{"paper_id":"98be4532-30d8-449d-b10e-b13d20cb9101","body_text":"Prevalence of Abuse in Women with Endometriosis and Relationship to Pain Symptoms: A Cross-Sectional Questionnaire Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of Abuse in Women with Endometriosis and Relationship to Pain Symptoms: A Cross-Sectional Questionnaire Study Alyssa Gaerke, Caitlin Anne Jago, Teresa Flaxman, Sukhbir S. Singh, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3889054/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Sexual and physical abuse are associated with endometriosis, but their relationship to pain in endometriosis patients has not been studied. The aim of this study was to characterize the prevalence of sexual and physical abuse history in an endometriosis population and its relationship to severity and type of pain symptoms. Methods This was a cross-sectional questionnaire study conducted from May 2017 to May 2018 at a tertiary care gynecology clinic. Women with clinically suspected or surgically confirmed endometriosis were included. Patients completed the Endometriosis Phenome and Biobanking Harmonization Project (EPHect) Clinical Questionnaire, the International Pelvic Pain Society Pelvic Pain Assessment Form, and the Medical Outcome Survey (SF-36). Relationships between history of sexual abuse or physical abuse, pelvic pain type and severity, anxiety/depression diagnosis, quality of life, and demographics were analysed using Chi square, independent t-tests, Mann-Whitney U test, and logistic regression models. Results Forty-four women were surveyed. Severity and type of pain symptoms were similar in patients with and without a history of sexual or physical abuse. Forty-three percent (n = 19) of patients with endometriosis reported history of physical abuse and 43% (n = 19) reported history of sexual abuse with a 68% overlap between both groups. Patients with a history of sexual abuse had significantly higher rates of depression (53% vs 16%; p = 0.012) and anxiety (58% vs 12%; p = 0.001) than those reporting no history of sexual abuse and reported significantly lower mean SF-36 mental component summary scores (34 ± 14 vs 42 ± 12, p = 0.028). Conclusions No differences in severity and type of pain symptoms in patients with a history of sexual or physical abuse were observed compared to those without. More than 40% (n = 19) of patients with endometriosis reported a history of sexual abuse, with more anxiety and depression and lower mental quality of life scores compared to patients who reported no history of sexual abuse. This highlights the need for sexual abuse and mental health screening in an endometriosis population. Gynecology women’s health endometriosis abuse mental health quality of life depression questionnaire study pelvic pain Background Endometriosis is an estrogen-dependent chronic inflammatory disease, where endometrial-like tissue is found outside of the uterine cavity [ 1 ]. The gold standard for definitive diagnosis has traditionally been laparoscopy with histologic confirmation [ 2 ], however with improved attention to history, physical examination, and expert guided imaging, it can also be diagnosed clinically [ 3 – 5 ]. Endometriosis affects an estimated 1 in 10 women of reproductive age [6 − 8]. Despite multiple theories and on-going investigations, the etiology remains largely undetermined [ 1 ] and diagnosis may be delayed for 4–10 years after onset of pain symptoms [ 8 – 13 ]. Endometriosis has a negative impact on quality of life [ 14 , 15 ], affecting mental health [ 16 ], work productivity [ 17 ], and social and intimate relationships [ 18 ]. While symptoms vary, pelvic pain is a key clinical feature including dysmenorrhea, dyspareunia, dyschezia, dysuria, and non-cyclic pelvic pain. If left untreated, endometriosis-related pain may progress to chronic pelvic pain [ 19 – 21 ]. Many studies have suggested that early life stressors such as childhood sexual and physical abuse are associated with pain conditions such as endometriosis, chronic pelvic pain, fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome (IBS) [ 22 – 32 ]. Specifically, several studies have linked a history of childhood abuse to endometriosis, although results have been conflicting [ 29 – 34 ]. In one study, Harris et al. (n = 60 595) showed that there is a higher rate of laparoscopically-confirmed endometriosis in women with a history of childhood sexual or physical abuse, and severity and chronicity of abuse showed a dose-response association with endometriosis risk [ 29 ]. A study by Thomas et al. (n = 98) found significantly higher rates of sexual abuse history but not physical abuse history when comparing women with concurrent chronic pelvic pain and endometriosis to pain-free controls [ 30 ]. This is supported by Liebermann et al. (n = 842) who report higher prevalence of childhood sexual abuse in women with endometriosis compared to the general population control group [ 31 ]. In contrast, other reports of abuse history in women with endometriosis found only significant associations with physical abuse [ 32 ] or no associations at all with history of physical or sexual abuse [ 33 , 34 ]. To date there is no causal link between history of abuse and diagnosis of endometriosis, although possible explanations have been proposed [ 35 – 38 ]. In certain pain conditions such as IBS and fibromyalgia, childhood abuse is associated with increased pain severity [ 39 , 40 ]. This association of pain severity and childhood abuse was also shown in patients with substance use disorders and chronic pain [ 41 ]; this association with pain severity has not been shown in the chronic pelvic pain population [ 42 – 45 ]. To date, no studies have looked specifically at the relationship between pain severity and history of childhood abuse in an endometriosis population. As such, the primary purpose of our research was to assess whether there is a difference in severity and type of pain symptoms in patients with endometriosis that report a history of sexual and/or physical abuse compared to patients