Sexual Satisfaction and Frequency of Orgasm in Women With Chronic Pelvic Pain due to Endometriosis

BackgroundDyspareunia, one of the main symptoms of the chronic gynecological pelvic pain disorder endometriosis, may interfere with the likelihood of reaching an orgasm, yet for women with dyspareunia, no data on orgasm rates in different sexual activities are available.AimThe aim of this study was to evaluate the ability to reach an orgasm and its association with sexual satisfaction during different sexual activities in women with a chronic pelvic pain disorder and in healthy control women.MethodsA set of questionnaires including the brief index of sexual functioning and global sexual functioning was used to evaluate sexuality in women affected with endometriosis (n = 434) and a nonaffected control group (n = 434) recruited in German-speaking countries.OutcomesThe primary outcome measure of this study was the orgasm rate during different types of sexual activities.ResultsOnly the ability to have an orgasm during sexual intercourse (P = .002) but not during masturbation (P = .509) or partnered noncoital sexual activities (P = .229) is affected by endometriosis. Dyspareunia was associated with a reduced ability to experience an orgasm during intercourse for endometriosis patients (P = .020) and control women (P = .006). The ability to orgasm during noncoital sexual activities (P = .006) and sexual intercourse (P = .038) was associated with a higher sexual satisfaction in women with endometriosis. For controls, only the ability to achieve an orgasm with sexual intercourse was associated with sexual satisfaction (P = .038).Clinical implicationsSexual counselling as part of medical support could help couples living with chronic pelvic pain of the female partner integrate noncoital sexual activities in their sex lives, leading to fewer sex-related problems and higher sexual desire and satisfaction.Strengths and limitationsThis study is the first to examine different ways of achieving an orgasm and sexual satisfaction in a large group of women with endometriosis and a matched control group. The breadth of the questionnaire allowed a differentiated analysis of factors influencing the likelihood of achieving an orgasm and overall sexual satisfaction. The one limitation is that the length and the intimate nature of the questionnaire possibly resulted in reluctance to answer this part of the questionnaire.ConclusionPartnered noncoital sexual activities may represent an alternative to reach orgasm for women with endometriosis-related chronic pelvic pain or anorgasmia during sexual intercourse.Hämmerli S, Kohl-Schwartz A, Imesch P, et al. Sexual Satisfaction and Frequency of Orgasm in Women With Chronic Pelvic Pain due to Endometriosis. J Sex Med 2020;17:2417–2426.     

Sexual Function in Patients with Deep Infiltrating Endometriosis

IntroductionEndometriosis is a benign condition that causes pain and infertility. Sexual dysfunction, particularly deep dyspareunia, is common in patients with endometriosis and interferes with quality of life and conjugal satisfaction.AimThe study aims to assess sexual function in women with deep infiltrating endometriosis.MethodFifty-seven women diagnosed with deep infiltrating endometriosis were recruited from Hospital Universitário Pedro Ernesto (HUPE) between July and December 2011. The control group comprised 38 healthy women recruited at the HUPE family planning clinic.Main Outcome MeasuresThe main outcomes are full-scale and individual domain scores on the Female Sexual Function Index (FSFI), a validated questionnaire for functional assessment of sexual function in women.ResultsPatients with endometriosis had more pain in intercourse than controls, which correlates with lower scores in the FSFI pain domain. However, there were no statistically significant between-group differences in overall (full-scale) FSFI scores.ConclusionWomen with endometriosis exhibit significant dysfunction in the pain domain of the FSFI questionnaire, but this finding was not sufficient to affect the overall sexual function. Evangelista A, Dantas T, Zendron C, Soares T, Vaz G, and Oliveira MAP. Sexual function in patients with deep infiltrating endometriosis. J Sex Med 2014;11:140–145.     

