Partners matter: The psychosocial well-being of couples when dealing with endometriosis

The mediating effect of social support on the relationship between intimacy and perceived partner responsiveness in endometriosis women of childbearing age

Purposes

The mediating effect of social support on the relationship between intimacy and perceived partner responsiveness (PPR) was examined among the endometriosis women of childbearing age.

Method

201 endometriosis (EM) women of childbearing age were investigated in the gynecology outpatient clinic and ward of a tertiary general hospital in Nantong City, Jiangsu Province. Intimacy, PPR, and social support were measured by using the scales of Quality of Relationship Index (QRI), PPR Scale (PPRS), and Social Support Rating Scale (SSRS). A four-step hierarchical regression analysis was conducted.

Results

Positive correlations were found among intimacy and subjective support, support utilization, and PPR. Mediation analysis indicated a partial mediating effect of support utilization on the relationship between intimacy and PPR.

Conclusion

There is a positive correlation between intimacy and PPR in EM patients of childbearing age, and the support utilization plays a partial mediating role.

Associations between health-related quality of life, infertility-related psychological well-being, and relationship quality in individuals with endometriosis: A cross-sectional study

BACKGROUND

Endometriosis is the most frequent gynecological diseases and accompanied by both physical and psychological symptoms. An increasing number of studies suggested acknowledging endometriosis as a systematic disease due to the multifactorial effects throughout the body. The chronic disease significantly impacts daily life, including romantic relationships. This study aimed to investigate the associations between health-related quality of life (HRQoL), infertility-related psychological well-being (IPW), constructive communication, and relationship quality in individuals with endometriosis.

METHODS

A total of 627 individuals with endometriosis participated in this online cross-sectional study. We measured HRQoL in all participants and IPW specifically in those who reported an unfulfilled wish for a child. Additionally, relationship quality and constructive communication were assessed. We used Pearson's product moment correlation to examine the association of HRQoL/IPW and relationship quality. Mediation analysis was used to assess the role of constructive communication in the association between HRQoL/IPW and relationship quality. In an explorative analysis, differences between subsamples with and without an unfulfilled wish for a child were analyzed.

RESULTS

Poorer HRQoL was associated with lower relationship quality overall (p = .002) and specifically with three subscales of relationship quality: worse sexuality (p = .016), increased mistrust towards the partner (p < .001), and restriction of freedom/independence (p = .003). There was no significant association between IPW and relationship quality. The mediation analysis including constructive communication as mediator showed a full mediation between HRQoL/IPW and relationship quality. The subsamples with and without an unfulfilled wish for a child differed in HRQoL but not in relationship quality or constructive communication.

CONCLUSION

The findings indicated an association between HRQoL in individuals with endometriosis and relationship quality. In addition, we observed a full mediation between HRQoL/IPW and relationship quality, when constructive communication was considered as a mediator. Therefore, constructive communication plays a key role in effectively managing the impact of the disease within a relationship. Individuals with endometriosis experiencing difficulties conceiving should have access to appropriate psychological counseling.

Predictors of partnership and sexual satisfaction and dyadic effects in couples affected by endometriosis and infertility

PURPOSE

Endometriosis and infertility are associated with impaired partnership and sexuality of the patients, but also of their male partners. Also, endometriosis is one of the most common causes of infertility, resulting in a large overlap of both pathologies. The aim of this study was to determine the association of different predictors of partnership and sexual satisfaction and dyadic effects in couples with endometriosis and infertility.

METHODS

A cross-sectional study was conducted with n = 62 women with endometriosis and n = 46 partners, including a total of n = 44 couples, some of whom were affected by infertility. The questionnaire included items on partnership, sexuality, depression, social support, and desire for a child. Multiple linear regression and the actor-partner-interdependence-model were used for analysis.

RESULTS

Significant dyadic effects only occurred in couples with both endometriosis and infertility. Depression showed a significant negative actor effect in men for partnership satisfaction and a negative actor and partner effect in women for sexuality satisfaction (p < .05). For women, social support showed a significant positive actor effect for partnership satisfaction (p < .05), age showed a significant actor and partner effect for sexuality satisfaction (p < .05).

CONCLUSION

The results show a significant association of endometriosis and infertility with partnership and sexuality satisfaction. Infertility could be a decisive factor. However, the large overlapping of both endometriosis und infertility in many couples support the importance of further studies to differentiate between the both effects.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00014362 on the 29.03.2018.

