Six-month follow-up of minimally invasive nerve-sparing complete excision of endometriosis: What about dyspareunia?

• Published in: PloS one 2021-04, Vol.16 (4), p.e0250046-e0250046
• Main Authors: Crispi, Jr, Claudio Peixoto, Crispi, Claudio Peixoto, de Oliveira, Bruna Rafaela Santos, de Nadai Filho, Nilton, Peixoto-Filho, Fernando Maia, Fonseca, Marlon de Freitas
• Format: Article
• Language: English
• Subjects: Adult; Biology and Life Sciences; Complications; Complications and side effects; Dyspareunia; Dyspareunia - surgery; Endometriosis; Endometriosis - surgery; Female; Follow-Up Studies; Humans; Infertility; Intestine; Laparoscopy; Laparoscopy - methods; Magnetic resonance imaging; Medical records; Medicine and Health Sciences; Multidisciplinary teams; Pain; Pain Measurement; Physiological aspects; Quality of life; Retrospective Studies; Risk factors; Sexual intercourse; Surgery; Treatment Outcome; Vagina; Womens health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0250046

To assess individual changes of deep dyspareunia (DDyspareunia) six months after laparoscopic nerve-sparing complete excision of endometriosis, with or without robotic assistance. This preplanned interdisciplinary observational study with a retrospective analysis of intervention enrolled 126 consecutive women who underwent surgery between January 2018 and September 2019 at a private specialized center. Demographics, medical history and surgery details were recorded systematically. DDyspareunia (primary outcome), dysmenorrhea and acyclic pelvic pain were assessed on self-reported 11-point numeric rating scales both preoperatively and at six-month follow-up. Cases with poor prognosis in relation to dyspareunia were described individually in greater detail. Preoperative DDyspareunia showed weak correlation with dysmenorrhea (rho = .240; P = .014) and pelvic pain (rho = .260; P = .004). Although DDyspareunia improved significantly (P < .001) by 3 points or more in 75.8% (95%CI: 64.7-86.2) and disappeared totally in 59.7% of cases (95%CI:47.8-71.6), individual analysis identified different patterns of response. The probability of a preoperative moderate/severe DDyspareunia worsening more than 2 points was 4.8% (95%CI: 0.0-10.7) and the probability of a woman with no DDyspareunia developing "de novo" moderate or severe DDyspareunia was 7.7% (95%CI: 1.8-15.8) and 5.8% (95%CI: 0.0-13.0), respectively. In a qualitative analysis, several conditions were hypothesized to impact the post-operative DDyspareunia response; these included adenomyosis, mental health disorders, lack of hormone therapy after surgery, colporrhaphy, nodule excision in ENZIAN B compartment (uterosacral ligament/parametrium), the rectovaginal septum or the retrocervical region. Endometriosis surgery provides significant improvement in DDyspareunia. However, patients should be alerted about the possibility of unsatisfactory results.