Current issues in the treatment and prevention of psychoemotional disorders and sexual dysfunctions in women with pain syndrome associated with genital endometriosis

Zhigalova E. V.
Postgraduate Student, Department of Epidemiology, Parasitology and Disinfectology; Department of Psychotherapy, Medical Psychology and Sexology¹

Fedorova A. I.
Dr. of Sci. (Med.), Professor, Department of Psychotherapy, Medical Psychology and Sexology¹

1Federal State Budgetary Educational Institution of Higher Education «North-Western State Medical University named after I.I. Mechnikov» of the Ministry of Health of Russia, 191015, St. Petersburg, Kirochnaya St., 41.

Zhigalova Elena Vladimirovna; e-mail: zhigalova1979@gmail.com

The study had no sponsorship.

The authors declare no conflict of interest.

Introduction. Pain syndrome (PS) in genital endometriosis (GE) and the associated psychoemotional disorders, sexual dysfunctions, and family-sexual disharmonies negatively affect women's quality of life. Psychoemotional disorders and sexual dysfunctions, in turn, are involved in the pathogenetic mechanisms of the formation and exacerbation of PS in GE. Currently, medical practice lacks an algorithm for the diagnosis and treatment-preventive measures for PS in GE that considers psychoemotional and psychosexual factors of its development. This necessitates the development of an interdisciplinary therapeutic approach for managing patients with PS in GE, in accordance with the biopsychosocial model integrating knowledge of somatic symptoms with the latest research in psychiatry and sexology. Objective: To improve the components (strategy) of a comprehensive approach to the examination, prevention, and therapy of pain syndrome in genital endometriosis, taking into account psychoemotional and psychosexual factors. Materials and research methods. Study type: retrospective descriptive analytical case-control study with selective coverage of subjects. The research was based on epidemiological, clinical-anamnestic, clinical, clinical-psychopathological, clinical-sexological, psychometric, and statistical methods. Research results and discussion. A comparative clinical assessment of the psychoemotional and personal characteristics of patients with painful and non-painful forms of GE, conducted in the study, revealed the influence on the development and chronicity of pain syndrome from impairments in psychoemotional state, anxiety-asthenic, anxiety-depressive, and anxiety-hypochondriac syndromes within neurotic, stress-related, and somatoform disorders, as well as such personal characteristics as alexithymia, a tendency towards catastrophizing, somatization, high personal and situational anxiety, a tendency to obsession-compulsion, hostility, and paranoid tendencies. Conclusion. The fully implemented treatment and rehabilitation measures demonstrated high effectiveness in reducing the severity of pain syndrome, normalizing psychoemotional state, harmonizing the sexual sphere, and improving the quality of life of women, as evidenced by the results of follow-up data.

genital endometriosis, pain syndrome, psychosexual development, sexual dysfunctions, family-sexual disharmonies, psychoemotional disorders

10.29234/2308-9113-2025-13-4-90-105

1. Adamyan L.V., Sharov M.N., Murvatov K.D., et al. Vozmozhnosti povysheniya effektivnosti kompleksnoi terapii endometrioza i khronicheskoi tazovoi boli u patsientok reproduktivnogo vozrasta. [Opportunities to increase the effectiveness of complex therapy for endometriosis and chronic pelvic pain in patients of reproductive age.] Problemy reproduktsii [Problems of Reproduction] 2023;29(3):91-97, doi: 10.17116/repro20232903191. (In Russ.)

2. Adamyan L.V., Sukhikh G.T., Serov V.N., et al. Algoritmy vedeniya patsientok s endometriozom: soglasovannaya pozitsiya ekspertov Rossiiskogo obshchestva akusherov-ginekologov. [Management algorithms for patients with endometriosis: A consensus position of experts from the Russian Society of Obstetricians and Gynecologists.] Akusherstvo i ginekologiya [Obstetrics and Gynecology] 2023;(5):159-176, doi: 10.18565/aig.2023.132. (In Russ.)

3. Begovich E., Solopova A.G., Khlopkova S.V., et al. Kachestvo zhizni i osobennosti psikhoemotsional'nogo statusa bol'nykh naruzhnym genital'nym endometriozom. [Quality of life and psychoemotional status in patients with external genital endometriosis.] Akusherstvo, Ginekologiya i Reproduktsiya [Obstetrics, Gynecology and Reproduction] 2022;16(2):122-133, doi: 10.17749/2313-7347/ob.gyn.rep.2022.283. (In Russ.)