Partnership and relationship happiness in endometriosis related chronic pelvic pain: a multicenter case-control study

Introduction

Partnership is an important resource in dealing with endometriosis related chronic pain. Hence, our objective was to assess partnership in the context of endometriosis and its symptoms, considering the perspectives of both individuals involved.

Methods

The study was designed as a multi-center matched case-control study in Switzerland, Germany and Austria. Altogether 381 women with surgically/histologically confirmed endometriosis and 381 control women, 250 male partners of endometriosis-affected women and 229 of control women were evaluated. Partnership quality, partnership happiness, separation thoughts, and areas of conflict were evaluated through the Partnership Questionnaire and a validated list of conflict areas.

Results

Quality of partnership was rated as high by 60.1% of the women with endometriosis and 66.7% of the control women, as well as by 45.8 and 50.2% of their respective partners. Women with endometriosis mentioned separation thoughts, mostly related to sexual satisfaction, more often (34.9%/28.3%) and experienced more partnership-related conflicts than control women. Chronic pain, dyspareunia, dissatisfaction with sexuality, fatigue, and infertility were significantly associated with partnership conflicts. Fatigue and infertility but not pain experiences were related to lower partnership quality. Male partners in both groups reported separation thoughts equally often. In men, a high intensity of pain experienced by their partner was associated with reduced partnership happiness.

Conclusion

Given the significance of partnership in dealing with chronic diseases and the connection between symptoms of endometriosis and a decrease in partnership quality, it is essential to incorporate strategies that alleviate the negative impacts on relationships for both partners into medical support.

Clinical trial registration

identifier NCT02511626.

The "most bothersome symptom" construct: A qualitative study of Australians living with endometriosis

INTRODUCTION

"Improvement in the most bothersome symptom" was recently selected as a core outcome for endometriosis intervention trials. This study aimed to explore the applicability of the construct of "symptom bother" in representing the lived experiences of people with endometriosis.

MATERIAL AND METHODS

Semi-structured interviews were conducted to understand the meaning of "symptom bother" and related constructs. Eighteen interviews were conducted: 14 among people with a surgical diagnosis of endometriosis who were recruited from the community, and four with people who were recruited from a private gynecology clinic who had either a confirmed diagnosis or a high suspicion of the disease. All interviews were audio recorded, transcribed verbatim, and analyzed thematically.

RESULTS

Three primary themes were identified: (1) endometriosis symptoms and priorities vary with time and context, (2) endometriosis symptoms impair normal daily functioning, (3) endometriosis symptoms are more than just a "bother." The concept of "bother" to describe endometriosis symptoms did not resonate with most participants. Whilst "bother" was familiar language, it did not encompass the broader implications of living with endometriosis. Participants felt "bother" implied emotional distress, lacking a full understanding of the consequences of the disease. Instead, "symptom impact" was endorsed, allowing participants to quantify and objectively assess their symptoms, free from negative connotations.

CONCLUSIONS

This was the first qualitative study to explore "symptom bother" among people living with endometriosis. Instead of "bother," "impact" was widely endorsed as a suitable construct. This term more appropriately captured the broad ways in which endometriosis symptoms impair daily functioning.

Endometriosis and mental health disorders: identification and treatment as part of a multimodal approach

Endometriosis is a disease marked by more than just pain and infertility, as it transcends the well-characterized physical symptoms to be frequently associated with mental health issues. This review focuses on the associations between endometriosis and anxiety, depression, sexual dysfunction, and eating disorders, all of which show a higher prevalence in women with the disease. Studies show that pain, especially the chronic pelvic pain of endometriosis, likely serves as a mediating factor. Recent studies evaluating genetic predispositions for endometriosis and mental health disorders suggest a shared genetic predisposition. Healthcare providers who treat women with endometriosis should be aware of these associations to best treat their patients. A holistic approach to care by gynecologists as well as mental health professionals should emphasize prompt diagnosis, targeted medical interventions, and psychological support, while also recognizing the role of supportive relationships in improving the patient's quality of life.

Correlation between pain and depressive symptoms in patients with confirmed endometriosis during COVID-19 pandemic

BACKGROUND

Endometriosis is a chronic, estrogen-dependent, inflammatory condition which affects women of reproductive age physically and psychologically in their everyday life. The most common symptom is chronic lower abdominal pain. Apart from physical pain, endometriosis often also leads to an unfulfilled desire to give birth. In general, these two main aspects alone lead to emotional stress for patients and often initiate depressive symptoms. To what extent endometriosis patients are additionally affected by the COVID pandemic and its effects is to be determined in this study.

