{"paper_id":"7e313ab5-b712-423d-9136-820a69e18e79","body_text":"health psychology report · 6\noriginal article\nbackground\nEndometriosis, a  chronic and often painful gynecological \ncondition characterized by the presence of endometrial-\nlike tissue outside the uterine cavity, significantly impacts \nmultiple facets of women’s lives, including their sexual \nhealth, psychological well-being, and overall quality of \nlife. The  heterogeneous presentation of symptoms, rang -\ning from dysmenorrhea and dyspareunia to infertility, \nexerts not only a physical toll but also an emotional and \nsocial burden. This cross-sectional study explored how so-\ncial support contributed to the quality of life in Portuguese-\nspeaking women residing in Portugal with endometriosis \nand how sexual satisfaction could contribute to explaining \nthese associations.\nparticipants and procedure\nA total of 106 women with a self-reported diagnosis of en -\ndometriosis, with a mean age of 33.54 years (SD = 7.43), par -\nticipated in the study. Data were collected online between \nJanuary and May 2024 using self-report measures of quality \nof life, sexual satisfaction, and perceived social support.\nresults\nThe results revealed that higher social support is signifi-\ncantly associated with greater sexual satisfaction (B = .17, \nSE = .06, t = 2.84, p < .001, 95% CI [.05, .29]) and improved \noverall quality of life (B = .19, SE = .03, t = 5.44, p < .001, \n95%  CI [.12, .26]). Sexual satisfaction significantly medi-\nated the relationship between social support and quality of \nlife (indirect effect = .05, SE = .02, 95% CI [.01, .09].\nconclusions\nThese findings underscore the importance of social con -\nnections and sexual health in managing endometriosis \namong Portuguese-speaking women residing in Portugal, \noffering valuable insights for clinical practice and future re-\nsearch on holistic care for women with chronic conditions.\nkey words\nperceived social support; sexual satisfaction; quality of life; \nendometriosis\nNoa Cacete\n1 · A,B,E\nJuliana Pedro id\n2,3 · A,D,E\nFilipa Pimenta id\n4 · A,D,E\nTânia Brandão id\n4 · A,C,D,E\nQuality of life in women with endometriosis \nin Portugal: a cross-sectional study on the roles \nof social support and sexual satisfaction\norganization – 1: School of Psychology, ISPA – University Institute, Lisboa, Portugal · 2: Center for Reproductive \nGenetics Prof. Alberto Barros, Porto, Portugal · 3: Center for Psychology at the University of Porto, Porto, Portugal · \n4: William James Center for Research, ISPA – University Institute, Lisboa, Portugal\nauthors’ contributions – A: Study design · B: Data collection · C: Statistical analysis · D: Data interpretation · \nE: Manuscript preparation · F: Literature search · G: Funds collection\ncorresponding author – Prof. Tânia Brandão, William James Center for Research, ISPA – University Institute, \nRua Jardim do Tabaco 34, 1149-041 Lisboa, Portugal, e-mail: tbrandao@autonoma.pt\nto cite this article  – Cacete, N., Pedro, J., Pimenta, F., & Brandão, T. (2026). Quality of life in women with endometriosis \nin Portugal: a cross-sectional study on the roles of social support and sexual satisfaction. Health Psychology Report. \nhttps://doi.org/10.5114/hpr/216284\nreceived 08.07.2025 · reviewed 18.11.2025 · accepted 30.12.2025 · online publication 12.03.2026\n \n This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 \nInternational (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/)\n\nNoa Cacete, \nJuliana Pedro, \nFilipa Pimenta, \nTânia Brandão\n2 health psychology report\nBackground\nEndometriosis is a  chronic gynecological condition \ncharacterized by the growth of tissue similar to the \nendometrium outside the uterus, resulting in inflam‑\nmation and scarring (WHO, 2025). Clinically, the con‑\ndition is described across four subtypes: superficial \nperitoneal involvement; deep infiltrating endometrio‑\nsis; ovarian cysts (endometriomas); and extra‑pelvic \nlesions (As‑Sanie et al., 2025).\nCurrent evidence suggests that approximately \n10% of women of reproductive age worldwide live with \nendometriosis (WHO, 2025). However, reported rates \nare not uniform (ranging from 2% to 71.4%), since they \nreflect variations in geography, clinical setting, symp‑\ntom presentation, age distribution, and the methods \nused to establish the diagnosis (Ghiasi et al., 2020). For \ninstance, in symptomatic women, prevalence varied \nbetween 35% and 100% (Nnoaham et al., 2011). In Por‑\ntugal, where the present study was conducted, national \nestimates suggest that approximately 700,000 women \nmay be affected, with the condition most often diag‑\nnosed between the ages of 25 and 30 (Adamson et al., \n2010; Setúbal, 2023). Despite its prevalence, the etiol‑\nogy of endometriosis remains unclear, with potential \ncauses including hereditary predisposition, immune \ndysfunction, and environmental factors such as life ‑\nstyle choices, smoking, and unhealthy dietary habits \n(Della‑Corte et al., 2020; Wu et al., 2024). \nDiagnosis is often challenging due to the nonspe‑\ncific and sometimes atypical nature of symptoms, re‑\nsulting in substantial delays (from 5 to 12 years) (De \nCorte et al., 2025). Laparoscopy remains the most ac ‑\ncurate diagnostic method, offering direct visualization \nof lesions and facilitating treatment planning (Duarte \n& Righi, 2021; Hsu et al., 2010). Symptoms of endo ‑\nmetriosis include dysmenorrhea and dyspareunia, \nchronic pain, and infertility, frequently resulting in \nsignificant psychological difficulties, including anxi ‑\nety and depression, impairing women’s mental health \nand quality of life, social interactions, professional ac‑\ntivities, and intimate relationships (Ameratunga et al., \n2017; Facchin et al., 2020; Gruber & Mechsner, 2021; \nLaganà et al., 2017; Missmer et al., 2021; Rossel et al., \n2025). \nQuality of life\nQuality of life (QoL), as defined by the WHO, rep‑\nresents “individuals’ perception of their position in \nlife in the context of the culture and value systems in \nwhich they live and in relation to their goals, expec‑\ntations, standards, and concerns” (WHO, 1997, p. 1). \nModels developed in pain research show that QoL is \nshaped by interactions between physical symptoms, \nemotional functioning, and social resources (e.g., the \nmodel of quality of life in a  group of people with \nchronic low back pain), highlighting the relevance \nof these dimensions for understanding QoL in other \nchronic conditions such as endometriosis (Ziętale‑\nwicz & Bargiel‑Matusiewicz, 2024). \nFor women with endometriosis, QoL is profound‑\nly impaired by a combination of chronic pain, sexual \ndysfunction, and professional, social, and psycho‑\nlogical challenges (Bień et  al., 2020; Hudson et  al., \n2013). Research consistently shows that QoL in these \nwomen is diminished not only in physical domains \nbut also across psychological and social dimensions; \nthese reductions are primarily attributed to the \nsymptoms of endometriosis rather than the diagnosis \nitself (Gao et al., 2006; Marinho et al., 2018).