Association between health behaviors and sexual activity during menstruation and endometriosis: A case-control study

Abstract

Introduction: The prevalence of endometriosis in the general population is estimated at 7-10%. It seems sexual activity leading to orgasm during menstruation and some health behaviors increase the retrograde menstruation, seeding endometrial tissue to an abnormal location and thus increase the risk of endometriosis. There are various risk factors for this disease. The present study aimed to determine the association between health behaviors and sexual activity during menstruation and endometriosis. Methods: This case-control study recruited 555 women visiting Alzahra Hospital in Tabriz, Northwest of Iran in 2017. The case group comprised 185 women of reproductive age with confirmed endometriosis. The control group comprised 370 women of reproductive age without endometriosis visiting the hospital for other problems, e.g. vaginitis, in whom the absence of endometriosis was confirmed based on their symptoms by a gynecologist colleague. Participants in case and control groups matched for age. Data were collected using a researcher-made questionnaire based on previous studies. Univariate analysis was performed using the chi-squared test, and multivariate analysis was done using conditional logistic regression to control confounding variables. Results: Based on multivariate logistic regression, the health behaviors of two groups during menstruation were significantly different. Taking hot baths [OR (95% CI) = 4.78 (2.22 to 10.30); P>0.001] and performing vaginal washing [OR (95% CI) = 7.20 (1.32 to 39.22); P = 0.022], during menstruation increase the risk of endometriosis approximately five and seven times. Moreover, the chance of developing endometriosis was about two times higher in women who used cloth menstrual pad during menstruation than those who did not [OR (95% CI) = 1.97 (1.12 to 3.44); P = 0.017]. The sexual activity of two groups during menstruation was significantly different. Having vaginal intercourse leading to orgasm during menstruation [OR (95% CI) = 5.23 (2.16 to 12.66)] and non-coital sexual activity leading to orgasm during menstruation [OR (95% CI) = 2.90 (1.28 to 6.55)] increase the risk of endometriosis approximately five and three times. Conclusion: Based on the results, there was a relationship between taking hot baths and performing vaginal washing during menstruation as well as using cloth menstrual pad during menstruation and endometriosis. Also, there was an association between vaginal intercourse and non-coital sexual activity leading to orgasm during menstruation with endometriosis. Therefore, the identification of these risk factors can help to prevent and treat endometriosis early, as a result, complications can be prevented.