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Cited by 26Endometriosis Research and TreatmentChild Abuse and TraumaSexual Assault and Victimization Studies

Severe pelvic pain is associated with sexual abuse experienced during childhood and/or adolescence irrespective of the presence of endometriosis

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Bourdon, M, Antoine, V, Combes, U, Maitrot-Mantelet, L, Marcellin, L, Maignien, C, Chapron, C, Santulli, P·2023·Human Reproduction
DOI 10.1093/humrep/dead119
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Abstract

STUDY QUESTION: Is endometriosis associated with childhood and/or adolescent sexual abuse? SUMMARY ANSWER: Endometriosis is not associated with a history of sexual abuse, unlike the presence of severe pelvic pain. WHAT IS KNOWN ALREADY: Several studies have highlighted a link between pelvic pain and sexual abuse during childhood/adolescence. Moreover, an inflammatory state has been described in patients with a history of childhood maltreatment. Given that inflammation and pelvic pain are two entities often encountered with endometriosis, several teams have investigated whether endometriosis is associated with abuse during childhood/adolescence. However, the results are conflicting, and the link between sexual abuse and the presence of endometriosis and/or pain is hard to disentangle. STUDY DESIGN, SIZE, DURATION: A survey nested in a cohort study of women surgically explored for benign gynecological indications at our institution between January 2013 and January 2017. For each patient, a standardized questionnaire was completed during a face-to-face interview with the surgeon in the month preceding the surgery. Pelvic pain symptoms (dysmenorrhea, deep dyspareunia, non-cyclic chronic pelvic pain, and gastrointestinal or lower urinary tract symptoms) and their intensities were assessed with a 10 cm visual analog scale (VAS). Pain was considered to be severe when the VAS score was ≥7. PARTICIPANTS/MATERIALS, SETTING, METHODS: A 52-question survey was sent in September of 2017 to evaluate abuses, especially sexual abuse during childhood and/or adolescence, and the psychological state during childhood and adolescence. The survey was structured to cover the following sections: (i) abuses and other life events during childhood and adolescence; (ii) puberty and body changes; (iii) onset of sexuality; and (iv) family relationships during childhood and adolescence. The patients were divided into groups according to whether or not they exhibited histologically proven endometriosis. Statistical analyses were conducted using univariate and multivariate logistic regression models. MAIN RESULTS AND THE ROLE OF CHANCE: Two hundred and seventy-one patients answered all the questions of the survey: 168 with (endometriosis group) and 103 without endometriosis (control group). The mean ± SD overall population age was 32.2 ± 5.1 years. There were 136 (80.9%) and 48 (46.6%) women who experienced at least one severe pelvic pain symptom in the endometriosis and the control groups, respectively (P < 0.001). No differences were found between the two study groups regarding the following characteristics: (i) a history of sexual, physical, or emotional abuse; (ii) a history of abandonment or bereavement; (iii) the psychological state regarding puberty; and (iv) the family relationships. After multivariable analysis, we found no significant association between endometriosis and a history of sexual abuse during childhood and/or adolescence (P = 0.550). However, the presence of at least one severe pelvic pain symptom was independently associated with a history of sexual abuse (odds ratio = 3.6, 95% CI (1.2–10.4)). LIMITATIONS, REASONS FOR CAUTION: Evaluation of the psychological state during childhood and/or adolescence can be subject to recall bias. In addition, selection bias is also a possibility given that some of the patients surveyed did not return the questionnaire. WIDER IMPLICATIONS OF THE FINDINGS: Severe gynecological painful symptoms in women with or without histologically proven endometriosis may be linked to sexual abuse experienced during childhood and/or adolescence. Patient questioning about painful symptoms and abuses is important to provide comprehensive care to the patients, from a psychological to a somatic point of view. STUDY FUNDING/COMPETING INTEREST(S): No funding or competing interests. TRIAL REGISTRATION NUMBER: N/A.

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  • Traumatic experiences generally reduce pain tolerance, and persons affected by early-childhood and/or repeated traumas are more likely to develop a pain disorder.