Sexual Satisfaction,Sexual Compatibility,and Relationship Adjustment in Couples: The Role of Sexual Behaviors,Orgasm, and Men's Discernment of Women's Intercourse Orgasm

IntroductionResearch indicated that (i) vaginal orgasm consistency is associated with indices of psychological, intimate relationship, and physiological functioning, and (ii) masturbation is adversely associated with some such measures.AimThe aim of this study was to examine the association of various dyadic and masturbation behavior frequencies and percentage of female orgasms during these activities with: (i) measures of dyadic adjustment; (ii) sexual satisfaction; and (iii) compatibility perceived by both partners.MethodsIn a sample of 85 Czech long‐term couples (aged 20–40; mean relationship length 5.4 years), both partners provided details of recent sexual behaviors and completed sexual satisfaction, Spanier dyadic adjustment, and Hurlbert sexual compatibility measures. Multiple regression analyses were used.Main Outcome MeasureThe association of sexual behaviors with dyadic adjustment, sexual compatibility, and satisfaction was analyzed.ResultsIn multivariate analyses, women's dyadic adjustment is independently predicted by greater vaginal orgasm consistency and lower frequency of women's masturbation. For both sexes, sexual compatibility was independently predicted by higher frequency of penile–vaginal intercourse and greater vaginal orgasm consistency. Women's sexual satisfaction score was significantly predicted by greater vaginal orgasm consistency, frequency of partner genital stimulation, and negatively with masturbation. Men's sexual satisfaction score was significantly predicted by greater intercourse frequency and any vaginal orgasm of their female partners. Concordance of partner vaginal orgasm consistency estimates was associated with greater dyadic adjustment.ConclusionsThe findings suggest that specifically penile–vaginal intercourse frequency and vaginal orgasm consistency are associated with indices of greater intimate relationship adjustment, satisfaction, and compatibility of both partners, and that women's masturbation is independently inversely associated with measures of dyadic and personal function. Results are discussed in light of previous research and an evolutionary theory of vaginal orgasm. Klapilová K, Brody S, Krejčová L, Husárová B, and Binter J. Sexual satisfaction, sexual compatibility, and relationship adjustment in couples: The role of sexual behaviors, orgasm, and men's discernment of women's intercourse orgasm. J Sex Med 2015;12:667–675.     

Evaluation of Quality of Life and Sexual Satisfaction in Women Suffering from Chronic Pelvic Pain With or Without Endometriosis

IntroductionChronic pelvic pain (CPP) is one of the most frequent symptoms in women of reproductive age. This is an enigmatic clinical condition that results from the complex interactions of physiological and psychological factors with direct impact on the social, marital, and professional lives of women.AimTo evaluate the quality of life and sexual satisfaction of women who suffer from CPP with or without endometriosis.MethodForty‐nine patients who had been diagnosed with endometriosis and 35 patients with CPP diagnosed with another gynecological condition, all 84 of whom were treated at the Chronic Pelvic Pain and Endometriosis Clinic at Universidade Federal de São Paulo (UNIFESP) from January to July of 2008. The controls were 50 healthy women from the Family Planning Clinic at UNIFESP.Main Outcome MeasuresWorld Health Organization Quality of Life Assessment‐Bref (WHOQOL‐BREF) quality of life questionnaire and the Golombok‐Rust Inventory of Sexual Satisfaction (GRISS).ResultsNo statistically significant differences were observed between the groups with CPP symptoms, in either the results from the WHOQOL‐BREF or in the GRISS questionnaire. In both questionnaires, differences were observed when the two groups of symptomatic women were compared with the group of healthy women.ConclusionCPP caused by endometriosis or other gynecological conditions leads to a significant reduction of quality of life and sexual satisfaction. Tripoli TM, Sato H, Sartori MG, de Araujo FF, Girão MJBC, and Schor E. Evaluation of quality of life and sexual satisfaction in women suffering from chronic pelvic pain with or without endometriosis. J Sex Med 2011;8:497–503.     

