Health-related Quality of Life and Preferred Sexual Activity Amoung Women With Endometriosis After Surgical Treatment
1Medical University of Warsaw, Department of Gyneacology and Obstetrics
2Medical University of Warsaw, Department of Medical Psychology
3Medical University of Warsaw, Head of Gyneacology and Obstetrics Department
Background: The quality of life (QoL) is a multidimensional concept relating to different areas of life and human behavior. The World Health Organization defines quality of life as the health-related quality of life (HRQoL). HRQoL is an assessment of how the individual's well-being may be affected over time by a disease. Endometriosis is a disease defined as the presence of the endometrium (glandular and stroma cells) outside the uterine cavity. The endometrium outside the uterine cavity functions similar to in the uterine cavity. This consequences are very serious, because the menstrual excretions gather at the site for implantation. This disease puts the most commonly on the ovaries, fallopian tubes, sacral ligaments and ligaments cross - uterine, as well as other organs: brain, lung, urinary bladder or intestines. Endometriosis is one of the most common gynecological diseases. It applies from 6% to 10% of women of childbearing age. The chronic pain in the pelvic, dyspareunia, and dysmenorrhea (abundant or scarce, irregular bleeding) are associated with this disease. Endometriosis is one of the most important causes of the infertility. The removal of outbreaks of the disease pain relief and fertility restoration are an important goal of treatment. The treatment of endometriosis in most cases carried out by surgical intervention. Endometriosis impossible to meet the many important for a woman needs, including sexual needs and may impair functioning in a relationship. This may affect the quality of life of these women. The aim of the study is to examine correlations between the level of quality of life and sexual activity in women with endometriosis after surgical treatment. We formulated the following research questions in relation to the basic aim of this research: 1. What is the level of general quality of life among women with endometriosis after surgery? 2. What is the level of quality of life in the dimension of somatic, psychological, social and environmental among women with endometriosis after surgery? 3. Which sexual activity give the greatest pleasure to women with endometriosis? 4. Has the quality of life a relationship with preferred sexual activity by this patients? Methods: 24 women aged from 27 to 38 participated in the study. The mean age of patients was 31.5 years. The subjects were recruited from patients who were: 1) over 18, 2) with diagnosed endometriosis, 3) the form of surgical treatment was used, 4) and gave informed consent to be part of the study. All patients gave informed consent. Medical and psychosocial variables were analyzed in this study. The medical variables included: 1) the stages of endometriosis, 2) duration of endometriosis, calculated to the date of diagnosis to this study, 3) the location of endometriosis. The psychosocial variables were: 1) the general quality of life and its four dimensions: somatic, psychological, social, environmental, 2) sexual activity, 3) current marital status, 4) the level of education. Two research tools were used in the study: 1) the WHOQoL-BREF. This questionnaire was developed by the World Health Organization and is an abbreviated version of the WHOQoL-100. It can be used to assess quality of life in both healthy people and patients, for both cognitive and clinical purposes. The WHOQoL-BREF has 26 items. Respondents respond on a five-point Likert scale. A quality of life profile can be charted for four aspects of life: psychological, physical, social and environmental. The higher the score on a given scale, the better the quality of life. 2) Sexual Stimulus Scale (SSS) by Z. Lew-Starowicz. SSS consists of 43 sexual activity structured to reflect a wide range of sexual behavior. Respondents evaluated each activity on a 4-point scale (1 - "not suit me" to 4 - "I very like it"). All sexual stimulus were divided into four groups: face and body caresses, sexual positions, sexual activity, non-standard sexual behavior and orgasm as a result of stimulation. The data were analyzed statistically using SPSS 18 software. The p?0.05 criterion of statistical significance was adopted. Findings: Patients with endometriosis were characterized by good quality of life (M=4). Women also highly assessed their quality of life in terms of four aspects: psychological (X=16,20±1,41), physical (16,67±1,91), social (16,40±2,59) and environmental (17,20±1,62). There were no statistically significant relationship between the general quality of life and duration of endometriosis. Similar observations were reported in the case of the analyzed dimensions of quality of life - somatic psychological, social and environmental. The hugging (86,7%) and face’s kisses (73,3%) provide the most pleasure patient with endometriosis in terms of face and body caresses. Sexual behavior associated with stimulation of the vagina by hand (53,3%) provide the least pleasure. The level of general quality of life was characterized by a positive correlation with the pleasure of hugging (rho=0,389;p=0,017) and kissing face (rho=0,379;p=0,020). Similar relationships were recorded in the case of dimension psychological and environmental functioning. Women had the most pleasure from the classical position (66,7%), but the least from the back position (53,3%) and a standing position (46,7%). The pleasure of making sex in classical position positively correlated with the general quality of life (Rho=0,600;p=0,000) and four aspects of life: psychological (Rho=0,554;p=0,001), physical (Rho=0,585;p=0,000), social (Rho=0,372;p=0,022) and environmental (Rho=0,536;p=0,001). The most pleasure provided advantage of active partner in sexual intercourse (60%) in women with endometriosis. The patients had the smallest pleasure from the advantage of themselves activity in sexual intercourse (46,7%). The pleasure of provided advantage of active partner in sexual intercourse positively correlated with the general quality of life (Rho=0,423;p=0,010) and four aspects of life: psychological (Rho=0,567;p=0,001), physical (Rho=0,588;p=0,000), social (Rho=0,381;p=0,019) and environmental (Rho=0,539;p=0,001). Patients with endometriosis declared the smallest pleasure from making sexual activity associated with group sex (20%) and intercourse with two partners (20%). Women declared the greatest pleasure from the use of elongated techniques of sexual intercourse (53,3%) in terms of non-standard sexual behavior. The pleasure of use of elongated techniques of sexual intercourse positively correlated with the general quality of life (Rho=0,603;p=0,00), and four aspects of life: psychological (Rho=0,887;p=0,000), physical (Rho=0,797;p=0,000), social (Rho=0,669;p=0,000) and environmental (Rho=0,801;p=0,000). Women with endometriosis declared the greatest pleasure from orgasm due to excite by hand (46,7%), and the smallest of achieving orgasm due to excite by water during shower (33,3%). The pleasure from orgasm due to excite by hand positively correlated with the general quality of life (Rho=0,407;p=0,013) and four aspects of life: psychological (Rho=0,872;p=0,000), physical (Rho=0,833; p=0,000), social (Rho=0,679;p=0,000) and environmental (Rho=0,801;p=0,000). Discussion: The pain is a major cause of physical, psycho-social and emotional problems among women with endometriosis. The surgical treatment relieves pain and can affect the quality of life of these patients. Our research showed that the quality of life of women with endometriosis characterized by a significant correlation from pleasure of sexual activity. This may affect the quality of the closed relationship of these women and satisfaction with life and their sexual activity. Further research is warranted to evaluate the impact of endometriosis on HRQL. The studies concerning the relationship between quality of life and pleasure of sexual activity are a new area of interdisciplinary research combining the achievements of health psychology and other sciences.