    “we need to bear in mind that traumatic experiences will generally reduce pain tolerance and that persons affected by early-childhood and/or repeated traumas will be more likely to develop a pain disorder.”

    From Endometriosis: patient–doctor communication and psychological counselling (2023) · cites this paper as [11]

    The Results report an association between childhood or adolescent sexual abuse and severe pelvic pain, and the Interpretation discusses increased pain sensitivity as a hypothesis. The paper does not establish that traumatic experiences generally reduce pain tolerance, or that repeated trauma specifically increases the likelihood of developing a pain disorder. (LLM, conf=0.86)

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  • A more recent French study comparing endometriosis patients and a control group found no difference in sexual abuse in their prehistory.

    “A more recent French study comparing endometriosis patients and a control group with regard to sexual abuse in their prehistory found no difference between the two [11]”

    From Endometriosis: patient–doctor communication and psychological counselling (2023) · cites this paper as [11]

  • In both groups of the French study, sexual traumatisation referred to in anamnesis was associated with an increased experience of pain.

    “but in both groups, sexual traumatisation referred to in anamnesis was associated with an increased experience of pain (similar to [12]).”

    From Endometriosis: patient–doctor communication and psychological counselling (2023) · cites this paper as [11]

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Research works printed but not linked: 5

  1. Cour F, Robain G, Claudon B, Chartier-Ka ¨stler E. [Childhood sexual abuse: how important is the diagnosis to understand and man- age sexual, anorectal and lower urinary tract symptoms]. Prog Urol 2013;23:780-792.
  2. Harrop-Griffiths J, Katon W, Walker E, Holm L, Russo J, Hickok L. The association between chronic pelvic pain, psychiatric diagnoses, and childhood sexual abuse. Obstet Gynecol 1988;71: 589-594.
  3. Jeammet P. Spe ´cificite ´s de la psychothe ´rapie psychanalytique a `l'ad- olescence. Psychothe ´rapies 2002;22:77.
  4. Labat J-J, Riant T, Delavierre D, Sibert L, Watier A, Rigaud J. [Global approach to chronic pelvic and perineal pain: from the concept of organ pain to that of dysfunction of visceral pain regulation sys- tems]. Prog Urol 2010;20:1027-1034.
  5. Paras ML, Murad MH, Chen LP, Goranson EN, Sattler AL, Colbenson KM, Elamin MB, Seime RJ, Prokop LJ, Zirakzadeh A. Sexual abuse and lifetime diagnosis of somatic disorders: a systematic review and meta-analysis. 2009;302:550-561.

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Authors
Bourdon, M., Antoine, V, Combes, U., Maitrot-Mantelet, L., Marcellin, L., Maignien, C., Chapron, C., & Santulli, P.
Affiliations
  • Inserm (FR)
  • Hôpital Cochin (FR)
  • Department of Gynaecology, Obstetrics II and Reproductive Medicine, Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin , Paris, France
Corresponding author
Santulli, P
ORCID
Venue
Human Reproduction
Publisher
Oxford University Press (OUP)
Published
2023-06-12
Volume
38
Issue
8
Pages
1499-1508
ISSN
  • 0268-1161 (ISSN-L)
  • 1460-2350
DOI
10.1093/humrep/dead119
OpenAlex
W4380300783
Cited by
26
References
47
Citations by year
2026: 8 · 2025: 5 · 2024: 11 · 2023: 2
FWCI
6.23
Type
journal article
Language
en
Open access
Licence
Locations
  • Human Reproduction (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Social Sciences › Gender Studies › Sexual Assault and Victimization Studies
Keywords
OSI, child sexual abuse, adolescent sexual abuse, dysmenorrhea, deep dyspareunia, child abuse, psychological state, inflammation
MeSH terms
Adolescent, Adult, Child, Endometriosis, Female, Humans, Infertility, Female, Male, Sex Offenses, Cohort Studies, Pelvic Pain

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