{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T15:30:04Z","timestamp":1777044604247,"version":"3.51.4"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T00:00:00Z","timestamp":1672790400000},"content-version":"vor","delay-in-days":1982,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2017,8,1]],"date-time":"2017-08-01T00:00:00Z","timestamp":1501545600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2017,7,13]],"date-time":"2017-07-13T00:00:00Z","timestamp":1499904000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["IHD-137431"],"award-info":[{"award-number":["IHD-137431"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"CIHR Transitional Open Operating Grant","award":["MOP-142273"],"award-info":[{"award-number":["MOP-142273"]}]},{"DOI":"10.13039\/100014823","name":"VGH and UBC Hospital Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014823","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["smoa.jsexmed.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Deep dyspareunia negatively affects women\u2019s sexual function. There is a known association between deep dyspareunia and endometriosis of the cul-de-sac or uterosacral ligaments in reproductive-age women; however, other factors are less clear in this population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>To identify anatomic sites and associated clinical factors for deep dyspareunia in reproductive-age women at a referral center.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This study involved the analysis of cross-sectional baseline data from a prospective database of 548 women (87% consent rate) recruited from December 2013 through April 2015 at a tertiary referral center for endometriosis and\/or pelvic pain. Exclusion criteria included menopausal status, age at least 50 years, previous hysterectomy or oophorectomy, and not sexually active. We performed a standardized endovaginal ultrasound-assisted pelvic examination to palpate anatomic structures for tenderness and reproduce deep dyspareunia. Multivariable regression was used to determine which tender anatomic structures were independently associated with deep dyspareunia severity and to identify clinical factors independently associated with each tender anatomic site.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main Outcome Measure<\/jats:title>\n                  <jats:p>Severity of deep dyspareunia on a numeric pain rating scale of 0 to\u00a010.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Severity of deep dyspareunia (scale\u00a0= 0\u201310) was independently associated with tenderness of the bladder (b\u00a0= 0.88, P\u00a0= .018), pelvic floor (levator ani) (b\u00a0= 0.66, P\u00a0= .038), cervix and uterus (b\u00a0= 0.88, P\u00a0= .008), and cul-de-sac or uterosacral ligaments (b\u00a0= 1.39, P &amp;lt; .001), but not with the adnexa (b\u00a0=\u00a0\u22120.16, P\u00a0= 0.87). The\u00a0number of tender anatomic sites was significantly correlated with more severe deep dyspareunia (Spearman r\u00a0= 0.34, P &amp;lt; .001). For associated clinical factors, greater depression symptom severity was specifically associated with tenderness of the bladder (b\u00a0= 1.05, P\u00a0= .008) and pelvic floor (b\u00a0= 1.07, P &amp;lt; .001). A history of miscarriage was specifically associated with tenderness of the cervix and uterus (b\u00a0= 2.24, P\u00a0= .001). Endometriosis was specifically associated with tenderness of the cul-de-sac or uterosacral ligaments (b\u00a0= 3.54, P &amp;lt; .001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In reproductive-age women at a tertiary referral center, deep dyspareunia was independently associated not only with tenderness of the cul-de-sac and uterosacral ligaments but also with tenderness of the\u00a0bladder, pelvic floor, and cervix and uterus.<\/jats:p>\n                  <jats:p>Yong PJ, Williams C, Yosef A, et\u00a0al. Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia. Sex Med 2017;5:e184\u2013e195.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1016\/j.esxm.2017.07.001","type":"journal-article","created":{"date-parts":[[2017,8,1]],"date-time":"2017-08-01T13:46:57Z","timestamp":1501595217000},"page":"e184-e195","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":37,"title":["Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia"],"prefix":"10.1093","volume":"5","author":[{"given":"Paul J.","family":"Yong","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology , Vancouver, BC, \u00a0 Canada"},{"name":"University of British Columbia; BC Women\u2019s Centre for Pelvic Pain and Endometriosis , Vancouver, BC, \u00a0 Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Vancouver, BC, \u00a0 Canada"},{"name":"University of British Columbia; BC Women\u2019s Centre for Pelvic Pain and Endometriosis , Vancouver, BC, \u00a0 Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Yosef","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Vancouver, BC, \u00a0 