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“The sound of silence” Giving voice to endometriosis-related positional dyspareunia

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Abstract

Deep dyspareunia is one of the main symptoms of endometriosis. It appears to be submerged by a two-way disconnection between patients and their physicians. The aim of our review is to provide clear, ready-to-use advice on how to manage deep dyspareunia overcoming the gap in communication. Sexual history should always be taken as part of routine health care in these regards, using a patient-centered approach. An educational pelvic examination, which actively includes patients in the identification of painful areas, may prove useful to improve patients’ understanding of their condition. Correlating painful pelvic areas with sexual positions and inviting patients to adopt alternative positions may represent a simple but extremely effective coping strategy to mitigate pain. Revealing and explaining to partners the nature of the pain is essential to allow them to take part in shared research of coping mechanisms, empowering the couple to make choices and changes. Couples who do not feel comfortable talking about intimacy by themselves may find that including a psychotherapist or a sexual therapist, may be a good way to start communication. Investigating and managing dyspareunia during medical encounters is a medical and ethical duty all healthcare practitioners should pursue.

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  1. Camilla Erminia Maria Merli and Giulia Emily Cetera have contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Gynecology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy

    Camilla Erminia Maria Merli, Giulia Emily Cetera, Carlotta Caia & Paolo Vercellini

  2. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Carlotta Caia & Paolo Vercellini

  3. Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy

    Federica Facchin

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All authors contributed to the literature review for the manuscript. The first draft of the manuscript was written by C.E.M.M. and G.E.C. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

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Merli, C.E.M., Cetera, G.E., Caia, C. et al. “The sound of silence” Giving voice to endometriosis-related positional dyspareunia. Arch Gynecol Obstet 309, 887–893 (2024). https://doi.org/10.1007/s00404-023-07205-3

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