Nerve-sparing Surgery for Deep Infiltrating Endometriosis: Laparoscopic Eradication of Deep Infiltrating Endometriosis with Rectal and Parametrial Resection According to the Negrar Method

ObjectiveTo show technical highlights of a nerve-sparing laparoscopic eradication of deep infiltrating endometriosis with rectal and parametrial resection according to the Negrar method.DesignStepwise demonstration of the technique with narrated video footage.SettingTertiary care endometriosis unit. Bowel endometriosis accounts for about 12% of the total cases of endometriosis. Most frequently, rectal infiltration also means parametrial infiltration from the widespread infiltrating disease. Its removal with inadequate anatomical surgical knowledge may lead to severe damage to visceral pelvic innervation, causing bladder, rectal, and sexual function impairments and lasting lifelong. Nerve-sparing techniques, which are the heritage of onco-gynecologic surgery, have been described to have lower post-operative bladder, rectal, and sexual dysfunctions than classical approaches.InterventionsLaparoscopic excision of deep infiltrating endometriosis was performed by following the nerve-sparing Negrar technique in 6 steps: step 0—adhesiolysis, ovarian surgery, and removal of the involved peritoneal tissues; step 1—opening of pre-sacral space, development of avascular spaces, and identification and preservation of pelvic sympathetic fibers of the inferior mesenteric plexus, superior hypogastric plexus, upper hypogastric nerves, and lumbosacral sympathetic trunk and ganglia; step 2—dissection of parametrial planes, isolation of ureteral course, lateral parametrectomy, and preservation of sympathetic fibers of postero-lateral parametrium and lower mesorectum (the lower hypogastric nerves and proximal part of the inferior hypogastric plexus or pelvic plexus); step 3—posterior parametrectomy, deep uterine vein identification, and preservation of the parasympathetic pelvic splanchnic nerves and the cranial and middle part of the mixed inferior hypogastric plexus in caudad posterior parametrium and lower mesorectal planes; step 4—preserving the caudad part of the inferior hypogastric plexus in postero-lateral parametrial ligaments; step 5—preserving the caudad part of the inferior hypogastric plexus in paravaginal planes; and step 6—rectal resection and colorectal anastomosis.ConclusionAs shown in this case, the laparoscopic nerve-sparing complete excision of endometriosis is a feasible and reproducible technique in expert hands and, as reported in the literature, offers good results in terms of bladder morbidity reduction with higher satisfaction than the classical technique.     

深部浸润型子宫内膜异位症相关肠道功能紊乱的研究进展

深部浸润型子宫内膜异位症（deeply infiltrating endometriosis,DIE）是子宫内膜异位症（endometriosis,EMs）最严重的类型,其伴随的周期性的排便痛、便血、肠绞痛、腹泻腹胀,甚至肠梗阻等肠道症状严重影响患者的生活和工作质量,但临床重视不足。目前,手术仍然是有症状的DIE患者首选的治疗方式,但关于手术对患者肠道症状的改善程度以及术后新发的肠道功能紊乱尚没有明确的临床研究。影响患者术后肠道功能恢复的因素有很多,因此术前需通过多种方法详细评估其肠道功能,联合多学科协同制定治疗方案,并在术后进一步探讨可能改善肠道功能的方法,从而改善患者肠道症状,促进其全面康复。     

Long-term Follow-up of Sexual Quality of Life after Laparoscopic Surgery in Patients with Deep Infiltrating Endometriosis