Canada"},{"name":"University of British Columbia; BC Women\u2019s Centre for Pelvic Pain and Endometriosis , Vancouver, BC, \u00a0 Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fontayne","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Vancouver, BC, \u00a0 Canada"},{"name":"University of British Columbia; BC Women\u2019s Centre for Pelvic Pain and Endometriosis , Vancouver, BC, \u00a0 Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed A.","family":"Bedaiwy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Vancouver, BC, \u00a0 Canada"},{"name":"University of British Columbia; BC Women\u2019s Centre for Pelvic Pain and Endometriosis , Vancouver, BC, \u00a0 Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarka","family":"Lisonkova","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Vancouver, BC, \u00a0 Canada"},{"name":"University of British Columbia; BC Women\u2019s Centre for Pelvic Pain and Endometriosis , Vancouver, BC, \u00a0 Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Allaire","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology , Vancouver, BC, \u00a0 Canada"},{"name":"University of British Columbia; BC Women\u2019s Centre for Pelvic Pain and Endometriosis , Vancouver, BC, \u00a0 Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2017,8,1]]},"reference":[{"key":"2023011909330092000_bib1","first-page":"1535","article-title":"Evaluation and differential diagnosis of dyspareunia","volume":"63","author":"Heim","year":"2001","journal-title":"Am Fam Physician"},{"key":"2023011909330092000_bib2","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1136\/jfprhc-2012-100530","article-title":"Let\u2019s talk about sex and endometriosis","volume":"40","author":"Hummelshoj","year":"2014","journal-title":"J\u00a0Fam Plann Reprod Health Care"},{"key":"2023011909330092000_bib3","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1093\/humupd\/dmi029","article-title":"Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications","volume":"11","author":"Fauconnier","year":"2005","journal-title":"Hum Reprod Update"},{"key":"2023011909330092000_bib4","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1783\/147118907781004831","article-title":"Endometriosis-associated dyspareunia: the impact on women\u2019s lives","volume":"33","author":"Denny","year":"2007","journal-title":"J\u00a0Fam Plann Reprod Health Care"},{"key":"2023011909330092000_bib5","first-page":"497","article-title":"Evaluation of quality of life and sexual satisfaction in women suffering from chronic pelvic pain with or without endometriosis","volume":"8","author":"Tripoli","year":"2011","journal-title":"J\u00a0Sex Med"},{"key":"2023011909330092000_bib6","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1097\/GCO.0b013e328305b9ca","article-title":"Deep dyspareunia: causes, treatments, and results","volume":"20","author":"Ferrero","year":"2008","journal-title":"Curr Opin Obstet Gynecol"},{"key":"2023011909330092000_bib7","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.jpsychores.2006.06.003","article-title":"Living with endometriosis: the perspective of male partners","volume":"61","author":"Fernandez","year":"2006","journal-title":"J\u00a0Psychosom Res"},{"key":"2023011909330092000_bib8","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1177\/1933719110382921","article-title":"Priorities for endometriosis research: a proposed focus on deep dyspareunia","volume":"18","author":"Vercellini","year":"2011","journal-title":"Reprod Sci"},{"key":"2023011909330092000_bib9","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1016\/j.fertnstert.2012.07.1129","article-title":"\u201cI can\u2019t get no satisfaction\u201d: deep dyspareunia and sexual functioning in women with rectovaginal endometriosis","volume":"98","author":"Vercellini","year":"2012","journal-title":"Fertil Steril"},{"key":"2023011909330092000_bib10","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1093\/humrep\/deh627","article-title":"Presurgical diagnosis of posterior deep infiltrating endometriosis based on a standardized questionnaire","volume":"20","author":"Chapron","year":"2005","journal-title":"Hum Reprod"},{"key":"2023011909330092000_bib11","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/S0015-0282(02)03331-9","article-title":"Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis","volume":"78","author":"Fauconnier","year":"2002","journal-title":"Fertil Steril"},{"key":"2023011909330092000_bib12","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1093\/humrep\/del465","article-title":"Deep dyspareunia and sex life after laparoscopic excision of endometriosis","volume":"22","author":"Ferrero","year":"2007","journal-title":"Hum Reprod"},{"key":"2023011909330092000_bib13","doi-asserted-by":"crossref","first-page":"3450","DOI":"10.1093\/humrep\/des313","article-title":"Surgical versus medical treatment for endometriosis-associated severe deep dyspareunia: I. 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