Deep dyspareunia and central sensitization in endometriosis: A prospective study with online daily pain diary - 10/08/25

Doi : 10.1016/j.jeud.2025.100132

Natasha L. Orr ^a,^b, Michelle Lisonek ^a, Heather Noga ^c, MA Catherine Allaire ^a,^b, Mohamed A. Bedaiwy ^a,^b, Sarka Lisonkova ^b, Kelly B. Smith ^d, Paul J. Yong ^a,^b,^c,⁎
^a BC Women’s Centre for Pelvic Pain and Endometriosis, 4500 Oak Street, Vancouver, BC V6H3N1, Canada
^b Department of Obstetrics and Gynecology, University of British Columbia, 2329 West Mall, Vancouver, BC V6T1Z4, Canada
^c Women’s Health Research Institute, 4500 Oak Street, Vancouver, BC V6H2N9, Canada
^d Hope to Health Research & Innovation Centre, 625 Powell St, Vancouver, BC V6A1H2, Canada

^⁎Corresponding author.

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Highlights

•	Central sensitization may play a role in endometriosis-associated deep dyspareunia.
•	Pain-pressure threshold (PPT) – quantitative sensory testing marker of central sensitization.
•	Bladder/pelvic floor tenderness (BPFT) – physical examination marker of central sensitization.
•	Daily pain diaries, including deep dyspareunia scores, were collected for 6 weeks.
•	BPFT, but not PPT, was associated with deep dyspareunia on daily diaries.

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Abstract

Objective

A role for central sensitization has been suggested for endometriosis-associated deep dyspareunia. We explored the relationship between prospective deep dyspareunia scores with pain-pressure threshold (PPT) and bladder/pelvic floor tenderness (BPFT).

Material and methods

Observational prospective study from January 2017–April 2019 at a tertiary center for endometriosis. Inclusion criteria: 18-49 years; diagnosed endometriosis; new or re-referred to the center and consented to the center’s data registry [cases]. People without endometriosis were also recruited [controls]. Extra-pelvic PPT was measured at bilateral deltoids and first-dorsal interosseous (FDI) muscles on the test day. After the test day, case participants prospectively completed a daily pain diary over six weeks, with the deep dyspareunia severity (0-10) at each episode of sexual intercourse.

Results

: 36 people with endometriosis and 19 controls were included. No significant differences in extra-pelvic PPT were found between controls and cases. Among people with endometriosis, PPT trended lower in people with higher deep dyspareunia on the prospective daily diaries, although not significantly different. In contrast, BPFT (present/absent) was significantly associated with higher deep dyspareunia on the prospective daily diaries (5.90 ± 2.77 vs 3.65 ± 2.39, p = .029).

Conclusion

In patients with endometriosis, prospective daily diaries of deep dyspareunia were not associated with extra-pelvic PPT but were associated with BPFT.

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Keywords : Endometriosis, Deep dyspareunia, Central sensitization, Bladder/pelvic floor tenderness, Pain-pressure threshold.