\nBeyond the physical symptoms already men‑\ntioned, psychological effects such as depression and \nanxiety are frequently reported, along with disrup‑\ntions in sexual and social relationships (Della‑Corte \net al., 2020; Li et al., 2025). The economic burden is \nanother significant factor, as many women experi‑\nence reduced working hours, reduced productivity, \njob transitions, or even withdrawal from the work‑\nforce due to debilitating symptoms (Della‑Corte \net al., 2020; Fourquet et al., 2010; Moradi et al., 2014). \nThis often leads to financial strain, compounding \nemotional stress within couples and families. \nThe impact of endometriosis symptoms on inti ‑\nmate partner relationships has been shown to signifi‑\ncantly affect women’s overall QoL, underlining the \nimportance of addressing relational dynamics (Bień \net  al., 2020). Indeed, to improve the QoL of women \nwith endometriosis, there is a growing call to address \nemotional, social, and sexual issues as integral compo‑\nnents of care (Bień et al., 2020). However, a recent re ‑\nview has highlighted a lack of research into psychoso‑\ncial factors that may further influence women’s QoL, \nnamely in terms of social support (Kalfas et al., 2022). \nPerceived social su PPort \nand endometriosis \nEndometriosis, while primarily affecting women, ex‑\nerts a significant impact on their partners and families \n(Schick et al., 2022). The daily challenges and emotion‑\nal burden associated with the disease often strain rela‑\ntionships, underscoring the pivotal role of social sup‑\nport in mitigating these effects. Despite its recognized \nimportance, research on the influence of perceived so‑\ncial support on pain management and QoL in women \nwith endometriosis remains sparse (Kalfas et al., 2022).\nAccording to Zimet’s model (Zimet et  al., 1988), \nperceived social support reflects individuals’ subjec‑\ntive appraisal of the support they believe is available \nfrom three key sources (including family, friends, and \nsignificant others), emphasizing perceived availabil‑\nity rather than the mere presence of people in one’s \nsocial network. Perceived social support, particularly \n\nQuality of life  \nin women  \nwith endometriosis\n36\nfrom partners and family, is a  well‑established de‑\nterminant of physical and mental well‑being in the \ncontext of chronic diseases (Maguire et al., 2021). It \nenhances self‑efficacy and reduces perceived stress, \nenabling individuals to better adapt to the challenges \nposed by chronic conditions (Luo et  al., 2023). Evi‑\ndence from other women’s health contexts indicates \nthat social support plays a significant role in protect‑\ning psychological well‑being and quality of life, even \nunder emotionally demanding circumstances (e.g., \ncomplicated grief) (Skalski‑Bednarz et al., 2026). \nAlso, women consistently identify support from \npartners as essential in navigating the condition \n(Márki et al., 2022). Partners provide emotional and \npractical assistance, including help with daily tasks, \naccompanying women to medical appointments, and \nengaging in treatment decisions (Culley et al., 2017). \nIn a recent study it was found that perceived social \nsupport positively influenced partnership satisfac ‑\ntion in couples affected by endometriosis and infertil‑\nity (van Eickels et al., 2024). Beyond family support, \nbroader networks – such as friends, online communi‑\nties, and support groups – offer women with endome‑\ntriosis a sense of belonging, understanding, and hope \n(Márki et al., 2022). \nTo the best of our knowledge, no studies have spe‑\ncifically examined the role of perceived social support \nin the sexual satisfaction of women with endome ‑\ntriosis. However, research in other contexts, such as \nrheumatic diseases, has highlighted the importance \nof social support in influencing women’s sexual \nhealth. For example, dissatisfaction or lack of fulfill ‑\nment in partner relationships has been associated \nwith increased sexual dysfunction (Granero ‑Molina \net al., 2018). Furthermore, studies have suggested that \nsocial support plays a crucial role in facilitating cop ‑\ning mechanisms for chronic illnesses, which, in turn, \ncan contribute to improved sexual health outcomes \n(Kengen Traska et  al., 2012; Schulman ‑Green et  al., \n2016). A systematic review by Sánchez‑Fuentes et al. \n(2014) examining factors associated with sexual satis‑\nfaction identified variables related to social support, \nsuch as strong social networks and positive family \nrelationships, as predictors of higher sexual satisfac‑\ntion. However, the authors noted the limited research \navailable on these topics. \nsexual satisfaction and endometriosis \nAccording to the WHO, sexual health refers to “a state \nof physical, emotional, mental and social well ‑being \nin relation to sexuality; it is not merely the absence of \ndisease, dysfunction or infirmity” (WHO, 2024, p. 1). \nSexual health is recognized as a vital component of \nwomen’s quality of life, even in the context of chronic \nhealth conditions (Flynn et al., 2016). Sexual satisfac ‑\ntion is generally understood as a  multidimensional \nconstruct influenced by interpersonal, behavioral, \nand psychological aspects. Theoretical frameworks \ndescribe it as a  subjective appraisal of sexual expe ‑\nriences that extends beyond the presence of sexual \nproblems, involving emotional closeness, relational \nprocesses, and personal sexual functioning. Models in \nthis field highlight both individual dimensions, such \nas desire and well ‑being, and relational