Sexual health is a vital part of overall well-being, yet people with endometriosis often struggle with sexual dysfunction, impacting their quality of life and relationships. Studies show that about 78-80% of individuals with endometriosis experience sexual difficulties, such as pain during intercourse (dyspareunia). Many cope by avoiding intimacy or continuing sexual activity despite discomfort.

Healthcare providers, especially general practitioners (GPs), play a key role in addressing these issues through education, treatment, and referrals. However, sexual health conversations in general practice are rare. Research shows that GPs often expect patients to raise sexual concerns, fearing the topic is too intrusive or outside their expertise. On the other hand, patients may hesitate to bring up these issues due to fear of judgment, feeling misunderstood, or not wanting to “waste” their doctor’s time.

A new study used an online survey to explore the experiences of individuals with endometriosis regarding barriers and facilitators to discussing sexual health with GPs. The survey was designed to be anonymous, allowing participants to share sensitive information comfortably. It included questions about participants’ sexual health, personal experiences, and demographic details. Tools like the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R) were used to assess sexual well-being. It also included a reflective task where participants noted five positive life experiences to mitigate potential negative feelings after answering sensitive questions.

Participants were recruited via social media, with the study open to Australian residents aged 18 and older who self-reported an endometriosis diagnosis. Once the responses were collected, the research team analyzed qualitative responses using a thematic analysis method. This approach involved identifying key themes from participant accounts and refining them through collaboration.

In the end, the researchers uncovered four key themes that influence communication between patients and GPs about sexual health in the context of endometriosis: systemic factors, practitioner factors, patient factors, and interpersonal factors. All of these themes included “barriers” to and “facilitators” for conversations about sexual health.

Systemic factors often hinder discussions due to limited consultation times and difficulty finding consistent care. Many participants felt rushed or unable to raise sensitive issues in brief appointments. However, continuity of care with a trusted GP, telehealth options, and longer appointment times were seen as helpful facilitators. For instance, some patients found it easier to discuss sexual health concerns through telehealth, as it reduced anxiety about physical exams.

Practitioner factors included barriers such as discomfort or a lack of knowledge about endometriosis and its impact on sexual health. Male GPs or those with conservative cultural or religious views were perceived as less approachable. On the other hand, female GPs, expertise in endometriosis, and inclusive practices, such as addressing diverse sexual orientations, made participants feel more at ease. GPs who initiated discussions about sexual health and took symptoms seriously were also seen as instrumental in creating a safe space for open communication.

Patient factors involved feelings of embarrassment, fear of judgment, and a lack of confidence in discussing sexual health. Some participants were unsure how to articulate their concerns or felt hopeless about treatment outcomes. These barriers made it challenging to initiate conversations, even with understanding practitioners. On the other hand, patients with an understanding of the importance of their sexual health and good self-confidence found it easier to talk their GPs about this topic.

Lastly, interpersonal factors emphasized the importance of trust and empathy. Participants valued GPs who actively listened, validated their experiences, and provided clear care plans. A strong GP-patient relationship was pivotal in fostering open dialogue and addressing sexual health concerns. Conversely, limited rapport, privacy concerns, and past experiences of invalidation from GPs made it more difficult for patients to trust their GPs.

This study highlights the challenges and opportunities in addressing sexual health concerns for individuals with endometriosis in general practice. The findings suggest that practitioner warmth, prioritizing sexual health, and clear communication can encourage patients to share concerns. Understanding these factors can help develop educational tools to improve communication and ensure that sexual health becomes a routine part of care for people with endometriosis.

References:

• Davenport, R. A., Mills, J., McHardy, H., Lores, T., Sherman, K., Misajon, R., & Van Niekerk, L. (2025). “No doctor ever asked me…so I thought it wasn't a valid concern”: Endometriosis patients’ perspectives of barriers and facilitators to sexual health communication in general practice. The Journal of Sexual Medicine, 22(1), 26–35. https://doi.org/10.1093/jsxmed/qdae145