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Cited by 129Endometriosis Research and TreatmentGynecological conditions and treatmentsEctopic Pregnancy Diagnosis and Management

Surgical versus medical treatment for endometriosis-associated severe deep dyspareunia: I. Effect on pain during intercourse and patient satisfaction

Vercellini, P., Somigliana, E., Consonni, D., Frattaruolo, M. P., De Giorgi, O., Fedele, L.·2012·Human Reproduction
DOI 10.1093/humrep/des313
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Abstract

STUDY QUESTION: Does surgical or medical treatment for endometriosis-associated severe deep dyspareunia achieve better results in terms of patients' satisfaction (main study outcome), variation of coital pain and frequency of intercourse? SUMMARY ANSWER: Surgery and progestin therapy were equally effective in the treatment of deep dyspareunia in women with rectovaginal endometriosis, whereas medical therapy performed significantly better than excisional treatment in those without deeply infiltrating lesions. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Conservative surgery and hormonal therapies have been used independently for endometriosis-associated deep dyspareunia with inconsistent results. This study reports a direct comparison between the two treatment options in women with severe pain during intercourse. DESIGN: Patient preference, parallel cohort study with a 12-month follow-up. The effect of conservative surgery at laparoscopy was compared with treatment with a low-dose of norethisterone acetate per os (2.5 mg/day) in women with persistent/recurrent severe deep dyspareunia after first-line surgery. PARTICIPANTS AND SETTING: A total of 51 patients chose repeat surgery and 103 progestin treatment. Patient satisfaction was graded according to a five-category scale. Variations in pain during intercourse were measured by means of a 100-mm visual analogue scale. MAIN RESULTS AND THE ROLE OF CHANCE: In the surgery group, a marked and rapid short-term dyspareunia score reduction was observed, followed by partial recurrence of pain. The pain relief effect of the progestin was more gradual, but progressive throughout the study period. At a 12-month follow-up, the frequency of intercourse per month (mean ± SD) was 4.6 ± 1.8 in the surgery group and 5.3 ± 1.5 in the norethisterone acetate group (P = 0.02). A total of 22/51 (43%) women were satisfied in the surgery group compared with 61/103 (59%) in the progestin group [adjusted odds ratios (OR), 0.36; 95% confidence interval (CI), 0.16-0.82; P = 0.015]. Corresponding figures in women with and without rectovaginal endometriotic lesions were, respectively, 13/24 (54%) versus 18/35 (51%; adjusted OR, 0.77; 95% CI, 0.22-2.67; P = 0.68), and 9/27 (33%) versus 43/68 (63%; adjusted OR, 0.23; 95% CI, 0.07-0.76, P = 0.02). BIAS, CONFOUNDING, AND OTHER REASONS FOR CAUTION: Treatments were not randomly assigned, and distribution of participants as well as of dropouts between study arms was unbalanced. However, the possibility of choosing the treatment allowed assessment of the maximum potential effect size of the interventions. GENERALIZABILITY TO OTHER POPULATIONS: Caucasian patients able to choose their treatment. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by a research grant from the University of Milan School of Medicine (PUR number 2009-ATE-0570). None of the authors have a conflict of interest.

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Crossref · 10.1093/humrep/des313

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  • In the authors' experience, when thoroughly informed on potential benefits, harms, and drawbacks of medical and surgical treatments, most women not seeking conception express their preference for the former option.

    “In our experience, when thoroughly informed on potential benefits, harms, and drawbacks of medical and surgical treatments, most women not seeking conception express their preference for the former option (21), thus confirming that patients who engage in shared decision-making tend to choose nonsurgical treatment alternatives (62).”

    From A stepped-care approach to symptomatic endometriosis management: A participatory research initiative (2018) · cites this paper as [21]

  • Numerous studies demonstrated efficacy of a reduced daily NETA dose of 2.5 mg.

    “numerous studies by independent groups demonstrated the efficacy of a reduced daily dose of 2.5 mg [13-16].”

    From Oral and depot progestin therapy for endometriosis: towards a personalized medicine (2017) · cites this paper as [15]

  • At 1-year follow-up, NETA performed better than surgery in women without deep lesions, whereas in those with rectovaginal endometriosis, the two treatments showed comparable efficacy.

    “At 1-year follow-up, NETA performed better than surgery in women without deep lesions, whereas in those with rectovaginal endometriosis, the two treatments showed comparable efficacy [15].”

    From Oral and depot progestin therapy for endometriosis: towards a personalized medicine (2017) · cites this paper as [15]

  • In a patient-preference cohort of women with severe deep dyspareunia, satisfaction rate was significantly higher in progestin (NETA) group than surgery group (59% vs 43%).

    “Satisfaction rate was statistically significantly higher in the progestin group (59% versus 43%).”

    From Oral and depot progestin therapy for endometriosis: towards a personalized medicine (2017) · cites this paper as [15]

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Authors
Vercellini, P., Somigliana, E., Consonni, D., Frattaruolo, M. P., De Giorgi, O., & Fedele, L.
Affiliations
  • University of Milan (IT)
  • Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
Corresponding author
Vercellini, P.
ORCID
Venue
Human Reproduction
Publisher
Oxford University Press (OUP)
Published
2012-08-27
Volume
27
Issue
12
Pages
3450-3459
ISSN
  • 0268-1161 (ISSN-L)
  • 1460-2350
DOI
10.1093/humrep/des313
OpenAlex
W2126339803
Cited by
129
References
49
Citations by year
2026: 5 · 2025: 9 · 2024: 9 · 2023: 6 · 2022: 10 · 2021: 11 · 2020: 12 · 2019: 12 · 2018: 14 · 2017: 12 · 2016: 8 · 2015: 8 · 2014: 7 · 2013: 6
FWCI
7.82
Type
journal article
Language
en
Open access
closed
Locations
  • Human Reproduction (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
Keywords
endometriosis, deep dyspareunia, dyspareunia, rectovaginal endometriosis, conservative surgery, laparoscopic resection, norethisterone acetate, progestin therapy, patient satisfaction, sexual frequency, treatment preferences, deep infiltrating endometriosis
MeSH terms
Norethindrone Acetate, Adult, Coitus, Dyspareunia, Endometriosis, Female, Humans, Norethindrone, Pain Measurement, Cohort Studies, Body Mass Index, Logistic Models, Patient Satisfaction

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