Sexual self-efficacy and sexual quality of life before and after laparoscopic surgery in women with endometriosis lesions: A cross-sectional study

Abstract Background Endometriosis is one of the most common gynecological diseases and is associated with an increased risk of dyspareunia. Objective This study aimed to evaluate sexual self-efficacy (SSE) and sexual quality of life (SQOL) before and after laparoscopic surgery of endometriosis lesions. Materials and Methods This cross-sectional study measured the dependent variable by questionnaires before and after the surgery, and was performed with 36 women with endometriosis (aged 20-40 yr) who were referred to Arash hospital, Tehran, Iran between December 2018 and July 2019 using a convenience sampling method. Data collection tools included SQOL and SSE questionnaires, and a visual analogue scale. Data were collected before, and 3 and 6 months after laparoscopic surgery. Results Out of the 36 women included in this study, 91.7% had pelvic endometriosis and 8.3% had abdominal and pelvic endometriosis. 9 participants (25.0%) were in stages I or II of the disease, and 29 (75.0%) had endometriosis with higher involvement. The findings of the study showed a positive effect of laparoscopic surgery on SQOL and SSE in participants (p < 0.001). Conclusion Laparoscopic surgery in cases of endometriosis can improve SQOL and SSE in affected women and improve dyspareunia.


Introduction
Endometriosis is an estrogen-dependent inflammatory disease, in which endometrial cells are found somewhere outside the uterine cavity (1). Although many endometriosis patients are asymptomatic, they may experience menstrual pain, intercourse pain, and chronic pelvic pain (2). Endometriosis is one of the most common gynecological diseases. In 2012, its prevalence was estimated to be 5-20% among women of childbearing age in Tehran (3). Severe pelvic pain is often associated with endometriosis, and this pain can be alleviated by treatments that suppress estrogen production. Endometriosis is commonly seen in the pelvis, ovaries, cul-desac, uterine ligament, pelvic peritoneum, and rectovaginal septum. Extrauterine endometriosis occurs when endometriosis lesions are found elsewhere in the body, such as in the cervix, vulva, vagina, intestine, urinary system, abdominal wall, chest, lung, and central nervous system (4).
Several studies have reported an association between endometriosis and sexual dysfunction (5)(6)(7). The severity of the endometriosis is also directly related to the deep dyspareunia severity (8). Dyspareunia is also associated with other forms of sexual disorders due to fear of pain (9).
Endometriosis is treated using a variety of methods, divided into 2 categories: medical and surgical treatments (10). Medical treatments seek to achieve hypoestrogenic status in the patient and to reduce patient pain but are associated with the possibility of recurrence after discontinuation; moreover, the primary goal in surgical treatment is to eliminate the whole disease and its associated symptoms (11). It is now known that medical treatment alone is insufficient, and surgical intervention is needed in these patients (12).
Some studies have suggested that laparoscopy not only has a positive effect on recovery and dyspareunia, but also can improve the individual's sexual quality of life (SQOL) (13)(14)(15). Endometriosis is known to increase the chance of deep dyspareunia, which can have negative consequences for overall female sexual functioning and couple relationships (15). Previous studies that have compared the medical and laparoscopic therapies of this disease have focused on the therapeutic aspect of endometriosis and have neglected the impact of this disease on other aspects of life (16)(17). Also, the limited previous studies that have studied the impact of this disease on sexual life have only examined the effects of this disease on specific issues such as sexual satisfaction and SQOL (13,11,(14)(15)(18)(19). No studies have examined the effect of this disease on sexual self-efficacy (SSE), which is one of the most important components of having a successful marital relationship; these women may develop different ways to cope with the experience of pain and recurrent loss of desire and orgasm. Therefore, the present study aimed to evaluate the differences in SSE and SQOL before and after laparoscopic surgery of endometriosis lesions.

Study setting and participants
This cross-sectional study was conducted at Arash hospital, Tehran, Iran between December 2018 to July 2019. The sample size was calculated based on female SQOL before and 3 months after

Inclusion and exclusion criteria
The inclusion criteria were: women aged 18

Ethical considerations
Ethical approval for this study was obtained from

Results
All 36 participants were followed up until the end of the study. The mean age of the participants   (Table III).

Limitations
The

Conclusion
Laparoscopic surgery for endometriosis can improve SQOL and SSE in affected women and can improve dyspareunia. Given the relationship between SSE and SQOL in participants with dyspareunia and due to the multifactorial nature of sexual function, it seems that the application of psychosexual therapy approaches should be considered by the healthcare team to improve the treatment process. Since this was a cross-sectional study, further studies such as case-control studies are recommended to evaluate the results with a control group.