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Gozdziewicz, T.;  Jarzabek-Bielecka, G.;  Luwanski, D.;  Wojcik, M.;  Plagens-Rotman, K.;  Mizgier, M.;  Pisarska-Krawczyk, M.;  Kedzia, W. Endometriosis during the COVID-19 Pandemic. Encyclopedia. Available online: https://encyclopedia.pub/entry/40711 (accessed on 15 December 2025).
Gozdziewicz T,  Jarzabek-Bielecka G,  Luwanski D,  Wojcik M,  Plagens-Rotman K,  Mizgier M, et al. Endometriosis during the COVID-19 Pandemic. Encyclopedia. Available at: https://encyclopedia.pub/entry/40711. Accessed December 15, 2025.
Gozdziewicz, Tomasz, Grazyna Jarzabek-Bielecka, Dawid Luwanski, Malgorzata Wojcik, Katarzyna Plagens-Rotman, Malgorzata Mizgier, Magdalena Pisarska-Krawczyk, Witold Kedzia. "Endometriosis during the COVID-19 Pandemic" Encyclopedia, https://encyclopedia.pub/entry/40711 (accessed December 15, 2025).
Gozdziewicz, T.,  Jarzabek-Bielecka, G.,  Luwanski, D.,  Wojcik, M.,  Plagens-Rotman, K.,  Mizgier, M.,  Pisarska-Krawczyk, M., & Kedzia, W. (2023, February 01). Endometriosis during the COVID-19 Pandemic. In Encyclopedia. https://encyclopedia.pub/entry/40711
Gozdziewicz, Tomasz, et al. "Endometriosis during the COVID-19 Pandemic." Encyclopedia. Web. 01 February, 2023.
Endometriosis during the COVID-19 Pandemic
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This entry is adapted from the peer-reviewed paper 10.3390/jcm11195825

Patients with endometriosis had limited possibilities for contemporary diagnosis and treatment during the SARS-CoV-2 (COVID-19) pandemic. Surgeries that may have eliminated pain or restored fertility were postponed. Endometriosis may affect the vagina, peritoneum, bladder, or other organs outside the pelvis and impact women’s sexual health, especially during pandemics.

endometriosis pain visceral therapy sexual health

1. Introduction

Patients with endometriosis had limited access to diagnosis and treatment after the beginning of the COVID-19 pandemic. Outpatient medical specialist visits and surgeries were postponed due to fear of contracting COVID-19 (caused by the SARS-CoV-2 virus). The need for isolation to avoid disease spread aggravated the problem, which exerted negative effects on women’s sex lives and psychological health. Endometriosis is often connected with painful intercourse or dyspareunia.
Endometriosis is characterized by the presence of endometrial implants outside the uterine cavity. The most common locations are ovaries, tubes, uterine ligaments, and the pelvic peritoneum. However, implants that also affect the vagina, bladder, rectum, or other organs outside the pelvis are referred to as deep infiltrating endometriosis (DIE). Endometrial implants bleed during menstruation, often causing severe pain during menstruation, intercourse, defecation, or urination. Severe menstrual bleeding connected with acute pelvic and spinal pain are common sequalae of this disease.
Endometriosis affects approximately 11% of females, including over 1 million in Poland. The mean time to diagnosis, beginning at first symptoms, exceeds 10 years. Hormones that regulate menstruation similarly affect the ectopic endometrium. Chronic pelvic inflammation and bleeding from endometrial implants can produce clinical symptoms, pelvis adhesions, ovarian cysts, and other pathological conditions.

2. Etiology of Endometriosis

Endometriosis is an enigmatic disease. Although its etiopathology remains unknown, there are several popular theories including retrograde menstruation (Sampson 1927), metaplasia (Waldeyer 1890), and induction (Levande and Norman 1955). New insights into etiology focus on abnormal fetal programming due to preeclampsia, prematurity, or maternal cigarette smoking during pregnancy. Heavy menstrual blood flow is associated with early menarche, prolonged menstruation, or even short cycles. All lead to clinical symptoms; however, the cyclical nature of endometriosis-associated pain is its most characteristic feature.