elements, \nincluding communication and perceived responsive‑\nness (Sánchez‑Fuentes et al., 2014). \nSexual satisfaction is often diminished in individu‑\nals coping with chronic illnesses (Flynn et al., 2016). \nResearch shows that women with endometriosis often \nexperience impaired sexual functioning and reduced \nlevels of sexual satisfaction compared to women \nwithout the condition (Kfoury et al., 2023; Montana ‑\nri et al., 2013; Vercellini et al., 2012). Also, a system ‑\natic review and meta ‑analysis revealed that women \nwith endometriosis have an approximately twofold \nincreased risk of experiencing sexual dysfunction \ncompared to women without the condition (OR 2.38) \n(Pérez‑López et al., 2020). Another systematic review \ncorroborated these findings, reporting a  1.71 ‑fold \nhigher risk of sexual dysfunction in women with en‑\ndometriosis (95% CI: 1.21‑2.43). Women with endome‑\ntriosis consistently scored lower across all domains of \nsexual functioning, including desire, arousal, lubrica‑\ntion, orgasm, satisfaction, and pain, as assessed by the \nFemale Sexual Function Index (FSFI) (Zhu et al., 2023).\nAmong the primary contributors to poor sexual \nfunction are symptoms such as dyspareunia and deep \npelvic pain, which are hallmark features of this con‑\ndition (Shum et al., 2018; Youseflu et al., 2020). How‑\never, the impact of endometriosis on sexual health \nextends beyond physical pain. Psychological and \nemotional factors, including anxiety, depression, low \nself‑esteem, and infertility‑related challenges, also \nplay a significant role in the development of sexual \ndysfunction (Norinho et  al., 2020; Shi et  al., 2023; \nYouseflu et al., 2020). Additionally, poor sleep qual‑\nity – a common issue in women with chronic pain \nconditions – can further exacerbate sexual difficulties \n(Youseflu et al., 2020). These findings underscore the \npervasive and multifaceted impact of endometriosis \non women’s sexual health, highlighting the critical \nneed for comprehensive management strategies. \nt he Present study\nEndometriosis has a  profound impact on women’s \nQoL, affecting physical, psychological, and social do‑\nmains. Chronic pain, sexual dysfunction and dissatis‑\nfaction, and relational challenges are central contrib‑\nutors to reduced QoL in this population (Bień et al., \n2020; Hudson et al., 2013). However, the psychosocial \nmechanisms underlying QoL, particularly the roles \nof social support and sexual satisfaction, remain un‑\n\nNoa Cacete, \nJuliana Pedro, \nFilipa Pimenta, \nTânia Brandão\n4 health psychology report\nderexplored. Social support, a critical determinant of \nhealth and well‑being in chronic diseases, is associ‑\nated with improved coping strategies, reduced stress, \nand better overall outcomes (Luo et al., 2023; Maguire \net al., 2021). Despite this, little research has examined \nthe specific influence of social support on QoL in \nwomen with endometriosis, particularly its indirect \neffects through sexual satisfaction.\nSexual dysfunction and sexual dissatisfaction are \nprevalent problems in endometriosis (e.g., Pérez ‑\nLópez et  al., 2020; Zhu et  al., 2023). Research from \nother chronic disease contexts suggests that relational \nfactors and social support are critical for sexual health \n(Granero‑Molina et  al., 2018; Kengen Traska et  al., \n2012; Sánchez‑Fuentes et al., 2014). Dissatisfying re ‑\nlationships and lack of partner support have been \nlinked to greater sexual problems, while adequate \nsocial support facilitates coping and enhances emo ‑\ntional well‑being, potentially improving sexual func‑\ntioning (Schulman‑Green et al., 2016).\nIn this study, we tested a  mediational model to \ninvestigate the relationships between social support, \nsexual satisfaction, and QoL in Portuguese‑speaking \nwomen residing in Portugal with endometriosis. \nSpecifically, we hypothesized that sexual satisfaction \nmediates the link between perceived social support \nand QoL. This model builds on prior evidence sug‑\ngesting that social support not only directly enhanc‑\nes QoL but also exerts indirect effects by influencing \nthe relational and psychological burdens associated \nwith sexual dissatisfaction. By examining these path‑\nways, our research sought to provide a  more com‑\nprehensive understanding of the psychosocial factors \ninfluencing QoL in women with endometriosis and \nto inform the development of holistic interventions, \ntailored for women with this clinical condition. \nPartici Pants and Procedure\nPartici Pants\nEligibility required having a formal medical diagnosis \nof endometriosis. Participants were asked to indicate \nwhether a healthcare professional had diagnosed them \nwith endometriosis, and only those who confirmed \na  medically established diagnosis were included.  \nOther inclusion criteria for the study required partici‑\npants to be women of reproductive age and current ‑\nly experiencing at least one symptom related to the \ndisease. Women with asymptomatic endometriosis, \npregnant women, and those who were not proficient \nin Portuguese were excluded from the study. Further‑\nmore, all participants were required to provide in ‑\nformed consent prior to participating in the research.\nUsing G*Power 3.1, we estimated that for a linear \nmultiple regression with two predictors (social sup ‑\nport and sexual satisfaction), assuming a medium ef ‑\nfect size (f² = .15), α = .05, and desired power of .90, \na minimum sample of approximately 88 participants \nwould be required. This cross‑sectional study included \n106 women who reported a diagnosis of endometrio ‑\nsis, aged between 18 and 52 (M\nage = 33.54, SD = 7.43). \nMost of the participants (89.6%) were in a relationship. \nRegarding the presence of children, 19.8% of the wom‑\nen had at least one child. In terms of education, most \nof the participants had higher education (32.1% with \na master’s degree and 25.5% with a bachelor’s degree).\nIn addition, 34% self‑reported a diagnosis of infer ‑\ntility associated with endometriosis (see Table 1 for \na detailed description of participants’ characteristics).