Grant: Operating Grant - PA: Reproductive and Child Heath (start-up grants)

Endometriosis is present in 1 of 10 reproductive-aged women, 5 of 10 women with infertility, and 5 of 10 women with pelvic pain. It is defined as tissue normally inside the uterus (womb), being abnormally present outside of the uterus, typically elsewhere in the pelvis. Endometriosis is responsible for $1.8 billion in total annual costs to Canadian society due to its impact on women's fertility and pain. In particular, endometriosis causes pelvic pain with intercourse/penetration during sexual activity, which is known as dyspareunia. The vast majority of women (86%) with endometriosis experience dyspareunia, which reduces women's sexual activity, sexual satisfaction, self-esteem, and quality-of-life. Partners of women with endometriosis also describe depression, anxiety, powerlessness, and grief. Dyspareunia is one of the most difficult clinical problems to manage in endometriosis, primarily because how endometriosis causes dyspareunia is largely unknown. Our objective is to identify the causes of dyspareunia in endometriosis. We propose that dyspareunia in endometriosis is caused by sensitization of the nervous system, in various parts of the body such as near the endometriosis itself, in the brain, and at the bladder. We also propose that some women are predisposed to dyspareunia due to a gene that promotes local nerve formation near endometriosis. This research will produce a significant change in how we understand endometriosis. It will provide a holistic model for how endometriosis leads to pain (such as dyspareunia) that involves the whole person, ranging from psychological, anatomic, cellular, and genetic factors. This will help women with endometriosis to understand the different reasons why sex may be painful, and will help clinicians and researchers to better treat this pain.