Attractiveness of women with endometriosis

By Paolo Vercellini, Laura Buggio, Edgardo Somigliana, Giussy Barbara, Paola Vigano, and Luigi Fedele

We would like to clarify the aims – and significance – of our recently published study on the “attractiveness of women with endometriosis”

The observation that people with specific physical traits are prone to the development of particular diseases is a well-known medical principle.

Nowadays, these relationships tend to be explained based on genotype-phenotype associations, which have been suggested for more than one hundred disorders, including endometriosis [1].

Why we did the study

We have seen recent advances in endometriosis research with multiple studies contributing to the definition of a general phenotype associated with the disease.

Such a phenotype appears to be indirectly linked with physical appearance, as several of the characteristics studied (including body size, body mass index, hair, eye, and skin color) have an impact on perception of beauty.

A biological gradient between the degree of expression of these traits and the degree of severity of endometriosis has also emerged. As an example, with regard to body size and figure, other researchers have detected an inverse relationship between body mass index and severity of the disease in general [2], and in particular in women with deep endometriosis [3].

Physical attractiveness is an area of research for several specialists, including neurologists, neurophysiologists, sociologists, biologists, psychiatrists, and psychologists.

In fact, attractiveness in both females and males may constitute the result of particular genetic and/or hormonal profiles. Moreover, the biological significance of beauty has generally been interpreted in terms of selection associated with presumed health advantages. In fact, attractive subjects are subliminally identified as carriers of the best gene pool.

In the case of females, attractiveness can also act as a clue for fertility and reproductive potential.

Attractiveness of women with endometriosis

It has been suggested that Marilyn Monroe had endometriosis

In our study we observed that physical characteristics and attractiveness of women with the most frequent forms of endometriosis (ie. peritoneal and ovarian endometriosis) do not differ from those of women without endometriosis [4].

However, there are some women in a specific subgroup with rectovaginal endometriosis (a particular form of the disease) who appeared more attractive than the majority of women with more common types of lesions as well as women without the disease.

This does not mean that more attractive women are at risk of rectovaginal endometriosis, nor that women with other disease forms are not attractive.  Almost 70% of women with rectovaginal endometriosis had physical characteristics and attractiveness similar to all the other women studied.

Evaluating phenotypes of women with endometriosis

The aim of our study was to evaluate the phenotype of women with and without endometriosis because the findings may provide us with further clues to target our research to understand the pathogenesis (origin) of the disease.

As an example, esthetic perception is influenced by sexual hormones [5]. Because female attractiveness could be the expression of higher oestrogen levels, it cannot be excluded that a stimulating endocrine environment might favour the development of aggressive and infiltrating endometriotic lesions particularly in women with the most feminine phenotype.

Alternatively, phenotypic characteristics of women with rectovaginal endometriosis might constitute indicators of specific gene polymorphisms associated with severe disease development.

In fact, a genetic link in the pathogenesis of deep endometriosis has been recently confirmed [6].

Significance of phenotyping women with endometriosis

Associate Professor Paolo Vercellini, the lead author of this unusual – yet potentially groundbreaking – study, has stressed the importance of the data not to be mis-interpreted for the sake of some sensational headlines.

Associate Professor Paolo Vercellini, University of Milano

By no means did we trivialise or disregard all the major problems associated with endometriosis.

We understand very well the suffering of women afflicted by this disease and, as physicians, strive every day to alleviate their physical and psychological pain.

For this reason we are eager to investigate new ideas that might help shed light on the still unclear causes of endometriosis. This is why we did this study and we hope our research can become another building block in our quest to understand why some women develop endometriosis – or even different types of endometriosis – and others don’t.

said  Paolo Vercellini.

  1. Viganò P, et al. Principles of phenomics in endometriosis. Human Reproduction Update 2012;18:248-59.
  2. Hediger ML, et al. Association of endometriosis with body size and figure. Fertil Steril 2005;84:1366-74.
  3. Lafay Pillet MC, et al. Deep infiltrating endometriosis is associated with markedly lower body mass index: a 476 case-control study. Hum Reprod 2012;27:265-72.
  4. Vercellini P, et al. Attractiveness of women with rectovaginal endometriosis: a case-control study. Fertil Steril 2012 [Epub ahead of print]
  5.  Cellerino A. Psychobiology of facial attractiveness. J Endocrinol Invest 2003;26:45-8.
  6. Chapron C, et al. Questioning patients about their adolescent history can identify markers associated with deep infiltrating endometriosis. Fertil Steril 2011;95:877-81.
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