Priorities for endometriosis research : a proposed focus on deep dyspareunia

Women with endometriosis have a substantial increase in risk of deep dyspareunia with respect to the general female population of corresponding age. This symptom has personal and intimate implications, including unfavorable emotional impact in partners. Deep dyspareunia caused by endometriosis can be viewed as an originally visceral type of pain secondary to chronic inflammation (nociception) but with several superimposed components, including hyperalgesia, abnormal cortical perception, and psychological factors. Therefore, a simplistic biometric approach does not allow a comprehensive and elaborated assessment of the global impact of the symptom on women's sexual function, psychological well-being, body-image, self-esteem, and relational adjustment. We suggest 10 specific issues to be addressed in future research on a clinically as well as scientifically neglected aspect of female health. Time has come to address this physically and psychologically distressing affliction without embarrassment and with a decidedly multidisciplinary perspective.