Impact of female sexual dysfunctions on women undergoing pipelle endometrial biopsy and endocervical curettage for abnormal uterine bleeding: a prospective cross-sectional study.

Abstract

Background: Endometrial and endocervical biopsy sampling provides critical information for diagnosing and planning treatment in cases of abnormal uterine bleeding or suspected gynecological conditions. However, documented failure rates of up to one-third due to difficulties accessing the uterine cavity or insufficient histological sampling might have considerable clinical consequences.

Aim: To assess the impact of female sexual dysfunction (FSD), depression, and anxiety on additional analgesic requirements (AAR), procedure failure (PF) due to endometrial inaccessibility, and biopsy failure (BF) among women undergoing pipelle endometrial biopsy and endocervical curettage (PEB- ECC).

Methods: This prospective study collected data through face-to-face interviews with 417 women who underwent PEB-ECC between November 2022 and 2023. Anxiety and depression were evaluated using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI), respectively. Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria were used to assess FSD and its related components. Age, body mass index, and educational level were considered potential confounders.

Outcome: Outcomes included the necessity for additional analgesics during the surgical process, PF attributed to challenges in accessing the uterine cavity, and BF resulting from inadequate histological sampling.

Results: A BAI score > 9, age ≥ 55 years, and the presence of FSD were independent predictors of AAR during PEB-ECC. PEB-ECC sampling failed in 71 women (17.0%), with PF in 7 (1.7%). Univariate analysis showed that only genito-pelvic pain/penetration disorder was associated with PF. Age ≥ 55 years and FSD were significant predictors of BF. Female orgasmic disorder was associated with BF as a component of FSD.

Clinical implications: Our findings highlight the significance of FSD in influencing the success of endometrial and endocervical biopsy sampling, which gynecologists and anesthesiologists should consider before and during the procedure.

Strengths and limitations: This study is the first to assess the impact of FSD on the success of PEB-ECC procedures. Intercultural variation exists in the prevalence and predictors of FSD; therefore, our findings should be interpreted cautiously. Validation studies remain warranted. We evaluated the presence and components of FSD during the interviews rather than its severity; the low response rate (417 [25.3%]) might have impacted the results.

Conclusion: Despite sufficient sedation/analgesia, FSD significantly influenced AAR, PF, and BF in women undergoing PEB-ECC. Anesthesiologists and gynecologists should consider additional factors to improve the success of sampling procedures.