4. Zhigalova E.V., Fedorova A.I., Aslanov B.I. Epidemiologicheskie aspekty sindroma khronicheskoi tazovoi boli pri genital'nom endometrioze (obzor literatury). [Epidemiological aspects of chronic pelvic pain syndrome in genital endometriosis (literature review).] Sibirskii nauchnyi meditsinskii zhurnal [Siberian Scientific Medical Journal] 2024;44(3):6-15, doi: 10.18699/SSMJ20240301. (In Russ.)

5. Podzolkova N.M., Fadeev I.E., Glazkova O.L., et al. Effektivnost' kombinirovannogo lecheniya patsientok s glubokim infiltrativnym endometriozom. [The effectiveness of combined treatment of patients with deep infiltrating endometriosis.] Voprosy ginekologii, akusherstva i perinatologii [Problems of Gynecology, Obstetrics and Perinatology] 2022;21(5):105-112, doi: 10.20953/1726-1678-2022-5-105-112. (In Russ.)

6. Sibirskaya E.V., Nikiforova P.O. Khronicheskaya tazovaya bol': psikhonevrologicheskii vzglyad na ginekologicheskuyu problemu. [Chronic pelvic pain: A psychoneurological view on a gynecological problem.] Effektivnaya farmakoterapiya [Effective Pharmacotherapy] 2023;19(37):36-39, doi: 10.33978/2307-3586-2023-19-37-36-39. (In Russ.)

7. Fedorova A.I. Psikhoterapiya seksual'nykh narushenii. [Psychotherapy of sexual disorders.] In: Vasil'eva A.V., Karavaeva T.A., Neznanov N.G., editors. Psikhoterapiya. Natsional'noe rukovodstvo. [Psychotherapy. National Guide.] Moscow: GEOTAR-Media; 2023. p. 909-928, doi: 10.33029/9704-7567-6-PSY-2023-1-992. (In Russ.)

8. Fedorova A.I., Zhigalova E.V. Psikhoemotsional'noe sostoyanie i seksual'naya funktsiya zhenshchin s khronicheskoi tazovoi bol'yu pri genital'nom endometrioze. [Psychoemotional state and sexual function of women with chronic pelvic pain in genital endometriosis.] Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova [S.S. Korsakov Journal of Neurology and Psychiatry] 2024;124(10):5-15, doi: 10.17116/jnevro20241241015. (In Russ.)

9. Ministerstvo zdravookhraneniya Rossiiskoi Federatsii, Rossiiskoe obshchestvo akusherov-ginekologov. Endometrioz: Klinicheskie rekomendatsii. [Ministry of Health of the Russian Federation, Russian Society of Obstetricians and Gynecologists. Endometriosis: Clinical guidelines.] Moscow; 2024 [cited 2025 Jun 22]. 62 p. Available from: https://roag-portal.ru/recommendations­_gynecology (In Russ.)

10. Dior U.P., Reddington C., Cheng C., Levin G., Healey M. Sexual Function of Women With Deep Endometriosis Before and After Surgery: A Prospective Study. J Sex Med. 2022 Feb;19(2):280-289, doi: 10.1016/j.jsxm.2021.11.009

11. Endometriosis and Chronic Pelvic Pain Training Center of Shandong Medical Doctor Association. WANG Guoyun, WANG Kai, YUAN Ming, CHEN Zijiang. Multidimensional management system for endometriosis (The Program for Shandong Province). Journal of Shandong University (Health Sciences). 2021; 59(10): 1-17.

12. Li R., Li B., Kreher D.A., Benjamin A.R., Gubbels A., Smith S.M. Association between dysmenorrhea and chronic pain: A systematic review and meta-analysis of population-based studies. American Journal of Obstetrics and Gynecology. 2020;223(3):350-371. https://doi.org/10.1016/j.ajog.2020.03.002

13. Perry C.P. Current Concepts of Pelvic Congestion and Chronic Pelvic Pain Article. J. Soc. Laparoendoscopic Surgeons. 2017; 59(2):105–110.

14. Smolarz B., Szyłło K., Romanowicz H. Endometriosis: epidemiology, classification, pathogenesis, treatment and genetics (review of literature). Int J Mol Sci. 2021; 22 (19): 10554. doi: 10.3390/ijms221910554