\nTable 1\nSociodemographic data of the sample\nVariable M/n SD/%\nAge 33.54 7.43\nMarital status\nLiving together 26 24.5\nMarried 37 34.9\nSingle 39 36.8\nDivorced 4 3.8\nNationality\nPortuguese 87 82.1\nBrazilian 15 14.2\nOther 4 3.8\nEducation\n2nd cycle 2 1.9\n3rd cycle or equivalent 4 3.8\nHigh school or equivalent 34 32.1\nBachelor 27 25.5\nPostgraduate 4 3.8\nMaster 34 32.1\nDoctorate 1 0.9\nRelationship\nYes 95 89.6\nNo 11 10.4\nChildren\nYes 21 19.8\nNo 85 80.2\nInfertility diagnosis\nYes 36 34.0\nNo 70 66.0\n\nQuality of life  \nin women  \nwith endometriosis\n56\nm easures\nQuality of life . The  Portuguese version of the \nWHOQOL‑BREF was used to measure women’s QoL \n(Vaz Serra et al., 2006). It was selected because it is \na theoretically grounded, multidimensional measure \nof quality of life that aligns with the WHO definition \nof health and has been widely validated for use in \nchronic health conditions. It is a 26 ‑item self‑report \ninstrument designed to assess quality of life across \nfour key domains: (1) Physical Domain: encompasses \nitems related to physical health, including mobility, \nenergy, pain, and sleep (item example: “How satis ‑\nfied are you with your health?”); (2) Psychological \nDomain: addresses emotional well‑being, self‑esteem, \nbody image, and mental health (item example: “How \noften do you have negative feelings such as blue \nmood, despair, anxiety, or depression?”); (3) Social \nRelationships Domain: evaluates satisfaction with \npersonal relationships, social support, and sexual life \n(item example: “How satisfied are you with the sup‑\nport you get from your friends?”); and (4) Environ ‑\nment Domain: examines environmental factors such \nas safety, financial resources, healthcare access, and \nthe physical environment (item example: “How satis‑\nfied are you with your transport?”). \nItems are rated on a  5 ‑point Likert scale, where \nhigher scores indicate better quality of life. In the pres‑\nent study, the WHOQOL ‑BREF instrument demon ‑\nstrated good internal reliability, with a Cronbach’s α \nvalue of .93 and ω coefficient of .92 for the overall ques‑\ntionnaire (the environment domain was not included \nas this study did not focus on environment issues). \nPerceived social support. Perceived social support \nwas measured using the Portuguese version of the \nMultidimensional Scale of Perceived Social Support \n(MSPSS; Carvalho et al., 2011). This instrument was \nselected because it is grounded in Zimet and col‑\nleagues’ theoretical model, which conceptualizes \nsocial support as deriving from distinct and mean‑\ningful sources (e.g., family, friends) with a focus on \nperceived support rather than objective presence of \nindividuals. \nIt has 12 items and assesses three sources of sup ‑\nport: family support (4 items; item example: “My \nfamily is willing to help me make decisions”), friend \nsupport (4 items; item example: “My friends really \ntry to help me”, and support from significant others \n(4 items; item example: “There is a special person who \nis around when I am in need”). Items are rated on \na  7‑point Likert scale, ranging from 1 ( strongly dis-\nagree) to 7 ( strongly agree). In the present study, the \nMSPSS exhibited good psychometric properties, with \na global Cronbach’s α of .95 and ω coefficient of .95 \nfor the total score. \nSexual satisfaction . Sexual satisfaction was as ‑\nsessed using the Portuguese version of the New Sexu‑\nal Satisfaction Scale (NSSS; Pechorro et al., 2016). This \ninstrument was selected because it is grounded in \ncontemporary theoretical models of sexual function‑\ning and satisfaction, and captures both personal and \nrelational dimensions of sexual experience.\nIt consists of 20 items, divided into two subscales: \nSelf‑Centeredness (10 items; item example: “The in‑\ntensity of my sexual arousal”) and Partner and Sexual \nActivity‑Centeredness (10 items; item example: “My \npartner’s emotional opening up during sex”. Items \nare scored on a  5‑point Likert‑type scale ranging \nfrom 1 (not at all satisfied) to 5 (extremely satisfied). \nIn this study, Cronbach’s α was .96 and ω was .96 for \nthe total score of the scale, indicating good internal \nreliability.\nProcedure\nThis study was approved by the Ethics Committee of \nISPA – University Institute (Reference: I‑134‑12‑23). \nThe  questionnaires were distributed and completed \nthrough Google Forms to provide the flexibility to al‑\nlow participants to complete the instruments at their \nconvenience. Participants were recruited through \nsocial networks, including Facebook groups and In‑\nstagram pages (e.g., pages dedicated to endometrio‑\nsis, pages of (in)fertility clinics, and pages managed \nby clinicians working in gynecology/reproductive \nmedicine) between January and May 2024. Prior to \ninitiating data collection (on the landing page), all \nparticipants were provided with detailed information \nabout the study’s objectives, procedures, inclusion \nand exclusion criteria, and ethical considerations to \nensure transparency and understanding. Informed \nconsent was obtained from each participant before \ntheir participation.\nData were collected anonymously, with no identi‑\nfiable information linked to participants’ responses to \nprotect their confidentiality. Strict security measures \nwere implemented to store and manage data, ensur ‑\ning that they were only accessible to the research \nteam. All data handling followed ethical guidelines \nand relevant data protection laws. Participants were \nalso informed about how their data would be used, \nstored, and analyzed, aligning with the principles of \nethical research (only for research purposes). Partici‑\npants did not receive any type of incentives. \nd ata analysis \nData were analyzed using SPSS (v. 29). Pearson cor‑\nrelations were used to analyze correlations among \nstudy variables. \nMediation analysis was conducted using the  \nPROCESS macro (model 4) (Hayes, 2017). The anal‑\nysis focused on whether sexual satisfaction acts as \na  mediator between social support (independent \n\nNoa Cacete, \nJuliana Pedro, \nFilipa Pimenta, \nTânia Brandão\n6 health psychology report\nvariables) and QoL (dependent variables) in women \nwith endometriosis. The PROCESS macro is a statis‑\ntical tool that allows for the testing of direct, indirect, \nand total effects in mediation models. Bootstrapping \nwith 5,000 resamples was performed to assess the \nsignificance of the indirect effects and provide confi‑\ndence intervals, with a 95% confidence level. Direct, \ntotal, and indirect effects are reported. A significance \nlevel of p < .05 was adopted for all analyses.