Advertisement

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

Published:October 05, 2020DOI:https://doi.org/10.1016/j.jsxm.2020.09.001

      Abstract

      Background

      Dyspareunia, 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.

      Aim

      The 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.

      Methods

      A 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.

      Outcomes

      The primary outcome measure of this study was the orgasm rate during different types of sexual activities.

      Results

      Only 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 implications

      Sexual 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 limitations

      This 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.

      Conclusion

      Partnered 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.

      Key Words

      To read this article in full you will need to make a payment
      ISSM Member Login
      Login with your ISSM username and password.
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Davison S.L.
        • Bell R.J.
        • LaChina M.
        • et al.
        The relationship between self-reported sexual satisfaction and general well-being in women.
        J Sex Med. 2009; 6: 2690-2697
        • Haning R.V.
        • O'Keefe S.L.
        • Randall E.J.
        • et al.
        Intimacy, orgasm likelihood, and conflict predict sexual satisfaction in heterosexual male and female respondents.
        J Sex Marital Ther. 2007; 33: 93-113
        • Mark K.
        • Herbenick D.
        • Fortenberry D.
        • et al.
        The object of sexual desire: examining the “what” in “what do you desire?”.
        J Sex Med. 2014; 11: 2709-2719
        • Haavio-Mannila E.
        • Kontula O.
        Correlates of increased sexual satisfaction.
        Arch Sex Behav. 1997; 26: 399-419
        • Leeners B.
        • Kruger T.H.
        • Brody S.
        • et al.
        The quality of sexual experience in women correlates with post-orgasmic prolactin surges: results from an experimental prototype study.
        J Sex Med. 2013; 10: 1313-1319
        • Büsing S.
        • Hoppe C.
        • Liedtke R.
        Sexual satisfaction of women - development and results of a questionnaire.
        Psychother Psychosom Med Psychol. 2001; 51: 68-75
        • Leeners B.
        • Hengartner M.P.
        • Rössler W.
        • et al.
        The role of psychopathological and personality covariates in orgasmic difficulties: a prospective longitudinal evaluation in a cohort of women from age 30 to 50.
        J Sex Med. 2014; 11: 2928-2937
        • Frederick D A.
        • Lever J.
        • Gillespie B.J.
        • et al.
        What keeps passion alive? Sexual satisfaction is associated with sexual communication, mood setting, sexual variety, oral sex, orgasm, and sex frequency in a national US study.
        J Sex Res. 2017; 54: 186-201
        • Philippsohn S.
        • Hartmann U.
        Determinants of sexual satisfaction in a sample of German women.
        J Sex Med. 2009; 6: 1001-1010
        • Zietsch B.P.
        • Miller G.F.
        • Bailey J.M.
        • et al.
        Female orgasm rates are largely independent of other traits: Implications for “female orgasmic disorder” and evolutionary theories of orgasm.
        J Sex Med. 2011; 8: 2305-2316
        • Prause N.
        The human female orgasm: Critical evaluations of proposed psychological sequelae.
        Sex Relat Ther. 2011; 26: 315-328
        • Kinsey A.C.
        • Pomeroy W.B.
        • Martin C.E.
        • et al.
        Sexual behavior in the human female.
        Indiana University Press, Philadelphia1998
        • Frederick D.A.
        • John H.K.S.
        • Garcia J.R.
        • et al.
        Differences in orgasm frequency among gay, lesbian, bisexual, and heterosexual men and women in a US national sample.
        Arch Sex Behav. 2018; 47: 273-288
        • McBride K.R.
        • Fortenberry J.D.
        Heterosexual anal sexuality and anal sex behaviors: a review.
        J Sex Res. 2010; 47: 123-136
        • Lindberg L.D.
        • Jones R.
        • Santelli J.S.
        Noncoital sexual activities among adolescents.
        J Adolesc Health. 2008; 43: 231-238
        • Howard F.M.
        Chronic pelvic pain.
        Obstet Gynecol. 2003; 101: 594-611
        • Zondervan K.T.
        • Yudkin P.L.
        • Vessey M.P.
        • et al.
        Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database.
        BJOG. 1999; 106: 1149-1155
        • Moore J.
        • Kennedy S.
        Causes of chronic pelvic pain.
        Best Pract Res Clin Obstet Gynaecol. 2000; 14: 389-402
        • Ballard K.
        • Seaman H.
        • De Vries C.S.
        • et al.
        Can symptomatology help in the diagnosis of endometriosis? Findings from a national case–control study—part 1.
        BJOG. 2008; 115: 1382-1391
        • Galle P.
        Clinical presentation and diagnosis of endometriosis.
        Obstet Gynecol Clin North Am. 1989; 16: 29-42
        • Eskenazi B.
        • Warner M.L.
        Epidemiology of endometriosis.
        Obstet Gynecol Clin North Am. 1997; 24: 235-258
        • Hämmerli S.
        • Schwartz A.S.K.
        • Geraedts K.
        • et al.
        Does endometriosis affect sexual activity and satisfaction of the man partner? A comparison of partners from women diagnosed with endometriosis and controls.
        J Sex Med. 2018; 15: 853-865
        • Garry R.
        • Clayton R.
        • Hawe J.
        The effect of endometriosis and its radical laparoscopic excision on quality of life indicators.
        BJOG. 2000; 107: 44-54
        • Tripoli T.M.
        • Sato H.
        • Sartori M.G.
        • et al.
        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