METHODS

Patients who presented at our endometriosis center and met the study criteria were offered participation in the study. A link to an online questionnaire (SoSci-Survey) was sent by email. The online questionnaire evaluated depressive symptoms before and during the pandemic as well as the pain perception and perceived support during the pandemic. The data of 167 fully completed questionnaires were evaluated and analyzed using SPSS.

RESULTS

The analysis of the questionnaires revealed a significant association between pain levels and depressive symptomatology in endometriosis patients during the pandemic. Patients with more severe pain showed significantly higher depressive symptoms than patients with little or no pain. During the pandemic, patients showed higher depressive symptoms than before. In addition, it was found that those endometriosis patients who felt left alone with their pain due to the consequences of the COVID pandemic, or who felt they had to endure the pain alone, also had higher depressive symptoms.

CONCLUSION

In summary, it can be observed that endometriosis patients with a high pain burden had significantly higher depressive symptoms during the COVID pandemic. The consequences of the pandemic often led to the feeling of having to cope with the symptoms alone or having to endure pain alone, which in turn increased the depressive symptoms. As treating physicians, we should be aware of these connections and try to counteract them with targeted offers and support.

Endometriosis: patient-doctor communication and psychological counselling

The fact that endometriosis is one of the most frequent gynaecological disorders in women and girls is gradually attracting greater public and political attention. There is also substantial awareness of the disorder among German gynaecologists, albeit without sufficient "equipment" for discussing the condition with patients and providing psychological counselling. This article offers hands-on proposals for medical counselling and the discussion of relevant issues, as well as other practical tips and suggested verbalisations for use by women suffering from endometriosis (and their partners). These practical recommendations will certainly help to improve the doctor-patient relationship in the case of endometriosis. The resources mentioned below (guidebooks, websites) focus on German-language offerings only.

"I think to myself 'why now?'" - a qualitative study about endometriosis and pain in Austria

BACKGROUND

Endometriosis is a chronic, benign, and oestrogen-dependent condition and about 10-15% of all women of reproductive age are affected by endometriosis worldwide. It is not curable and pain is one of the most common symptoms of endometriosis and leads to low quality of life in affected women. To our knowledge, in German-speaking countries, no studies with qualitative methods approaches are available concerning women who suffer from pain caused by endometriosis and possible associated coping strategies. Our study aims to familiarise ourselves with the individual pain experience of selected women who suffer from endometriosis in Austria and their coping strategies.

METHODS

A qualitative study design was based on problem-centred interviews for data collection and qualitative content analysis for data analysis. The research participants were women aged between 18 and 55 diagnosed with endometriosis and living in Austria. The interview period was from 27 February to 26 March 2019 and interviews lasted between 50 and 75 min.

RESULTS

Eight categories were formulated, of which category 3 (thoughts and feelings regarding endometriosis and pain - 'why?'), category 5 (effects and changes caused by endometriosis and pain - 'quality of life'), category 7 (taboos - 'don`t talk about it'), and category 8 (talking about it - 'contact with others in the same position') were relevant for this article. The remaining four categories [1-4] have already been published elsewhere.

CONCLUSION

Our data show that the social environment plays a fundamental role in coping strategies concerning pain caused by endometriosis. Women in our study reported that exchange with peers offers support. This opens a door for information events, patient organizations like support groups, and the inclusion of these in the supporting system. Involving occupational medicine and workplace health promotion departments in companies should be further goals to support affected women.

Understanding Psychological Symptoms of Endometriosis from a Research Domain Criteria Perspective

Endometriosis is currently the second most common gynecological disease and is associated with severe pain, vegetative impairment, and infertility. In association, there are considerable psychological symptoms that limit the quality of life of those affected. In this narrative review, the Research Domain Criteria (RDoC) framework was utilized to display the different transdiagnostic processes involved in disease progression and maintenance in regard to psychosocial functioning. Using the RDoC framework, it becomes clear that immune/endocrinological dysregulation is interlocked with (pelvic) pain chronification processes and psychological symptoms such as depressive mood, loss of control, higher vigilance toward the onset or worsening of symptoms, social isolation, and catastrophizing. This paper will discuss and identify promising treatment approaches, in addition to medical care, as well as further research implications. Endometriosis can come with substantial psychosomatic and social burden, requiring more research to understand the interdependence of different factors involved in its chronic development pathway. However, it is already clear that standard care should be extended with multifaceted treatments addressing pain, as well as the psychological and social burden, in order to halt the cycle of aggravation of symptoms and to improve quality of life for patients.