Endometriosi e sessualità: aspetti psicologici ed emotivi associati alla sessualità

Summary: Endometriosis is a chronic gynecological disease often associated with a strong impairment of sexual life, mainly characterized by the experience of genital-pelvic pain during intercourses. The literature highlighted that endometriosis mainly affects the female reproductive system and therefore has a strong impact on sexuality, on gender identity, on the quality of a woman's relational and mental life. The present study arises from the intention to deepen the psycho-affective health situation of women with endometriosis. The overall goal is to explore the characteristics associated with psycho-affective and sexual health in a small group of women with endometriosis by comparing it with a group of healthy women. The general hypothesis is that endometriosis women would report worse scores in all the areas examined (sexual function, alexithymia, emotions endorsed during sexual activity and psychological symptoms). Data were collected in two groups of women: 35 patients in child-bearing age (age range 18-45 years, M = 34.83 SD = 7.70) with a diagnosis of endometriosis (verified by laparoscopy) belonging to the department of Gynecology and Obstetrics of the Policlinico Umberto I and 41 healthy women from the general population. All women completed a socio-demographic questionnaire, the Toronto Alexithymia Scale (TAS), the Female Sexual Function Index (FSFI), the MCGill Pain Questionnaire (MCGILL), the Positive and Negative Affect Schedule (PANAS) and the Symptom Check-List-90-R (SCL-90-R). In the results, the group with endometriosis reported clinical scores in the area of sexuality (overall sexual functioning and pain), a higher level of psychological distress (especially in the somatization dimension) and a more negative emotions endorsed during sexual activity compared to the control group. Surprisingly, there was no significant difference between the two groups regarding to alexithymia. Although there are no significant differences between the two groups in this dimension, however, women with endometriosis showed a light tendency to report greater difficulty in identifying feelings. The presence of alexithymia might represent a defense mechanism against mental and physical pain that should be better deepened in future studies. Chronic diseases involve a series of bodily, affective and cognitive transformations that force the individual to a radical existential change and an identity redefinition. The results obtained are in line with the data in the literature that testify the tendency of people suffering from chronic diseases to translate their internal conflicts through somatic symptoms. Women with endometriosis usually show passive and avoidant coping, negative emotions associated with poor mental status, and this is important to be considered for clinical purposes. This study further confirms how endometriotic pathology can have important repercussions, as well as on the body, even in the psycho-affective and sexual sphere of the women affected. A profile emerged of women suffering and tending to somatization and a greater experience of negative emotions associated with sexual suffering. The literature suggests that a biopsychosocial approach, which places the woman to the center of a system and takes into account the psychological, biological and social variables in play, may be the most suitable for coping with the complexity of endometriosis. A model of this type is inspired by an integrated approach to the individual, the couple and the disease. Finally, it is important to remember that the analysis of the problem from a psycho-sexological point of view as well as a physiological one, with particular attention to the diagnosis and treatment phases, could result in an improvement of the assistance services and a higher probability of therapeutic success in the endometriosis pathology.

Riassunto: L’endometriosi è una patologia ginecologica cronica spesso associata ad una forte compromissione della vita sessuale, prevalentemente caratterizzata dall’esperienza di dolore genito-pelvico durante i rapporti. L’obiettivo del presente studio è di esplorare l’area psico-affettiva e sessuale in un gruppo di donne con endometriosi confrontandole con un gruppo di donne sane. L’ipotesi è che le prime riportino punteggi peggiori in tutte le aree prese in esame (funzione sessuale, alessitimia, emozioni esperite nella sessualità e sintomatologia psicologica). Lo studio è stato condotto su 76 donne che hanno compilato un questionario socio-anagrafico, la Toronto Alexithymia Scale (TAS), il Female Sexual Function Index (FSFI), il MCGill Pain Questionnaire (MCGILL), il Positive and Negative Affect Schedule (PANAS) ed il Symptom Check-List-90-R (SCL-90-R). Il gruppo con endometriosi riporta, punteggi clinici nell’area della sessualità (funzionamento sessuale e dolore), un livello di disagio psichico più elevato (soprattutto nella dimensione della somatizzazione) ed un’affettività più negativa rispetto al gruppo di controllo. Non è emersa alcuna differenza significativa tra i due gruppi rispetto all’alessitimia. I risultati dello studio suggeriscono l’importanza di un approfondimento psico-sessuologico durante la fase di diagnosi e trattamento dell’endometriosi secondo il modello biopsicosociale che ponga la donna al centro di un sistema di comprensione delle variabili in gioco.