Body Functionality Appreciation: What Is It and How Can It Help with Endometriosis?

Endometriosis is a chronic inflammatory condition that affects roughly 10% of people with uteri internationally. The most common characteristic is endometrial tissue developing outside of the uterus, commonly referred to as scar tissue. Endometriosis can present as a variety of symptoms, such as pelvic pain, infertility, severe period cramps, and dyspareunia (pain in the genitals or pelvis that’s associated with sexual intercourse), the latter of which can negatively affect sexual function and often increase sexual distress. Dyspareunia can also cause issues with arousal and achieving orgasm.

Existing studies suggest dyspareunia associated with endometriosis can affect a woman’s perception of her own body. It is often related to reduced sexual activity, pre-sexual anxiety, physical tension, anxiety, depression, and lower levels of self-esteem or sexual quality of life. Many women with dyspareunia have reported that they may avoid sexual activity altogether, which can result in sexual distress. However, these studies hardly include any emphasis on dyspareunia-related sexual issues.

Researchers recently set out to study what else may influence the relationship between dyspareunia and sexual distress, hoping to find a link to potential medical or psychological methods that could help improve sexual health in women experiencing dyspareunia. The primary variable involved in this study was body functionality appreciation, which is when individuals have appreciation for what the body can do beyond function alone. The concept emphasizes strengths, rather than limitations of bodily ability and can serve as a protective factor against distress, often relevant to populations of individuals with chronic pain and illness.

To test how the severity of dyspareunia may affect a woman’s sexual distress in relation to body functionality appreciation, 232 non-pregnant women over the age of 18 with Italian language skills and a medical diagnosis of endometriosis were recruited through online patient associations to complete an extensive digital questionnaire that included:

• Questions about body mass index, sociodemographic information, and clinical history,
• Severity of dyspareunia over the past 3 months on a 0-10 numerical rating scale, where 0 is the lowest severity, and 10 is the highest,
• A 13-item self-assessment to evaluate the frequency of sexually related personal distress in the past 30 days on a 5-point Likert scale, where 0 is equal to “never”, and 4 is equal to “always”,
• A 7-item self-assessment that measures appreciation for what the body can do on a 5-point Likert scale where 1 is equal to “strongly disagree” and 5 is equal to “strongly agree”. Higher scores on this scale would likely mean greater body functionality appreciation.

The findings of this study suggest dyspareunia is associated with sexual distress both directly and indirectly through body functionality appreciation. It could be that women with a high severity of dyspareunia don’t naturally appreciate their body functionality and will defer to focusing on the negative areas of their bodies (physical pain/discomfort leading to unbearable sexual activity, hypersensitivity to pain, etc.) over the positive, which can lead to sexual distress. Or, negative body image issues due to dyspareunia could contribute to sexual distress, not necessarily because of the severity of the chronic pain, but its association with body functionality.

Body functionality appreciation could help individuals appreciate their body’s strengths by shifting focus away from what the body can’t do and onto what it can, learning resiliency, adaptability, self-care practices, and more. In this vein, researchers believe that some psychological interventions may be able to help foster positive body image by recognizing bodily capabilities and developing a kinder view of the self. These interventions could help develop the skills to accept physical limitations as integral to the human experience and could lead to greater overall well-being. The implications of body confidence from body functionality appreciation are that those with endometriosis may be able to approach sexual activity and intimacy with a more empowered spirit and positive outlook.

Conclusion

This study has shown positive associations between high body functionality appreciation and lower overall sexual distress among women with endometriosis, suggesting that having a positive image of your own body and accepting its disabilities to allow for a focus on its strengths, could serve as a protective factor against sexual distress. Researchers suggest clinicians acknowledge this protective role of body positivity even beyond the effects of dyspareunia severity and consider incorporating body functionality appreciation practices into their treatment strategies, mentioning cognitive behavioral therapy as an option that could be beneficial. They also believe that such psychological body functionality appreciation interventions used for unrelated chronic pain conditions may be adapted to treat endometriosis.

While further research will be needed to establish direct causal relationships between dyspareunia, body functionality appreciation, and sexual distress, and a wider population should be used, researchers believe there is a possibility that body functionality appreciation could help with the overall sexual health of those with endometriosis-related dyspareunia.

References:

Grano, C., Spinoni, M., Porpora, M. G., & Di Gesto, C. (2024). Investigating the link between severity of dyspareunia and female sexual distress among a group of women with endometriosis: The mediating role of Body Functionality Appreciation. The Journal of Sexual Medicine, 22(2), 324–333. https://doi.org/10.1093/jsxmed/qdae175