A History of Frequent Orgasm or Tampon Use During Menses Protects Against Endometriosis. HJ Kliman, EL Meaddough, DL Olive. Department of Obstetrics and Gynecology, Yale University, New Haven, CT.

Objectives: Retrograde menstruation, the backward flow of menstrual debris, is generally considered an etiologic factor in the development of endometriosis. However, relatively little attention has been given to behaviors which may moderate the amount of menstrual debris which is expelled through the fallopian tubes. Filer and Wu (1989) found that among infertile women, those who reported engaging in coitus during menstruation were more likely to be diagnosed with endometriosis than those who did not. In contrast, Darrow (1990) reported that there was no difference in sexual intercourse and/or orgasm during menstruation when she compared laparoscopically diagnosed endometriosis patients to medical and friend controls. The potential relationship between endometriosis and tampon usage is also unclear. Since there is an increased frequency of endometriosis among women with vaginal blockage, tampon use may have a similar effect.

Design: To test these possible associations we performed a case-control study of 2,012 survey respondents to determine if sexual behaviors, orgasm, and tampon use during menstruation modify the risk of endometriosis.

Materials and Methods: Two computer-scannable surveys were mailed to 9,135 members of the Endometriosis Association. The member was asked to complete one survey (case) and give the second survey to a friend (not a relative) who did not have endometriosis (control). Data was processed using an Opscan-5, ink-read scanner programmed using Windows-based Scan Tools software. Statistical analyses were performed using SAS software for Windows. Frequency distributions were determined for both study groups concerning endometriosis history, demographic variables, frequencies of sexual activity, sexual intercourse, masturbation, orgasm and tampon use during menses. Chi-square and Fisher's Exact analyses were performed to identify variables with significant differences in reporting between cases and controls.

Results: Controls were more likely than cases to report frequent sexual behavior during menses (p = .002, OR = 1.5), and sexual behaviors during menses that included frequent orgasm (p = .001, OR = 1.5). Controls were also more likely than cases to report using only tampons (p < .0001, OR = 2.6).

Conclusions: Our results suggest that sexual activity, orgasm, and tampon use during menstruation may confer protection against endometriosis, possibly by promoting flow of menstrual debris through the cervix, not through the tubes. Funded by a NICHD Shannon Award (HD30501) to HJK.

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