Study ObjectiveWe performed a long-term follow-up to quantify the impairment of sexual quality of life (SQL) and health-related QL (HRQL) in sexually active women after laparoscopic excision of deep infiltrating endometriosis (DIE).DesignProspective case-control study.SettingHospital Clinic of Barcelona.PatientsA total of 193 patients (after dropout and exclusions) were divided into 2 groups: one hundred twenty-nine premenopausal women with DIE (DIE group) and 64 healthy women who underwent tubal ligation (C group).InterventionsAll patients underwent laparoscopic surgery: laparoscopic endometriosis surgery in the DIE group and laparoscopic tubal ligation in the C group. All women were followed for at least 36 months, and they completed the Medical Outcomes Study 36-item short form questionnaire to assess their HRQL and 3 self-administered questionnaires that evaluate different aspects of SQL: the generic Sexual Quality of Life–Female questionnaire, the Female Sexual Distress Scale to evaluate “sexually related distress,” and the Brief Profile of Female Sexual Function to screen hypoactive sexual desire disorder. The patients with DIE as well as the controls completed the 4 questionnaires before surgery, and the patients with DIE also completed the questionnaires at 6 and 36 months after surgery.Measurements and Main ResultsA comparison of the patients and controls before surgery showed a statistically significant impairment in SQL and HRQL among the patients with DIE. A statistically significant improvement in SQL and HRQL was observed in the DIE group 6 months after surgery, with scores being similar to those of the C group. An evaluation 36 months after surgery showed that SQL and HRQL were better than presurgical SQL and HRQL in the DIE group, with a slight reduction compared with the 6-month evaluation.ConclusionSQL and HRQL improved in patients with DIE undergoing complete laparoscopic endometriosis resection and were comparable to those of healthy women at 6 months after surgery, showing a slight reduction at 36 months of follow-up.     

深部浸润型子宫内膜异位症诊治进展

深部浸润型子宫内膜异位症（DIE）是指子宫内膜异位病灶在腹膜下浸润深度超过5mm，主要分布于直肠子宫陷凹、子宫骶骨韧带、直肠阴道隔、膀胱及肠道。病史及临床症状仍然是DIE诊断的主要线索；妇科检查是DIE诊断的主要手段；阴道超声、核磁共振成像及直肠超声尤其是内镜直肠超声是DIE诊断和分型的重要辅助检查方法；手术治疗是DIE的主要治疗方法。     

深部浸润型子宫内膜异位症诊治进展

深部浸润型子宫内膜异位症(DIE)是指子宫内膜异位病灶在腹膜下浸润深度超过5mm,主要分布于直肠子宫陷凹、子宫骶骨韧带、直肠阴道隔、膀胱及肠道.病史及临床症状仍然是DIE诊断的主要线索;妇科检查是DIE诊断的主要手段;阴道超声、核磁共振成像及直肠超声尤其是内镜直肠超声是DIE诊断和分型的重要辅助检查方法;手术治疗是DIE的主要治疗方法.     

4种检查方法在123例深部浸润型子宫内膜异位症中的诊断价值探讨

目的:评价妇科检查、经阴道彩超(TVS)、直肠超声内镜(RES)及磁共振成像(MRI)4种方法检查深部浸润型子宫内膜异位症(DIE)的应用价值。方法:收集2010年6月至2014年6月就诊于我院经手术和病理确诊为DIE患者123例。所有患者在术前均完成妇科检查、TVS、RES及MRI 4项检查,并将4项检查结果与手术和病理检查结果对照,评估4项检查诊断DIE的敏感性、特异性、准确性等。结果:123例患者中妇科检查、TVS、RES及MRI诊断DIE的准确性分别为91.87%、34.15%、65.85%、86.99%。诊断子宫骶骨韧带DIE,以妇科检查的敏感性高,为90.10%;以RES特异性高,为100.00%。诊断阴道壁DIE,以MRI的敏感性高,为79.31%;以RES的特异性高,为100.00%。诊断阴道直肠隔DIE,以MRI敏感性高,为45.83%;以RES特异性高,为100.00%。诊断直肠DIE,以RES及MRI的敏感性、特异性较高,分别为93.10%、78.16%及94.44%、91.67%。结论:仔细的妇科检查及合适的影像学检查可以诊断DIE,根据不同的DIE病变部位选择不同的影像学方法有助于正确诊断。     

Sexual Function of Women With Deep Endometriosis Before and After Surgery: A Prospective Study

