–	–	–	–	–	–
Fritzer et al., ¹⁷17 Fritzer N, Tammaa A, Haas D, Oppelt P, Renner S, Hornung D, et al. When sex is not on fire: a prospective multicentre study evaluating the short-term effects of radical resection of endometriosis on quality of sex life and dyspareunia. Eur J Obstet Gynecol Reprod Biol. 2016;197:36–40 2016	Yes	rAFS	I: 28%; II: 21%; III: 26%; IV: 25%	No	–	Peritoneal lesions: 41%; DIE: 59%	–	–	–	37%	–
Pontis et al., ¹⁸18 Pontis A, Nappi L, Sedda F, Multinu F, Litta P, Angioni S. Management of bladder endometriosis with combined transurethral and laparoscopic approach. Follow-up of pain control, quality of life, and sexual function at 12 months after surgery. Clin Exp Obstet Gynecol. 2016;43(06):836–839 2016	Yes	–	–	No	–	Bladder: 100%	–	–	–	–	–
Riiskjaer et al., ²⁰20 Riiskjaer M, Greisen S, Glavind-Kristensen M, Kesmodel US Forman A, Seyer-Hansen M. Pelvic organ function before and after laparoscopic bowel resection for rectosigmoid endometriosis: a prospective, observational study. BJOG. 2016;123(08): 1360–1367 2016	No	–	–	No	–	–	–	–	–	–	100%
Uccella et al., ²⁹29 Uccella S, Gisone B, Serati M, Biasoli S, Marconi N, Angeretti G, et al. Functional outcomes of nerve-sparing laparoscopic eradication of deep infiltrating endometriosis: a prospective analysis using validated questionnaires. Arch Gynecol Obstet. 2018;298 (03):639–647 2018	No	Enzian	A1 B2 C3 (20.6%); A2 B2 C3 (26.5%); A3 B1 C1 (2.9%); A3 B2 C1 (5.9%); A3 B3 C1 (2.9%); A3 B3 C2 (5.9%); A3 B1 C0 FB (5.9%); A0 B3 C2 FA (5.9%); A3 B1 C1 FA (17.6%); A3 B1 C2 FA (2.9%); A3 B1 C1 FO (2.9%)	Yes	Bilateral adnexectomy/castration: 8.8%; ureterolysis: 100%; complications: 17.6% – transitory urinary retention	–	–	–	–	50%	47.1%
Lermann et al., ¹⁹19 Lermann J, Topal N, Renner SP, Beckmann MW, Burghaus S, Adler W, Heindl F. Comparison of preoperative and postoperative sexual function in patients with deeply infiltrating endometriosis with and without bowel resection. Eur J Obstet Gynecol Reprod Biol. 2019;239:21–29 2019	No	Enzian	–	No	–	WOB: 75.3%; WB: 72.4%	–	Unilateral – WOB: 48.3%; WB:8%; bilateral – WOB: 27%; WB: 24.1%	WOB: 89.9%; WB:87.4%	WOB: 41.6%; WB: 75.9%	WB: 74.33%
Ianieri et al., ²⁸28 Ianieri MM, Raimondo D, Rosati A, Cocchi L, Trozzi R, Maletta M, et al. Impact of nerve-sparing posterolateral parametrial excision for deep infiltrating endometriosis on postoperative bowel, urinary, and sexual function. Int J Gynaecol Obstet. 2022;159(01): 152–159 2022	Yes	rAFS	II: 2.9%; III: 43.5%; IV: 53.6%	Yes	Complications: 1% – hemoperitoneum; 2% – iatrogenic bowel injury	–	48%	–	–	15%	64%
Martínez-Zamora et al., ³⁴34 Martínez-Zamora MA, Coloma JL, Gracia M, Rius M, Castelo-Branco C, Carmona F. Long-term Follow-up of Sexual Quality of Life after Laparoscopic Surgery in Patients with Deep Infiltrating Endometriosis. J Minim Invasive Gynecol. 2021;28(11): 1912–1919 2021	Yes	–	–	No	–	Endometriomas – bilateral: 11.62%; left: 24.8%; right: 13.95%; ureter (no specific side): 24%; bladder: 28.68%; peritoneal lesions: 76%	47.28%	No specific side: 68.99%	11.62%	8.52%	39.53%
Zhang et al., ³⁰30 Zhang N, Sun S, Zheng Y, Yi X, Qiu J, Zhang X, et al. Reproductive and postsurgical outcomes of infertile women with deep infiltrating endometriosis. BMC Womens Health. 2022;22(01):83 2022	Yes	rAFS	I + II: 20%; III + IV: 35%	No	–	–	–	No specific side: 25.45%	43.63%	–	18%

[1] Address for correspondence Graziele Vidoto Cervantes, Departamento de Ginecologia, Centro de Endometriose e Cirurgia Laparoscópica, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil (e-mail: gra_cervantes@hotmail.com).

Brasil

Brasil

Sexual Function of Patients with Deep Endometriosis after Surgical Treatment: A Systematic Review

Função sexual em pacientes com endometriose profunda após o tratamento cirúrgico: Revisão sistemática

Abstract

Objective

Data Source

Study Selection

Data Collection

Synthesis of Data

Conclusion