\nr esults\nc orrelational analysis \nSocial support was moderately correlated with sex‑\nual satisfaction and strongly correlated with quality \nof life. Sexual satisfaction also demonstrated a strong \npositive correlation with quality of life (see Table 2). \nm ediational analysis \nA mediation analysis was conducted to investigate \nwhether sexual satisfaction mediated the relationship \nbetween social support and quality of life (see Fig ‑\nure 1), while controlling for participants’ age, marital \nstatus, and length of endometriosis diagnosis. Social \nsupport was positively associated with sexual satisfac‑\ntion (B = .17, SE = .06, t = 2.84, p < .001, 95% CI [.05, .29]). \nAge was also associated with sexual satisfaction \n(B = –.03, SE = .01, t  = –2.39, p < .05, 95% CI [–.06, –.01]). \nMarital status and length of endometriosis diagnosis \nwere not associated with sexual satisfaction (p > .05). \nSocial support had a significant total effect on qual‑\nity of life (B = .19, SE = .03, t = 5.44, p < .001, 95% CI \n[.12, .26]). In the mediation model, sexual satisfac ‑\ntion was significantly associated with quality of life \n(B = .30, SE = .05, t = 5.88, p < .001, 95% CI [.20, .40]), \nand social support was also significantly associated \nwith quality of life (B = .14, SE = .03, t = 4.44, p < .001, \n95% CI [.08, .20]). Participants’ age, marital status, and \nlength of endometriosis diagnosis were not associated \nquality of life (p >.05). The combined model explained \n50.71% of the variance in quality of life ( R\n2  =  .51, \nF(6, 98) = 16.80, p < .001). \nA significant indirect effect of social support on \nquality of life through sexual satisfaction was ob ‑\nserved (indirect effect = .05, SE = .02, 95% CI [.01, .09]). \nd iscussion\nThis study aimed to investigate the complex interplay \nbetween perceived social support, sexual satisfaction, \nand quality of life in Portuguese‑speaking women re‑\nsiding in Portugal with endometriosis, focusing on \nthe mediating role of sexual satisfaction. By address‑\ning these variables, the research sought to enhance \nunderstanding of the psychosocial factors influenc‑\ning the well‑being of these women living with this \nchronic condition, providing insights that may guide \ninterventions to improve their overall quality of life.\nAs anticipated, perceived social support was posi‑\ntively associated with higher quality of life. This find‑\ning aligns with existing literature, which consistently \nTable 2\nPearson correlations among study variables (N = 106)\nSocial support Sexual satisfaction Quality of life\nSocial support –\nSexual satisfaction .35* –\nQuality of life .54* .62* –\nNote. *p < .001.\nFigure 1\nUnstandardized direct, total, and indirect effects of social support and sexual satisfaction on quality of life \nof women (N = 106), controlling for age, marital status, and length of endometriosis diagnosis\nSexual  \nsatisfaction\nPerceived social \nsupport Quality of life\nDirect effect: .14, p < .001\nTotal effect: .19, p < .001\n.30, p < .001.17, p < .001\n\nQuality of life  \nin women  \nwith endometriosis\n76\nemphasizes the vital role of social support in promot‑\ning both physical and mental well‑being, particularly \nin the context of chronic diseases (e.g., Maguire et al., \n2021). Social support serves to enhance individuals’ \nresources in managing the stress and challenges as‑\nsociated with chronic conditions, such as increasing \nself‑efficacy, reducing perceived stress, and foster‑\ning resilience (Luo et al., 2023). Furthermore, studies \nhave highlighted that support from various sources, \nparticularly from partners, plays a  crucial role in \nnavigating chronic illnesses such as endometriosis. \nThis support helps mitigate feelings of isolation and \nenhances hope and understanding, ultimately con‑\ntributing to improved quality of life (Culley et  al., \n2017; Márki et al., 2022; van Eickels et al., 2024).\nAs anticipated, sexual satisfaction was positively \nassociated with improved quality of life. This aligns \nwith the understanding that sexual health, and sexu‑\nal satisfaction specifically, plays a significant role in \nwomen’s overall well‑being and quality of life (Flynn \net  al., 2016). A fulfilling sexual life may contribute \nto reducing symptoms such as anxiety, stress, and \nlow self‑esteem, which can have a profound impact \non mental and emotional health (Fritzer et al., 2013; \nGewirtz‑Meydan et al., 2019; La Rosa et al., 2020). \nFinally, as expected, social support was positively \nassociated with quality of life through sexual satisfac‑\ntion. This finding aligns with existing research across \ndifferent contexts, which highlights the critical role \nof social and relational factors in sexual health (Gra‑\nnero‑Molina et al., 2018; Kengen Traska et al., 2012; \nSánchez‑Fuentes et al., 2014). Poor or unsupportive \nrelationships have been linked to increased sexual \ndifficulties, while sufficient social support serves to \nfacilitate coping mechanisms and boost emotional \nwell‑being, ultimately enhancing sexual function and \nsatisfaction (Schulman‑Green et al., 2016). Also, open \nand secure communication between partners is cru‑\ncial to building satisfying relationships and enhanc‑\ning various aspects, including sexuality and overall \nquality of life (Hudson et al., 2013; Law et al., 2025; \nNorinho et  al., 2020). Overall, this study highlights \nthe importance of social support and sexual satisfac‑\ntion in improving the overall quality of life for wom‑\nen with endometriosis, offering valuable insights for \npromoting emotional and relational well‑being.\nlimitations and future research \nThis study has several limitations. First, the sample \nwas relatively small, comprising Portuguese‑speaking \nwomen residing in Portugal, which may limit the gen‑\neralizability of the findings. Additionally, the use of \nself‑reported data could introduce biases, such as so‑\ncial desirability or recall bias. Another limitation is the \ncross‑sectional design, which limits the ability to draw \ncausal inferences regarding the relationships between \nsocial support, sexual satisfaction, and quality of life. \nAnother limitation is the reliance on self‑reported dia‑ \ngnoses of endometriosis and infertility, which may be \nsubject to misclassification or reporting bias. Also, be‑\ncause recruitment occurred through social networks \nwithout the ability to monitor reach or link access, \nwe could not track how many individuals viewed the \nstudy announcement, accessed the survey, or were \nscreened for eligibility. Only the final number of par‑\nticipants who met the inclusion criteria is available.