Women who have deep infiltrating endometriosis (DIE) often experience lasting postpartum sexual dysfunction, despite treatment, researchers found in new data presented in a poster at the European Society of Human Reproduction and Embryology (ESHRE) 2026 Annual Meeting in London, England.

While pregnancy may temporarily relieve endometriosis-related symptoms, pain and sexual dysfunction frequently resurface after giving birth, noted the authors, led by Elisabeth Reiser, MD, with the Department of Gynecological Endocrinology at the Medical University of Innsbruck in Innsbruck, Austria.

Sexual Dysfunction Often Overlooked

Sexual dysfunction, defined in this study as any impairment in the sexual relationship realm, is often overlooked in the effort to treat the disease, Reiser told Medscape Medical News. “We have to address sexual function and quality of life when we see our patients postpartum. Physicians tend to look only at the small picture,” of relieving the symptoms, she said.

Reiser’s team conducted a prospective cohort study with 56 women who had surgically confirmed DIE, involving the recto-vaginal septum, sacrouterine ligaments and/or rectum who delivered a singleton infant and were followed for 12 months postpartum.

More Than 80% Report Lower Quality of Life

Reduced quality of life was reported by 80% of the women at 6 months postpartum and 83.3% at 12 months postpartum. Most also reported sexual dysfunction at 6 months (71.9%) and 12 months (59.5%) postpartum.

Reiser said many women with DIE choose cesarean section over vaginal delivery because of the perceived higher risk for sexual dysfunction after delivery, but their data found no differences in sexual dysfunction or overall quality of life either by mode of delivery or presence of minor obstetric perineal trauma (tear and/or episiotomy).

‘Vaginal Delivery Is an Option’

“I think we should tell our patients that vaginal delivery is an option,” Reiser said.

Study participants were recruited at a tertiary university hospital. Quality of life and sexual function were analyzed at 6 months and 12 months postpartum using the Endometriosis Health Profile-30 with added sexual domain.

“In endometriosis care, we have historically focused on three pillars: pain, fertility, and surgical outcomes,” said Sujithra Jayaraj-Sudarsan, MD, chair of the Department of Ob/Gyn at MedStar Montgomery Medical Center in Maryland. “Sexual function has often been the forgotten fourth pillar.”

“The postpartum period with hormonal shifts, breastfeeding-related hypoestrogenism, pelvic floor changes, sleep deprivation, and psychosocial stressors can create a perfect storm for recurrence or worsening of sexual dysfunction,” she said.

Jayaraj-Sudarsan told Medscape Medical News that several actions are needed, starting with routine screening for not just dyspareunia but also all domains of sexual function using validated tools.

Setting realistic expectations is also important, she said. “When counseling women with deep endometriosis about pregnancy, we should be transparent that while pregnancy may provide temporary symptom relief for some patients, sexual dysfunction may persist or recur postpartum regardless of delivery mode.” Providers should also integrate sexual health into postpartum follow-up for patients with deep endometriosis, she added.

Ann Peters, MD, MS, a gynecologist and surgeon with The Institute for Gynecologic Care at Mercy Medical Center in Baltimore, told Medscape Medical News it would be interesting to know how the women compared their sexual function before, during, and after pregnancy. But she said the spotlight on the disease is welcome.

“Endometriosis is a completely understudied disease,” she said. “If 1 in 10 women have endometriosis, why do we understand so little about it?”

Reiser, Jayaraj-Sudarsan, and Peters reported having no relevant financial relationships.