BackgroundDeep endometriosis (DE) may significantly affect women's quality of life. Limited data exists on the effect of surgery on the several domains of sexual function.AimTo prospectively compare various domains of sexual function before and after laparoscopic surgery for DE.MethodsA prospective observational cohort study in a tertiary university-affiliated referral center. Patients with suspected DE who were planned to undergo laparoscopic surgery completed the Female Sexual Function Index questionnaire before surgery. The same questionnaire was completed by the participants 6 weeks, 6 months, and 12 months after surgery. Rate of sexual dysfunction over time was compared using multilevel logistic regression. Summary scores were then compared at each time point to the corresponding score before surgery using multilevel linear regression. Multivariable analysis was performed of potential confounders.OutcomesChange in desire, arousal, orgasm, lubrication, satisfaction and pain summary scores as well as in the full-scale score between before and after surgery.ResultsWe followed 149 patients with surgically confirmed DE. Sexual dysfunction rate as per the full-scale score was 75.5% before surgery and remained over 60% to 12 months after. The full-scale sexual function score improved at 6 (change in score = 2.8 ± 9.5, P = .004) and 12 months (change in score = 2.1 ± 9.9, P = .03). None of the summary scores improved at 6 weeks. Desire score (P < .001), arousal score (P = .02), and pain score (P = .01) improved at 6 months. Desire score (P = .03) and pain score (P = .01) also improved at 12 months, as compared to before surgery. On multivariable multilevel analysis, scores before surgery significantly contributed to the scores after surgery (P < .001).Clinical translationWhile sexual function improved after surgery, dysfunction rate remained substantial. Proper preoperative counseling should address sexual function measures and clinical and research attention should be given to seek ways to further reduce sexual dysfunction.Strengths and limitationsThe main strengths of our study are the prospective design, the relatively long follow-up and the use of a detailed validated questionnaire allowing assessment of a large variety of clinically relevant sexual function domains and scores as well as a full-scale score. Among our limitations are the lower response rate at 12 months and the limited generalizability as this is a single center study.ConclusionSexual function is a major and often under reported domain of quality of life. Further research is needed to identify the specific populations who may improve, not change or experience deterioration in their sexual functioning after surgery.Dior UP, Reddington C, Cheng C, et al. Sexual Function of Women With Deep Endometriosis Before and After Surgery: A Prospective Study. J Sex Med 2022;19:280–289.     

Erectile Function and Sexual Satisfaction: The Importance of Asking About Sexual Desire

IntroductionErectile function, libido, and sexual bother are incompletely correlated: a man may or may not be satisfied for a given level of erectile function; similarly, 2 men may have the same erectile function and different levels of sexual desire.AimTo explore the relationship between erectile function, sexual satisfaction and sexual desire.MethodsWe examined the Spearman correlation among erectile function (International Index of Erectile Function [IIEF-6]), sexual desire, and sexual bother in 3,944 questionnaires completed by patients after radical prostatectomy as part of routine care. IIEF-6 scores were adjusted if a patient indicated that the reason for not having intercourse was other than lack of ability of confidence (eg, lack of partner).Main Outcome MeasurePatient-reported outcome instruments.ResultsMedian age at surgery and preoperative IIEF-6 were 63 years and 26, respectively. Among questionnaires completed after surgery, there was moderate correlation among the IIEF-6 score and both sexual desire (Spearman rho: 0.41) and sexual bother (Spearman rho: 0.30). In men who reported high or moderate bother relating to sexual function, there was a narrow distribution of erectile function scores, with most men reporting poor function (median IIEF-6: 6, interquartile range 3, 11). For men who reported small or no problem with sexual function, the distribution of erectile function scores was wide, and particularly bimodal as a function of sexual desire. Among patients with high desire, the correlation between sexual bother and erectile function was 0.61 (ie, the poorer is your function, the greater you are bothered), whereas it was -0.081 among patients with low desire, meaning that some men are not bothered by poor erections.Clinical ImplicationsWe provided useful insights to help physicians during sexual counselling after surgery for prostate cancer.Strength & LimitationsThe study included a large number of patients and provides evidence for implementation of patient-reported outcome insturments. Limitations include the retrospective nature of our data.ConclusionSexual desire helps explain the moderate correlation between erectile function and sexual bother. Sexual desire and bother questions should be incorporated in patient-reported outcome instruments for male sexual function.Bravi CA, Tin A, Montorsi F, et al. Erectile Function and Sexual Satisfaction: The Importance of Asking About Sexual Desire. J Sex Med 2020;17:349–352.     