\nFuture research should address these limitations \nby including larger, more diverse samples and em‑\nploying longitudinal designs to better understand the \ncausal relationships. Additionally, exploring the im‑\npact of specific types of social support (e.g., partner \nsupport versus family support) and examining other \npotential mediators and moderators of these relation‑\nships could provide deeper insights into how to im‑\nprove quality of life for women with endometriosis. \nFurther investigation into the role of psychological \nand emotional factors in shaping sexual satisfaction \nand quality of life is also warranted.\nPractical im Plications\nThe findings of this study highlight several practical \nimplications for healthcare professionals working \nwith Portuguese‑speaking women residing in Portu‑\ngal with endometriosis. Firstly, fostering strong social \nsupport networks – whether through family, friends, \npartners, or healthcare providers – can significantly \ncontribute to improving quality of life. Healthcare \npractitioners should emphasize the importance of \nemotional and relational support in managing chron‑\nic conditions such as endometriosis.\nAdditionally, addressing sexual health is crucial, \nas it plays a significant role in overall well‑being. In‑\nterventions aimed at enhancing sexual satisfaction \nand managing sexual dysfunction could be integrat‑\ned into treatment plans to support holistic care for \nwomen with endometriosis.\nLastly, promoting psychological counseling and \nsupport groups may help mitigate feelings of isola‑\ntion and improve coping mechanisms, which are es‑\nsential for managing both the physical and emotional \nchallenges associated with the disease. By focusing \non these areas, healthcare providers can offer more \ncomprehensive and effective care.\nDisclosures\nThis research received no external funding. \nThe study was approved by the Ethics Committee of \nthe ISPA – University Institute (Approval No. I-134-\n12-23).\nThe authors declare no conflict of interest.\n\nNoa Cacete, \nJuliana Pedro, \nFilipa Pimenta, \nTânia Brandão\n8 health psychology report\nReferences\nAdamson, G. D., Kennedy, S., &  Hummelshoj, L. \n(2010). Creating solutions in endometriosis: Glob-\nal collaboration through the World Endometriosis \nResearch Foundation. Journal of Endometriosis, 2, \n3–6. https://doi.org/10.1177/228402651000200102  \nAmeratunga, D., Flemming, T., Angstetra, D., Ng, S. K., \n& Sneddon, A. (2017). Exploring the impact of en-\ndometriosis on partners. Journal of Obstetrics and \nGynaecology Research, 43, 1048–1053. https://doi.\norg/10.1111/jog.13325 \nAs-Sanie, S., Mackenzie, S. C., Morrison, L., Schrepf, A., \nZondervan, K. T., Horne, A. W., & Missmer, S. A. \n(2025). Endometriosis: a review. JAMA, 334, 64–78. \nhttps://doi.org/10.1001/jama.2025.2975\nBień, A., Rzońca, E., Zarajczyk, M., Wilkosz, K., Wdo-\nwiak, A., & Iwanowicz-Palus, G. (2020). Quality of \nlife in women with endometriosis: a cross-section-\nal survey. Quality of Life Research, 29 , 2669–2677. \nhttps://doi.org/10.1007/s11136-020-02515-4\nCarvalho, S., Pinto-Gouveia, J., Pimentel, P., Mala, D., \n& Mota-Pereira, J. (2011). Características psicomé-\ntricas da versão portuguesa da Escala Multidimen-\nsional de Suporte Social Percebido (Multidimen -\nsional Scale of Perceived Social Support – MSPSS) \n[Psychometric properties of Portuguese version \nof the Multidimensional Scale of Perceived Social \nSupport (MSPSS)]. Psychologica, 54, 309–358.\nCulley, L., Law, C., Hudson, N., Mitchell, H., Denny, E., \n& Raine-Fenning, N. (2017). A qualitative study of \nthe impact of endometriosis on male partners. Hu-\nman Reproduction, 32 , 1667–1673. https://doi.org/\n10.1093/humrep/dex221 \nDe Corte, P., Klinghardt, M., von Stockum, S., & Hei-\nnemann, K. (2025). Time to diagnose endometrio-\nsis: Current status, challenges and regional charac-\nteristics – a systematic literature review. BJOG: An \nInternational Journal of Obstetrics & Gynaecology, \n132, 118–130. https://doi.org/10.1111/1471-0528.\n17973 \nDella-Corte, L., Di Filippo, C., Gabrielli, O., Reppuc -\ncia, S., La Rosa, V. L., Ragusa, R., Fichera, M., Com-\nmodari, E., Bifulco, G., & Giampaolino, P. (2020). \nThe burden of endometriosis on women’s lifespan: \na  narrative overview on quality of life and psy -\nchosocial wellbeing. International Journal of En -\nvironmental Research and Public Health, 17 , 4683. \nhttps://doi.org/10.3390/ijerph17134683\nDuarte, A. N., & Righi, M. (2021). Associação entre en-\ndometriose e infertilidade feminina: Uma revisão \nde literature [The association between endome-\ntriosis and female infertility: a literature review]. \nActa Elit Salutis, 4, 26895. https://doi.org/10.48075/\naes.v4i1.26895 \nFacchin, F., Buggio, L., & Saita, E. (2020). Partners’ per-\nspective in endometriosis research and treatment: \na systematic review of qualitative and quantita-\ntive evidence. Journal of Psychosomatic Research, \n137, 110213. https://doi.org/10.1016/j.jpsychores.