Fertility and Sterility

Paper: Attractiveness of women with rectovaginal endometriosis: a case control study
Paper authors: Vercellini P, Buggio L, Somigliana E, Barbara G, Viganò P, Fedele L
Paper ref: 2013 Jan;99(1):212-8

The aim of this study was to evaluate the physical attractiveness of women with and without endometriosis in order to verify a potential relationship and also determine how the aggressiveness of the disease relates to the degree of attractiveness.

Nulliparous women between the ages of 20 and 40 who were undergoing gynaecological surgery at a single tertiary centre were recruited. Exclusion criteria included previous pelvic procedures, an irregular menstrual cycle, acquired physical defects (eg. following accident, disease or surgery) and artificial aesthetic enhancement (eg. dyed hair, braces, plastic surgery). Four hundred and eighty-eight women were deemed eligible but 62 refused to participate and 126 excluded due to missing data or mixed pathology.

Preoperatively, the women were asked to fill out a questionnaire including a sexual history section. They then underwent a physical examination by two trained physicians obtaining BMI, hip, waist and breast measurements. Finally they were independently judged for ‘level of attractiveness’ by four physicians (two women and two men), blinded to the women’s preoperative diagnosis, using a five point graded rating scale.

Surgery was then performed three to four weeks later to finalise a diagnosis of either: rectovaginal endometriosis, peritoneal or ovarian endometriosis, or no endometriosis or other benign conditions. Women were characterised based on the worst lesion present. Overall three hundred women were recruited, one in each study group.

From the questionnaire 53 percent of women with rectovaginal endometriosis first had sexual intercourse before the age of 18 in comparison with 30 percent of those with no endometriosis (p = 0.002). There was no significant inter-group difference in number of sexual partners or engagement in sexual intercourse during menses.

From the examination the only significantly statistical differences were that women with rectovaginal endometriosis had a lower BMI and a higher breast to underbreast ratio and than those without endometriosis (p = 0.016 and p = 0.008 respectively). There was also a significant difference in breast to underbreast ratio between those with rectovaginal endometriosis and those with other endometriosis (p = 0.023).

Finally, on the attractiveness rating scale 31 percent of those with rectovaginal endometriosis were rated ‘very attractive’ or ‘rather attractive’ compared with eight percent of those with other disease forms (p < 0.001) and nine percent of those with no endometriosis (p < 0.001).

The authors suggest that their findings may represent a genotype-phenotype association where the emerging phenotype for endometriosis (lower BMI, leaner silhouette and larger breasts) appears to be linked with attractiveness. Another postulated mechanism was that raised oestrogen levels could drive both the aggressiveness of the disease and the development of these characteristics.

Upon reading the report, two main limitations of this study emerge. Firstly, the use of subjective rather than objective outcome measures with a limited number of assessors may not reflect a broader society’s perception of attractiveness, despite good agreement between the assessors used.

Secondly, the control group were still women with other types of gynaecological pathology (uterine leiomyomas, ovarian cysts, unexplained fertility) which may themselves be influenced by hormone levels or have their own particular phenotype and thus may not be an adequate control group.

Finally, although this study does suggest a correlation between rectovaginal endometriosis and attractiveness, the way in which this information could be useful in a clinical context is, at best, uncertain.

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