Sexual beliefs, modes and cognitive schemas in endometriosis women: a barrier in seeking help for sexual pain?

Objective Endometriosis is a chronic condition frequently characterized by genito-pelvic pain. Sexual and relational impairments in women with this condition are largely reported in literature. No prior study, at our knowledge, focused on the cognitive factors associated to sexuality (sexual beliefs, modes and schemas), which are widely recognized as risk and maintaining factors for sexual dysfunctions. The aim of the present study was to investigate the presence of sexual cognitions in a group of endometriosis patients compared to a group of healthy women similar for sociodemographic variables. Methods A group of 35 Endometriosis Women (EW), recruited in the Gynecological Department of the University Hospital “Policlinico Umberto I” of Rome (age 35.49±7.64), and a Control Group (CG) of 41 healthy women from the general population (age 34.27±7.81) completed: a socio-demographic questionnaire; the McGill Pain Questionnaire (MPQ); the Female Sexual Functioning Index (FSFI); the Sexual Dysfunctional Belief Questionnaire (SDBQ); the Sexual Modes Questionnaire (SMQ); and the Questionnaire of Cognitive Schema Activation in Sexual Context (QCSASC). Results EW reported general worse sexual functioning and higher levels of genital pain compared to CG [F(1,73)=7.43; p<.01], and rarely seek help for their sexual problems [chi2=6.84]. Regarding cognitions, EW reported higher scores on “Sexual Conservatism” [F(1,73)=7.63; p<.01] and on feeling “Helpless” [F(1,73)=5.34; p<.05], explaining respectively 9.8% and 18.8% of variance. SMQ resulted on no significant differences between groups, but some tendencies were highlighted. Conclusion General ideas such as “nobody can help me” and “sexual pain is normal for women” seem to be common in Endometriosis women. These cognitions might contribute to explain why many women do not seek help for sexual pain. This novel result should be confirmed with larger studies. General Practitioners and Gynecologists should be prepared to recognize and manage these possible cognitive resistances to let Endometriosis women move towards an integrate approach to sexual health