\n2020.110213\nFlynn, K. E., Lin, L., Bruner, D. W., Cyranowski, J. M., \nHahn, E. A., Jeffery, D. D., Reese, J. B., Reeve, B. B., \nShelby, R. A., & Weinfurt, K. P. (2016). Sexual sat-\nisfaction and the importance of sexual health to \nquality of life throughout the life course of U.S. \nadults. Journal of Sexual Medicine, 13, 1642–1650. \nhttps://doi.org/10.1016/j.jsxm.2016.08.011\nFourquet, J., Gao, X., Zavala, D., Orengo, J. C., Abac, S., \nRuiz, A., Laboy, J., & Flores, I. (2010). Patients’ re-\nport on how endometriosis affects health, work, \nand daily life. Fertility and Sterility, 93, 2424–2428. \nhttps://doi.org/10.1016/j.fertnstert.2009.09.017\nFritzer, N., Haas, D., Oppelt, P., Renner, S., Hor -\nnung, D., Wölfler, M., Ulrich, U., Fischerlehner, G., \nSillem, M., & Hudelist, G. (2013). More than just \nbad sex: Sexual dysfunction and distress in patients \nwith endometriosis. European Journal of Obstetrics, \nGynecology, and Reproductive Biology,  169, 392–\n396. https://doi.org/10.1016/j.ejogrb.2013.04.001\nGao, X., Yeh, Y. C., Outley, J., Simon, J., Botteman, M., \n& Spalding, J. (2006). Health-related quality of life \nburden of women with endometriosis: a  litera -\nture review. Current Medical Research and Opin -\nion, 22, 1787–1797. https://doi.org/10.1185/0300799\n06X121084\nGewirtz-Meydan, A., Hafford-Letchfield, T., Aya -\nlon, L., Benyamini, Y., Biermann, V., & Coffey, A. \n(2019). How do older people discuss their own sex-\nuality? A systematic review of qualitative research \nstudies. Culture, Health &  Sexuality, 21 , 293–308. \nhttps://doi.org/10.1080/13691058.2018.1465203\nGhiasi, M., Kulkarni, M. T., & Missmer, S. A. (2020). \nIs endometriosis more common and more severe \nthan it was 30 years ago? Journal of Minimally \nInvasive Gynecology, 27, 452–461. https://doi.org/\n10.1016/j.jmig.2019.11.018 \nGranero-Molina, J., Matarín Jiménez, T. M., Ramos \nRodríguez, C., Hernández-Padilla, J. M., Castro-\nSánchez, A. M., & Fernández-Sola, C. (2018). Social \nsupport for female sexual dysfunction in fibro -\nmyalgia. Clinical Nursing Research,  27, 296–314. \nhttps://doi.org/10.1177/1054773816676941 \nGruber, T. M., & Mechsner, S. (2021). Pathogenesis of \nendometriosis: The origin of pain and subfertility. \nCells, 10, 1381. https://doi.org/10.3390/cells10061381\nHayes, A. F. (2017). Introduction to mediation, mod-\neration, and conditional process analysis: a regres-\nsion-based approach (2nd ed.). Guilford Press.\nHsu, A. L., Khachikyan, I., & Stratton, P. (2010). In-\nvasive and noninvasive methods for the diagnosis \nof endometriosis. Clinical Obstetrics and Gyne-\ncology, 53, 413–419. https://doi.org/10.1097/GRF.\n0b013e3181db7ce8 \nHudson, N., Culley, L., Mitchell, H., Law, C., Den-\nny, E., & Raine-Fenning, N. (2013). Endometriosis: \n\nQuality of life  \nin women  \nwith endometriosis\n96\nImproving the wellbeing of couples. Summary re-\nport and recommendations. Retrieved from www.\ndmu.ac.uk/endopartreport\nKalfas, M., Chisari, C., & Windgassen, S. (2022). Psy -\nchosocial factors associated with pain and health-\nrelated quality of life in endometriosis: a systemat-\nic review. European Journal of Pain, 26, 1827–1848. \nhttps://doi.org/10.1002/ejp.2006\nKengen Traska, T., Rutledge, D. N., Mouttapa, M., \nWeiss, J., & Aquino, J. (2012). Strategies used for \nmanaging symptoms by women with fibromyal -\ngia. Journal of Clinical Nursing, 21, 626–635. https://\ndoi.org/10.1111/j.1365-2702.2010.03501.x\nKfoury, M., Barakat, H., Hallit, S., & Saliba, S. (2023). \nAssociation between endometriosis and sexual \nsatisfaction among a  sample of Lebanese wom-\nen. BMC Women’s Health, 23, 164. https://doi.org/\n10.1186/s12905-023-02361-4 \nLa Rosa, V. L., Barra, F., Chiofalo, B., Platania, A., Di \nGuardo, F., & Conway, F. (2020). An overview on \nthe relationship between endometriosis and infer-\ntility: The impact on sexuality and psychological \nwell-being. Journal of Psychosomatic Obstetrics \n&  Gynecology, 41, 93–97. https://doi.org/10.1080/\n0167482X.2019.1659775\nLaganà, A. S., La Rosa, V. L., Rapisarda, A. M. C., Va-\nlenti, G., Sapia, F., Chiofalo, B., Rossetti, D., Ban \nFrangež, H., Vrtačnik Bokal, E., &  Vitale, S. G. \n(2017). Anxiety and depression in patients with \nendometriosis: Impact and management chal-\nlenges. International Journal of Women’s Health, \n9, 323–330. https://doi.org/10.2147/IJWH.S119729\nLaw, C., Hudson, N., Mitchell, H., Culley, L., & Nor-\nton, W. (2025). ‘You feel like you’re drifting apart’: \na  qualitative study of impacts of endometriosis \non sex and intimacy amongst heterosexual cou-\nples. Sexual and Relationship Therapy, 40, 142–165. \nhttps://doi.org/10.1080/14681994.2024.2306316\nLi, W., Feng, H., & Ye, Q. (2025). Relationship between \nendometriosis and mental health. A systematic re-\nview and meta-analysis. Archives of Medical Science, \n21, 1985–1996. https://doi.org/10.5114/aoms/208502\nLuo, Z., Zhong, S., Zheng, S., Li, Y., Guan, Y., Xu, W., \nLi,  L., Liu, S., Zhou, H., Yin, X., Wu, Y., Liu, D., \n& Chen, J. (2023). Influence of social support on \nsubjective well-being of patients with chronic \ndiseases in China: Chain-mediating effect of self-\nefficacy and perceived stress. Frontiers in Public \nHealth, 11, 1184711. https://doi.org/10.3389/fpubh.\n2023.1184711 \nMaguire, R., Hanly, P., & Maguire, P. (2021). Living \nwell with chronic illness: How social support, \nloneliness and psychological appraisals relate to \nwell-being in a population-based European sam-\nple. Journal of Health Psychology, 26, 1494–1507. \nhttps://doi.org/10.1177/1359105319883004 \nMarinho, M. C. P., Magalhaes, T. F., Fernandes, L. F. C., \nAugusto, K. L., Brilhante, A. V. M., & Bezerra, L. R. P. S.  \n(2018). Quality of life in women with endometriosis: \nan integrative review. Journal of Women’s Health, \n27, 399–408. https://doi.org/10.1089/jwh.2017.63\nMárki, G., Vásárhelyi, D., Rigó, A., Kaló, Z., Ács, N., \n& Bokor, A. (2022). Challenges of and possible so-\nlutions for living with endometriosis: a qualitative \nstudy. BMC Women’s Health, 22, 20. https://doi.org/\n10.1186/s12905-022-01603-6\nMissmer, S. A., Tu, F. F., Agarwal, S. K., Chapron, C., \nSoliman, A. M., Chiuve, S., Eichner, S., Flores-Cal-\ndera, I., Horne, A. W., Kimball, A. B., Laufer, M. R., \nLeyland, N., Singh, S. S., Taylor, H. S., & As-Sanie, S. \n(2021). Impact of endometriosis on life-course po-\ntential: a narrative review. International Journal of \nGeneral Medicine, 14, 9–25. https://doi.org/10.2147/\nIJGM.S261139\nMontanari, G., Di Donato, N., Benfenati, A., Giova -\nnardi, G., Zannoni, L., Vicenzi, C., Solfrini, S., Mi -\ngnemi, G., Villa, G., Mabrouk, M., Schioppa,  C., \nVenturoli, S., & Seracchioli, R. (2013). Women with \ndeep infiltrating endometriosis: Sexual satisfac -\ntion, desire, orgasm, and pelvic problem interfer -\nence with sex. Journal of Sexual Medicine, 10, 1559–\n1566. https://doi.org/10.1111/jsm.12133\nMoradi, M., Parker, M., Sneddon, A., Lopez, V., & Ell-\nwood, D. (2014). Impact of endometriosis on wom-\nen’s lives: a qualitative study. BMC Women’s Health, \n14, 123. https://doi.org/10.1186/1472-6874-14-123\nNnoaham, K. E., Hummelshoj, L., Webster, P., \nd’Hooghe, T., de Cicco Nardone, F., de