3. Diagnosis of Endometriosis

Clinical symptoms together with careful clinical examination is crucial to the preliminary diagnosis of endometriosis. During speculum examination, blue implants or painful nodules may be observed in the vagina fornix, in addition to areas of thickening or shortened uterosacral ligaments. A retroflexed uterus also may suggest endometriosis [1]. Lack of uterine mobility during bimanual examination may suggest peritoneal endometriosis and adhesions [2]. Anterior vaginal wall tenderness during physical exam is another typical symptom in women with endometriosis [3]. Rectovaginal digital examination may reveal deep endometriosis involving the rectosigmoid colon.
Imaging tools assist with noninvasive diagnoses and include transvaginal ultrasound or magnetic resonance. Endometriosis imaging protocols often involve application of gel into the vagina and gel or water into the rectum [4].
Certain medical history factors may increase the risk of endometriosis. These include: (1) a familial history, particularly among first degree relatives (which conveys a 6–7 fold higher risk of endometriosis) [5]; (2) prematurity [6]; (3) low birth weight and abnormal uterine bleeding during the neonatal period [7]; (4) formula feeding of newborns [6]; (5) reduced growth during childhood [8]; (6) childhood abuse [9]; (7) painful menarche affecting social life; (8) pain-related school absences; (9) unsatisfactory response to non-steroidal anti-inflammatory drugs (NSAIDs) [10]; (10) migraines [11]; (11) low body mass index (BMI); (12) pigmented skin lesions; (13) freckles [12]; (14) infertility [13]; (15) cyclic pain that increases during menstruation [14]; (16) pain during menstruation from digestive or urological systems, diaphragm, lungs, or sciatica [15]; (16) fatigue syndrome: pain, insomnia, depression, and stress at work [16]; (17) obstetric history: miscarriages, adverse pregnancy outcomes [17][18]; (18) pelvic surgery for endometriosis or other gynecological indications [19][20]; and (19) autoimmune diseases [21]. However, to date no study has assessed whether using questionnaires or symptom diaries shortens or improves the diagnosis of endometriosis for screening or triaging symptomatic patients compared to traditional history-taking techniques.
Prescription of hormonal drugs such as progestins or oral contraceptives may be used as a clinical test in certain situations. However, such management can be proposed only for patients not planning to be pregnant soon. During the COVID-19 pandemic, patients underwent virtual or telehealth evaluations. Analysis of the patient’s medical history and symptoms can facilitate diagnosis of endometriosis and implementation of medical treatment. Some sequalae of endometriosis―such as ovarian tumors with suspected malignancy, bowel obstruction due to DIE, and hydronephrosis due to DIE ureter occlusion―indicate the need for emergent surgery. Other endometriosis-related surgeries were routinely postponed during the pandemic. Consequently, patients sought other solutions for managing pain. In addition to oral contraceptives and progestins, many patients were administered GnRH analogs, danazol, or aromatase inhibitors. GnRH agonists include Goserelin (Zoladex®) and Tryptorelin (Decapeptyl®); GnRH antagonists include injections of Degarelix (Firmagon®), Abarelix (Plenaxis®), Cetrorelix (Cetrotide®), and Ganirelix (Antagon®/Orgalutran®), as well as oral drugs such as Linzagolix (Yselty®, still not registered), Relugolix (Ryeqo®/Orgovyx®), and Elagolix (Orlissa®).
Although the gold standard for endometriosis diagnosis in the past was direct visualization of endometrial implants, a negative laparoscopy did not necessarily exclude this disease from consideration. Nowadays, the European Society of Human Reproduction and Embryology recommends consideration of endometriosis in patients presenting with the following cyclical and non-cyclical signs and symptoms: dysmenorrhea, deep dyspareunia, dysuria, painful bowel movements or dyschezia, painful rectal bleeding or hematuria, shoulder tip pain, lung collapse related to menstruation or catamenial pneumothorax, cyclical cough/hemoptysis/chest pain, cyclical scar swelling and pain, fatigue, or infertility. Moreover, advances in the quality and availability of imaging modalities for at least some forms of endometriosis may reliably detect or exclude endometriosis [22].