Sexual Desire in Trans Persons: Associations with Sex Reassignment Treatment

IntroductionSex steroids and genital surgery are known to affect sexual desire, but little research has focused on the effects of cross‐sex hormone therapy and sex reassignment surgery on sexual desire in trans persons.AimThis study aims to explore associations between sex reassignment therapy (SRT) and sexual desire in a large cohort of trans persons.MethodsA cross‐sectional single specialized center study including 214 trans women (male‐to‐female trans persons) and 138 trans men (female‐to‐male trans persons).Main Outcome MeasuresQuestionnaires assessing demographics, medical history, frequency of sexual desire, hypoactive sexual desire disorder (HSDD), and treatment satisfaction.ResultsIn retrospect, 62.4% of trans women reported a decrease in sexual desire after SRT. Seventy‐three percent of trans women never or rarely experienced spontaneous and responsive sexual desire. A third reported associated personal or relational distress resulting in a prevalence of HSDD of 22%. Respondents who had undergone vaginoplasty experienced more spontaneous sexual desire compared with those who planned this surgery but had not yet undergone it (P = 0.03).In retrospect, the majority of trans men (71.0%) reported an increase in sexual desire after SRT. Thirty percent of trans men never or rarely felt sexual desire; 39.7% from time to time, and 30.6% often or always. Five percent of trans men met the criteria for HSDD. Trans men who were less satisfied with the phalloplasty had a higher prevalence of HSDD (P = 0.02).Trans persons who were more satisfied with the hormonal therapy had a lower prevalence of HSDD (P = 0.02).ConclusionHSDD was more prevalent in trans women compared with trans men. The majority of trans women reported a decrease in sexual desire after SRT, whereas the opposite was observed in trans men. Our results show a significant sexual impact of surgical interventions and both hormonal and surgical treatment satisfaction on the sexual desire in trans persons. Wierckx K, Elaut E, Van Hoorde B, Heylens G, De Cuypere G, Monstrey S, Weyers S, Hoebeke P, and T'Sjoen G. Sexual desire in trans persons: Associations with sex reassignment treatment. J Sex Med 2014;11:107–118.     

Sexual Desire and the Female Sexual Function Index (FSFI): A Sexual Desire Cutpoint for Clinical Interpretation of the FSFI in Women with and without Hypoactive Sexual Desire Disorder

IntroductionA validated cutpoint for the total Female Sexual Function Index scale score exists to classify women with and without sexual dysfunction. However, there is no sexual desire (SD) domain-specific cutpoint for assessing the presence of diminished desire in women with or without a sexual desire problem.AimsThis article defines and validates a specific cutpoint on the SD domain for differentiating women with and without hypoactive sexual desire disorder (HSDD).MethodsEight datasets (618 women) were included in the development dataset. Four independent datasets (892 women) were used in the validation portion of the study.Main Outcome MeasuresDiagnosis of HSDD was clinician-derived. Receiver-operator characteristic (ROC) curves were used to develop the cutpoint, which was confirmed in the validation dataset.ResultsThe use of a diagnostic cutpoint for classifying women with SD scores of 5 or less on the SD domain as having HSDD and those with SD scores of 6 or more as not having HSDD maximized diagnostic sensitivity and specificity. In the development sample, the sensitivity and specificity for predicting HSDD (with or without other conditions) were 75% and 84%, respectively, and the corresponding sensitivity and specificity in the validation sample were 92% and 89%, respectively.ConclusionsThese analyses support the diagnostic accuracy of the SD domain for use in future observational studies and clinical trials of HSDD. Gerstenberger EP, Rosen RC, Brewer JV, Meston CM, Brotto LA, Wiegel M, and Sand M. Sexual desire and the female sexual function index (FSFI): A sexual desire cutpoint for clinical interpretation of the FSFI in women with and without hypoactive sexual desire disorder.     