Cicco Nar-\ndone, C., Jenkinson, C., Kennedy, S. H., Zonder -\nvan, K. T., & World Endometriosis Research Founda-\ntion Global Study of Women’s Health consortium \n(2011). Impact of endometriosis on quality of life \nand work productivity: a multicenter study across \nten countries. Fertility and Sterility, 96 , 366–373. \nhttps://doi.org/10.1016/j.fertnstert.2011.05.090 \nNorinho, P., Martins, M. M., &  Ferreira, H. (2020). \nA systematic review on the effects of endometrio-\nsis on sexuality and couple’s relationship. Facts, \nViews & Vision in ObGyn, 12, 197–205. \nPechorro, P. S., Pascoal, P. M., Jesus, S. N., Almei -\nda, A. I., Figueiredo, C. S., & Vieira, R. X. (2016). \nPropriedades psicométricas da versão portuguesa \nda Nova Escala de Satisfação Sexual – versão cur-\nta [Psychometric properties of the Portuguese ver-\nsion of the New Sexual Satisfaction Scale–Short]. \nRevista Internacional de Andrología, 14 , 94–100. \nhttps://doi.org/10.1016/j.androl.2016.04.006\nPérez-López, F. R., Ornat, L., Pérez-Roncero, G. R., \nLópez-Baena, M. T., Sánchez-Prieto, M., &  Che -\ndraui, P. (2020). The effect of endometriosis on sex-\nual function as assessed with the Female Sexual \nFunction Index: Systematic review and meta-anal-\nysis. Gynecological Endocrinology, 36 , 1015–1023. \nhttps://doi.org/10.1080/09513590.2020.1812570\nRøssell, E. L., Plana-Ripoll, O., Josiasen, M., Hansen, \nK. E., Bech, B. H., & Rytter, D. (2025). Association \n\nNoa Cacete, \nJuliana Pedro, \nFilipa Pimenta, \nTânia Brandão\n10 health psychology report\nbetween endometriosis and working life among \nDanish women. Human Reproduction, 40, 461–468. \nhttps://doi.org/10.1093/humrep/deae298 \nSánchez-Fuentes, M. M., Santos-Iglesias, P., &  Sie -\nrra, J. C. (2014). A systematic review of sexual satis-\nfaction. International Journal of Clinical and Health \nPsychology, 14, 67–75. https://doi.org/10.1016/S16\n97-2600(14)70038-9\nSchick, M., Germeyer, A., Böttcher, B., Hecht, S., \nGeiser, M., Rösner, S., Eckstein, M., Vomstein, K., \nToth, B., Strowitzki, T., Wischmann, T., &  Dit-\nzen, B. (2022). Partners matter: The psychosocial \nwell-being of couples when dealing with endome-\ntriosis. Health and Quality of Life Outcomes, 20, 86. \nhttps://doi.org/10.1186/s12955-022-01991-1\nSchulman-Green, D., Jaser, S. S., Park, C., & Whitte-\nmore, R. (2016). A metasynthesis of factors affect-\ning self-management of chronic illness. Journal of \nAdvanced Nursing, 72, 1469–1489. https://doi.org/\n10.1111/jan.12902\nSetúbal, A. (2023). Endometriose: sintomas, diagnósti-\nco e tratamentos [Endometriosis: symptoms, diag-\nnosis and treatments]. Hospital da Luz. Retrieved \nfrom https://www.hospitaldaluz.pt/pt/dicionario-\nde-saude/endometriose-sintomas-tratamentos\nShi, C., Xu, H., Zhang, T., & Gao, Y. (2023). Endome-\ntriosis decreases female sexual function and in-\ncreases pain severity: a meta-analysis. Archives of \nGynecology and Obstetrics, 307, 195–204. https://\ndoi.org/10.1007/s00404-022-06478-4\nShum, L. K., Bedaiwy, M. A., Allaire, C., Williams, C., \nNoga, H., Albert, A., Lisonkova, S., &  Yong,  P.  J. \n(2018). Deep dyspareunia and sexual quality of life \nin women with endometriosis. Sexual Medicine, 6, \n224–233. https://doi.org/10.1016/j.esxm.2018.04.006\nSkalski-Bednarz, S. B., Loichen, T., Toussaint, L., \nMendrek, A., Konaszewski, K. & Surzykiewicz, J. \n(2026). The moderating roles of social support and \nspirituality in the relationship between compli-\ncated grief and quality of life among women who \nhave experienced pregnancy loss. Health Psychol-\nogy Report, 14, 24–38. https://doi.org/10.5114/hpr/\n196641 \nvan Eickels, D., Schick, M., Germeyer, A., Rösner, S., \nStrowitzki, T., Wischmann, T., & Ditzen, B. (2024). \nPredictors of partnership and sexual satisfaction \nand dyadic effects in couples affected by endome-\ntriosis and infertility. Archives of Gynecology and \nObstetrics, 310, 2647–2655. https://doi.org/10.1007/\ns00404-024-07516-z \nVaz Serra, A., Canavarro, M. C., Simões, M. R., Perei-\nra, M., Gameiro, S., Quartilho, M. J., Carona, C., \nRijo, D., &  Paredes, T. (2006). Estudos psicomé-\ntricos do instrumento de avaliação da qualida-\nde de vida da Organização Mundial de Saúde  \n(WHOQOL-Bref) para Português de Portugal \n[Psychometric studies of the World Health Orga-\nnization’s quality of life assessment instrument \n(WHOQOL-Bref) for Portuguese from Portugal]. \nPsiquiatria Clínica, 27, 41–49.\nVercellini, P., Barbara, G., Buggio, L., Frattaruo-\nlo, M. P., Somigliana, E., & Fedele, L. (2012). Effect \nof patient selection on estimate of reproductive \nsuccess after surgery for rectovaginal endometri-\nosis: Literature review. Reproductive BioMedicine \nOnline, 24, 389–395. https://doi.org/10.1016/j.rbmo.\n2012.01.003\nWHO (1997). WHOQOL: Measuring quality-of-life. \nWorld Health Organization.\nWHO (2024). Sexual and reproductive health and re-\nsearch (SRH). Retrieved from https://www.who.\nint/teams/sexual-and-reproductive-health-and-\nresearch-(srh)/areas-of-work/sexual-health \nWHO (2025). Endometriosis. Retrieved from https://\nwww.who.int/news-room/fact-sheets/detail/en -\ndometriosis\nWu, Y. H., Lu, Y. Y., &  Liu, K. F. (2024). Factors in-\nfluencing health-related quality of life in women \nwith endometriosis: a cross-sectional study. Nurs-\ning & Health Sciences, 26, e13100. https://doi.org/\n10.1111/nhs.13100\nZiętalewicz, U., &  Bargiel-Matusiewicz, K. (2024). \nModel of quality of life in a group of people with \nchronic low back pain. Health Psychology Report, \n12, 337–351. https://doi.org/10.5114/hpr/185302 \nZimet, G. D., Dahlem, N. W., Zimet, S. G., &  Far-\nley, G. K. (1988). The  Multidimensional Scale of \nPerceived Social Support. Journal of Personal-\nity Assessment, 52, 30–41. https://doi.org/10.1207/\ns15327752jpa5201_2 \nZhu, X., Wu, Y., Jia, J., Zhao, X., & Zhao, X. (2023). Im-\npact of endometriosis on female sexual function: \nan updated systematic review and meta-analy-\nsis. Sexual Medicine, 11, qfad026. https://doi.org/\n10.1093/sexmed/qfad026\nYouseflu, S., Sadatmahalleh, S. J., Khomami, M. B., \n& Nasiri, M. (2020). Influential factors on sexual \nfunction in infertile women with endometriosis: \na  path analysis. BMC Women’s Health, 20, 92. \nhttps://doi.org/10.1186/s12905-020-00941-7","source_license":"CC0","license_restricted":false}