4. Dyspareunia and Sexual Health

Dyspareunia is the most common sexual health symptom of endometriosis. It is considered a form of female sexual dysfunction (FSD) and can take various forms, including decreased sexual desire, sexual aversion, disturbances in the course of excitement, orgasmic disorders, dyspareunia, and fear of vaginal penetration or vaginismus. FSD is common and can involve one, several, or all stages of sexual reaction (i.e., desire, excitement, orgasm, and relaxation).
While it is normal to experience pleasure and satisfaction during sexual intercourse, many patients report experiencing pain, humiliation, fear of sexual abuse, or objective treatment. Pain is sometimes a barrier to achieving complete sexual satisfaction. This pain may be acute, chronic, or recur in the genitals or small pelvis before, during, or after sexual intercourse. Experiencing pain at the beginning of intercourse may condition the individual to expect pain with each subsequent sexual contact. Usually, the pain increases with the intensity and duration of intercourse. This pain often reduces pleasure during the lead up to sex. When sex is associated with pain there is an increase in unpleasant sensations and a decrease in pleasurable sensations.
Sexual pain, at any age, can lead an individual to avoid sexual contact and may affect the sex partner. Some partners may feel comfortable forming non-sexual relationships, but experience fear and aversion when asked to assume the role of lover. Sex partners can become conditioned to avoid any activity temporally related to painful intercourse.
Dyspareunia refers to genital pain before, during, or immediately after intercourse. Although this condition can affect both sexes, it is much more common in females. Cross-sectional epidemiological studies by Danielsson et al., which focused on sexually active Swedish females, found a prevalence of 13%. Dyspareunia was reported twice as frequently by young females (20–29 years old) compared to older (50–60 years old) females. Dyspareunia involves pain associated with sexual intercourse, without shrinkage of the vulva and vagina, and is different from vaginismus, which prevents penetration.
Dyspareunia can be classified according to its physical location. (1) Superficial (shallow) dyspareunia is localized to the vestibule of the vagina; (2) deep dyspareunia involves the vaginal vault; and (3) generalized dyspareunia encompasses the entire vagina. Dyspareunia can also be characterized according to chronology. (1) Primary dyspareunia appears at the first sexual contact, whereas (2) secondary dyspareunia occurs as a result of some other activity (which can sometimes be revealed by a well-conducted interview). Dyspareunia can also be classified according to its relationship to time during intercourse. (1) Early dyspareunia manifests at the beginning of intercourse and disappears after its completion, whereas (2) late dyspareunia occurs at the end of intercourse, or even a few hours later.

