The impact of laparoscopic deep endometriosis surgery on sexual functioning and distress

Sexual functioning is a complex phenomenon driven by multiple physical, psychological and social factors, necessitating comprehensive evaluation.

To assess the impact of laparoscopic deep endometriosis (DE) surgery on sexual functioning and distress in comparison to healthy controls.

Retrospective cohort study including 125 sexually active women who underwent DE surgery and who completed patient-reported outcome measurements (PROMs) pre- and postoperatively. Postoperative data were compared to prospectively collected data from 134 healthy controls.

Postoperative female sexual function index (FSFI-9), including the FSFI-9 total score (percentage of best possible FSFI-9 score), and the Female Sexual Distress Scale-Revised score. Secondary outcomes included pain scores, depressive symptoms, quality of life (QoL), relational satisfaction and positive affect.

Sexual functioning significantly improved across all domains (desire, arousal, lubrication, orgasm, satisfaction, pain, distress) after DE surgery. The FSFI-9 total score increased from 65% pre-operatively [mean 29.3 (27.2, 31.23)] to 75% at 3 months [mean 33.6 (32.3, 34.9), P<0.001)] and 74% at 6 months [mean 33.1 (31.0-35.0), P<0.001] after DE surgery, compared to 85% in healthy controls [mean 38.08 (37.21-38.87)]. In addition, an improvement in QoL, pain scores, depressive symptoms and positive affect was observed. Bowel surgery or reoperations did not affect postoperative sexual functioning. Compared to healthy controls, DE patients reported similar sexual functioning 3 months post-surgery, except for significantly lower sexual arousal, lubrication and pain. At 6 months, these differences persisted, with DE patients also reporting significantly lower sexual satisfaction, higher pain scores and poorer QoL across multiple domains compared to controls.

DE surgery (including bowel surgery) does significantly improve sexual functioning and distress. However, sexual functioning and distress remain inferior compared to healthy peers.

This study provides comprehensive pre- and postoperative PROMs to assess the impact of DE surgery on sexual functioning and to evaluate other key influencing factors.