        • Steege J.F.
        • Zolnoun D.A.
        Evaluation and treatment of dyspareunia.
        Obstet Gynecol. 2009; 113: 1124-1136
        • Leeners B.
        • Imthurn B.
        [Psychosomatic aspects of endometriosis--current state of scientific knowledge and clinical experience].
        Gynakol Geburtshilfliche Rundsch. 2006; 47: 132-139
        • Bernays V.
        • Schwartz A.K.
        • Geraedts K.
        • et al.
        Qualitative and quantitative aspects of sex life in the context of endometriosis: a multicentre case control study.
        Reprod Biomed Online. 2019; 40: 296-304
        • Brody S.
        • Costa R.M.
        Satisfaction (sexual, life, relationship, and mental health) is associated directly with penile-vaginal intercourse, but inversely with other sexual behavior frequencies.
        J Sex Med. 2009; 6: 1947-1954
        • Costa R.M.
        • Brody S.
        Immature defense mechanisms are associated with lesser vaginal orgasm consistency and greater alcohol consumption before sex.
        J Sex Med. 2010; 7: 775-786
        • Von Elm E.
        • Altman D.G.
        • Egger M.
        • et al.
        The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.
        Int J Surg. 2014; 12: 1495-1499
        • Rosen C.B.
        • Heiman J.
        • Leiblum S.
        • et al.
        The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function.
        J Sex Marital Ther. 2000; 26: 191-208
        • Creti L.
        • Fichten C.S.
        • Amsel R.
        • et al.
        Global sexual functioning: a single summary score for Nowinski and LoPiccolos sexual history form (SHF).
        in: Davis C.M. Yarber W.L. Bauserman R. Handbook of sexuality-related measures. Sage Publications, Thousand Oaks, California1998: 261-267
        • Schneidewind-Skibbe A.
        • Hayes R.D.
        • Koochaki P.E.
        • et al.
        The frequency of sexual intercourse reported by women: a review of community-based studies and factors limiting their conclusions.
        J Sex Med. 2008; 5: 301-335
        • Denny E.
        Women's experience of endometriosis.
        J Adv Nurs. 2004; 46: 641-648
        • Ferrero S.
        • Esposito F.
        • Abbamonte L.H.
        • et al.
        Quality of sex life in women with endometriosis and deep dyspareunia.
        Fertil Steril. 2005; 83: 573-579
        • Montanari G.
        • Di Donato N.
        • Benfenati A.
        • et al.
        Women with deep infiltrating endometriosis: sexual satisfaction, desire, orgasm, and pelvic problem interference with sex.
        J Sex Med. 2013; 10: 1559-1566
        • Kinsey A.C.
        • Pomeroy W.R.
        • Martin C.E.
        Sexual behavior in the human male.
        Am J Public Health. 2003; 93: 894-898
        • Harris J.M.
        • Cherkas L.F.
        • Kato B.S.
        • et al.
        Normal variations in personality are associated with coital orgasmic infrequency in heterosexual women: a population-based study.
        J Sex Med. 2008; 5: 1177-1183
        • Blair K.L.
        • Cappell J.
        • Pukall C.F.
        Not all orgasms were created equal: differences in frequency and satisfaction of orgasm experiences by sexual activity in same-sex versus mixed-sex relationships.
        J Sex Res. 2018; 55: 719-733
        • Verit F.F.
        • Verit A.
        • Yeni E.
        The prevalence of sexual dysfunction and associated risk factors in women with chronic pelvic pain: a cross-sectional study.
        Arch Gynecol Obstet. 2006; 274: 297-302
        • Jarzabek-Bielecka G.
        • Radomski D.
        • Pawlaczyk M.
        • et al.
        Dyspareunia as a sexual problem in women with endometriosis.
        Arch Perinat Med. 2010; 16: 51-53
        • Fritzer N.
        • Haas D.
        • Oppelt P.
        • et al.
        More than just bad sex: sexual dysfunction and distress in patients with endometriosis.
        Eur J Obstet Gynecol Reprod Biol. 2013; 169: 392-396
        • Denny E.
        • Mann C.H.
        Endometriosis-associated dyspareunia: the impact on women's lives.
        J Fam Plann Reprod Health Care. 2007; 33: 189-193
        • De Graaff A.
        • Van Lankveld J.
        • Smits L.
        • et al.
        Dyspareunia and depressive symptoms are associated with impaired sexual functioning in women with endometriosis, whereas sexual functioning in their male partners is not affected.
        Hum Reprod. 2016; 31: 2577-2586
        • Ferrero S.
        • Abbamonte L.
        • Giordano M.
        • et al.
        Deep dyspareunia and sex life after laparoscopic excision of endometriosis.
        Hum Reprod. 2007; 22: 1142-1148
        • Dennerstein L.
        • Dudley E.C.
        • Hopper J.L.
        • et al.
        A prospective population-based study of menopausal symptoms.
        Obstet Gynecol. 2000; 96: 351-358
        • Miller S.A.
        • Byers E.S.
        Actual and desired duration of foreplay and intercourse: discordance and misperceptions within heterosexual couples.
        J Sex Res. 2004; 41: 301-309
        • Mercer C.H.
        • Tanton C.
        • Prah P.
        • et al.
        Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal).
        Lancet. 2013; 382: 1781-1794
        • Beckman N.
        • Waern M.
        • Gustafson D.
        • et al.
        Secular trends in self reported sexual activity and satisfaction in Swedish 70 year olds: cross sectional survey of four populations, 1971-2001.
        BMJ. 2008; 337: a279
        • Potts A.
        Coming, coming, gone: a feminist deconstruction of heterosexual orgasm.
        Sexualities. 2000; 3: 55-76
        • Butt F.S.
        • Chesla C.
        Relational patterns of couples living with chronic pelvic pain from endometriosis.
        Qual Health Res. 2007; 17: 571-585