Deep Infiltrating Endometriosis and Spontaneous Hemoperitoneum: A Life-Threatening Situation Treated by Laparoscopy

ObjectiveTo describe a case of spontaneous hemoperitoneum in a woman affected by deep infiltrating endometriosis (DIE).DesignTechnical video showing laparoscopic management of a spontaneous hemoperitoneum in a patient with DIE.SettingMinimally Invasive Gynecological Unit, Sant'Orsola Academic Hospital, Bologna, Italy.InterventionA 35-year-old nulliparous woman was admitted to our gynecologic emergency room because of pelvic pain and a fainting sensation. She had a history of DIE and had been followed for 6 months by our outpatient clinics. The patient underwent an immediate laparoscopy because of the rapid worsening of clinical conditions. After blood suction and difficult adhesiolysis, a vascular lesion with a huge blood flow, close to the left utero-ovarian ligament, was detected. Selective coagulation was performed with good results. During the follow-up visit after 1 month, the patient reported good health. Written informed consent was obtained from the patient for publication of this case report.ConclusionSpontaneous hemoperitoneum represents a rare and life-threatening complication associated with endometriosis. In patients with hemoperitoneum and a history of endometriosis, it is important to pay attention to the possible presence of uncommon bleeding localizations. Laparoscopy was useful and effective in this challenging situation, identifying the bleeding source and performing selective coagulation.     

Peritoneal Fluid Biochemistry in Infertile Women with Mild Pelvic Endometriosis

Although the factors involved in the pathophysiology of endometriosis are probably multiple and interrelated, prostaglandins may play an important role in the infertility of women with mild disease. In the present study, prostaglandin F2 alpha (PGF2 alpha) and 17 beta-oestradiol were measured in the peritoneal fluid of a selected group of infertile women who had mild pelvic endometriosis (without anatomical distortion) and compared with those values in normal women who had no pelvic disease and in women with pelvic infection. Although there was a wide scatter of PGF2 alpha values, the mean (1,066 pg/ml) in the endometriosis group was significantly greater than that in the other 2 groups (542 pg/ml, normal and 688 pg/ml, pelvic infection); the increase was found in both phases of the menstrual cycle. The mean concentration of 17 beta oestradiol was markedly higher in the luteal than the follicular phase in all 3 groups; however, no significant differences were found between the groups. Interestingly, the mean value of PGF2 alpha and 17 beta-oestradiol was higher in women with endometriosis who failed to conceive than in those who became pregnant. An estimation of PGF2 alpha in the peritoneal fluid may have prognostic value in the evaluation of infertile patients, especially those with mild endometriosis or in whom the problem is unexplained.     

Changes of Th1 and Th2 Cytokines in Superficial Endometriosis and Deep Infiltrating Endometriosis

目的:研究深部浸润型与表浅型子宫内膜异位症(EMs)临床特征以及腹腔液Th1、Th2细胞因子的表达差异.方法:收集术后病理证实诊断为EMs患者的临床资料及其腹腔液,根据术中诊断分为:表浅型(腹膜型,n=30)、深部浸润型(n=16);以同期因输卵管因素不孕症行腹腔镜探查的妇女(n=16)为对照组.用ELISA法测定3组腹腔液中IL-2、IL-4、IL-6、IL-10、TNF-α、IFN-γ的表达差异性.结果:表浅型EMs患者年龄较轻、不孕率高、腹水发生率高,而性交痛则是深部浸润型EMs患者的典型临床特征.与对照组相比,EMs组腹腔液中IL-4、IL-6、IL-10、TNF-α表达均升高,IFN-γ在EMs组表达均降低.IL-2仅在深部浸润型EMs组升高;深部浸润型EMs组与表浅型EMs组之间对比,IL-6在表浅型EMs的升高明显(P＜0.01),IL-10与TNF-α则在深部浸润型EMs组升高明显(P＜0.01),IFN-γ在深部浸润型EMs组下降更为明显(P＜0.01),IL-4在2个EMs组间表达无差异.结论:在表浅型与深部浸润型EMs的发病机制中,两者具有不同的免疫学改变.