References

  1. Piketty, M.; Chopin, N.; Dousset, B.; Millischer-Bellaische, A.E.; Roseau, G.; Leconte, M.; Borghese, B.; Chapron, C. Preoperative Work-up for Patients with Deeply Infiltrating Endometriosis: Transvaginal Ultrasonography Must Definitely Be the First-Line Imaging Examination. Hum. Reprod. 2009, 24, 602–607.
  2. Khawaja, U.B.; Khawaja, A.A.; Gowani, S.A.; Shoukat, S.; Ejaz, S.; Ali, F.N.; Rizvi, J.; Nawaz, F.H. Frequency of Endometriosis among Infertile Women and Association of Clinical Signs and Symptoms with the Laparoscopic Staging of Endometriosis. J. Pak. Med. Assoc. 2009, 59, 30–34.
  3. Paulson, J.D.; Paulson, J.N. Anterior Vaginal Wall Tenderness (AVWT) as a Physical Symptom in Chronic Pelvic Pain. JSLS J. Soc. Laparoendosc. Surg. 2011, 15, 6.
  4. Fernández, R.M.; Ortega, J.B. Magnetic Resonance Imaging of Pelvic Endometriosis Palabras Clave. Radiología 2017, 59, 286–296.
  5. Stefansson, H.; Geirsson, R.T.; Steinthorsdottir, V.; Jonsson, H.; Manolescu, A.; Kong, A.; Ingadottir, G.; Gulcher, J.; Stefansson, K. Genetic Factors Contribute to the Risk of Developing Endometriosis. Hum. Reprod. 2002, 17, 555–559.
  6. Vannuccini, S.; Lazzeri, L.; Orlandini, C.; Tosti, C.; Clifton, V.L.; Petraglia, F. Potential Influence of in Utero and Early Neonatal Exposures on the Later Development of Endometriosis. Fertil. Steril. 2016, 105, 997–1002.
  7. Borghese, B.; Sibiude, J.; Santulli, P.; Pillet, M.-C.L.; Marcellin, L.; Brosens, I.; Chapron, C. Low Birth Weight Is Strongly Associated with the Risk of Deep Infiltrating Endometriosis: Results of a 743 Case-Control Study. PLoS ONE 2015, 10, e0117387.
  8. Vitonis, A.F.; Vincent, K.; Rahmioglu, N.; Fassbender, A.; Buck Louis, G.M.; Hummelshoj, L.; Giudice, L.C.; Stratton, P.; Adamson, G.D.; Becker, C.M.; et al. World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonization Project: II. Clinical and Covariate Phenotype Data Collection in Endometriosis Research. Fertil. Steril. 2014, 102, 1223.
  9. Liebermann, C.; Kohl Schwartz, A.S.; Charpidou, T.; Geraedts, K.; Rauchfuss, M.; Wölfler, M.; Von Orelli, S.; Haberlin, F.; Eberhard, M.; Imesch, P.; et al. Maltreatment during Childhood: A Risk Factor for the Development of Endometriosis? Hum. Reprod. 2018, 33, 1449–1458.
  10. DiVasta, A.D.; Vitonis, A.F.; Laufer, M.R.; Missmer, S.A. Spectrum of Symptoms in Women Diagnosed with Endometriosis during Adolescence vs Adulthood. Am. J. Obstet. Gynecol. 2018, 218, 324.e1–324.e11.
  11. Miller, J.A.; Missmer, S.A.; Vitonis, A.F.; Sarda, V.; Laufer, M.R.; DiVasta, A.D. Prevalence of Migraines in Adolescents with Endometriosis. Fertil. Steril. 2018, 109, 685–690.
  12. Viganò, P.; Somigliana, E.; Panina, P.; Rabellotti, E.; Vercellini, P.; Candiani, M. Principles of Phenomics in Endometriosis. Hum. Reprod. Update 2012, 18, 248–259.
  13. Vercellini, P.; Viganò, P.; Somigliana, E.; Fedele, L. Endometriosis: Pathogenesis and Treatment. Nat. Rev. Endocrinol. 2014, 10, 261–275.
  14. Hurd, W.W. Criteria That Indicate Endometriosis Is the Cause of Chronic Pelvic Pain. Obstet. Gynecol. 1998, 92, 1029–1032.
  15. Fauconnier, A.; Chapron, C.; Dubuisson, J.B.; Vieira, M.; Dousset, B.; Bréart, G. Relation between Pain Symptoms and the Anatomic Location of Deep Infiltrating Endometriosis. Fertil. Steril. 2002, 78, 719–726.
  16. Ramin-Wright, A.; Schwartz, A.S.K.; Geraedts, K.; Rauchfuss, M.; Wölfler, M.M.; Haeberlin, F.; Von Orelli, S.; Eberhard, M.; Imthurn, B.; Imesch, P.; et al. Fatigue—A Symptom in Endometriosis. Hum. Reprod. 2018, 33, 1459–1465.
  17. Vannuccini, S.; Clifton, V.L.; Fraser, I.S.; Taylor, H.S.; Critchley, H.; Giudice, L.C.; Petraglia, F. Infertility and Reproductive Disorders: Impact of Hormonal and Inflammatory Mechanisms on Pregnancy Outcome. Hum. Reprod. Update 2016, 22, 104–115.
  18. Zullo, F.; Spagnolo, E.; Saccone, G.; Acunzo, M.; Xodo, S.; Ceccaroni, M.; Berghella, V. Endometriosis and Obstetrics Complications: A Systematic Review and Meta-Analysis. Fertil. Steril. 2017, 108, 667–672.e5.
  19. Liu, X.; Long, Q.; Guo, S.W. Surgical History and the Risk of Endometriosis:A Hospital-Based Case-Control Study. Reprod. Sci. 2016, 23, 1217–1224.
  20. Sibiude, J.; Santulli, P.; Marcellin, L.; Borghese, B.; Dousset, B.; Chapron, C. Association of History of Surgery for Endometriosis with Severity of Deeply Infiltrating Endometriosis. Obstet. Gynecol. 2014, 124, 709–717.
  21. Shigesi, N.; Kvaskoff, M.; Kirtley, S.; Feng, Q.; Fang, H.; Knight, J.C.; Missmer, S.A.; Rahmioglu, N.; Zondervan, K.T.; Becker, C.M. The Association between Endometriosis and Autoimmune Diseases: A Systematic Review and Meta-Analysis. Hum. Reprod. Update 2019, 25, 486–503.
  22. ESHRE Endometriosis Guideline Group; Becker, C.M.; Bokor, A.; Heikinheimo, O.; Horne, A.; Jansen, F.; Kiesel, L.; King, K.; Kvaskoff, M.; Nap, A.; et al. ESHRE Guideline: Endometriosis. Hum. Reprod. Open 2022, 2022, hoac009.
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Subjects: Obstetrics & Gynaecology
Contributors MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register : Tomasz Gozdziewicz , Grazyna Jarzabek-Bielecka , Dawid Luwanski , Malgorzata Wojcik , Katarzyna Plagens-Rotman , Malgorzata Mizgier ,
Magdalena Pisarska-Krawczyk
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Witold Kedzia
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Update Date: 01 Feb 2023
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