with no abuse history. Secondary objectives are to characterize any differences in quality of life and mental health in patients with concurrent pelvic pain and endometriosis between individuals with a history of physical and sexual abuse and those without. Methods Study design This is a cross-sectional cohort questionnaire study. Study population Seventy-two patients were recruited from a Canadian tertiary care gynecology clinic, specializing in endometriosis and pelvic pain, between May 2017 to May 2018. All patients presenting with suspected or confirmed endometriosis were eligible for inclusion. Inclusion criteria included age of 18 years or older, pre-menopausal, and capable of filling out the questionnaire. Patients were excluded from the study if they continued to surgical intervention and endometriosis was not confirmed by histology, and if they did not complete the study questionnaires. Data collection Patients who consented to be part of the study completed a set of questionnaires about their medical and surgical history as well as their quality of life as it related to endometriosis. The set of questionnaires included: the Endometriosis Phenome and Biobanking Harmonization Project (EPHect) Clinical Questionnaire [ 46 ], the International Pelvic Pain Society (IPPS) Pelvic Pain Assessment (IPPS-PPA) Form [ 47 ], and the Medical Outcome Survey (SF-36) [ 48 ]. Patient reported demographics, pelvic pain symptoms, and medical and surgical history were extracted from EPHect and IPPS-PPA questionnaires. Demographic variables included age, body mass index (BMI), parity, gravidity, ethnicity, cigarette smoking, alcohol consumption, marital status, and education level. Pelvic pain symptoms included: history of dysmenorrhea, dysuria, dyschezia, dyspareunia, and non-cyclic pelvic pain. Dysmenorrhea was separated into categories including mild (medication never or rarely needed), moderate (medication usually needed), and severe (medications and bed rest needed). Severity of pain was defined in the standardized EPHect questionnaire as a time in the patient’s life when the pelvic pain was at its worst and quantified on a numeric rating scale of 0 to 10 (0 = no pain; 10 = worst imaginable pain). Medical and surgical history included medical co-morbidities (including depression and anxiety), age of endometriosis diagnosis, age symptoms started, and previous abdominal surgeries. The SF-36 was used to quantify mental and physical quality of life using the mental component summary (MCS) and physical component summary (PCS) scores from SF-36, respectively, as described by Ware et al [ 49 ]. On the SF-36, a lower score is representative of reduced quality of life in each domain. Patient reports of sexual and physical abuse were extracted from the IPPS-PAA using validated questions from Leserman et al [ 50 ]. Physical abuse was defined as having someone hit, kick, beat, or seriously threaten the life of the respondent. Sexual abuse was defined as any act that ranged from unwanted exposure to rape. Patients were also classified into three groups based on their endometriosis type: superficial endometriosis, ovarian endometriomas, or deep endometriosis [ 51 ]. Endometriosis type was determined using surgical diagnosis or radiological imaging performed at a tertiary care centre with expertise in endometriosis imaging, using the International Deep Endometriosis Analysis group guidelines [ 52 , 53 ]. If patients had no previous surgical diagnosis and if imaging was negative, their endometriosis was classified as superficial based on history and clinical presentation, as superficial endometriosis is difficult to detect on imaging such as ultrasound [ 54 ]. Statistical analysis The data were summarized using descriptive statistics. The number (percentage) of patients with a history of sexual and/or physical abuse was calculated based on a patient reporting “yes” to any of the statements or questions in the sexual and physical abuse section of the IPPS-PPA form [ 47 ]. Pelvic pain prevalence and severity, rate of depression and anxiety, quality of life, and demographics were compared between patients with a history of sexual abuse and patients with no history of sexual abuse. Similarly, these variables were compared between patients with a history of physical abuse and patients without a history of physical abuse. Group comparisons were examined using Chi square tests for categorical variables, independent t-tests for continuous variables, and Mann Whitney U test for non-normal distribution variables (parity, education level and pain severity). When comparing the prevalence of different severity of dysmenorrhea, mild and moderate dysmenorrhea were classified under the value of 0 and severe dysmenorrhea was classified under the value of 1. The education level data was converted to ordinate data from 1–4 with 1 being less than 12 years of education and 4 being a postgraduate degree. To control for potential confounding factors of age, BMI, and parity, a binary logistic regression was conducted to evaluate the association between the outcomes of anxiety and depression, and a history of sexual and physical abuse (predictor, with no history as the reference category). An analysis of covariance for pain severity (outcome) compared in patients with and without a history of abuse (predictor) was conducted controlling for independent risk factors including depression, anxiety, mental quality of life, and physical quality of life. A p-value of 0.05 was considered statistically significant. Statistical analysis was performed using SPSS (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.). Results Of the 72 patients recruited, 44 (61%) were included in the final analyses. Reasons for exclusion were no response (n = 17, 24%), incomplete questionnaires (n = 9, 12%), and histological confirmation of no endometriosis at time of surgery (n = 2, 3%). Diagnosis of endometriosis was surgically confirmed in 30/44 (68%) patients; 12/44 patients (27%) were diagnosed by ultrasound and 2/44 (5%) were diagnosed based on clinical symptoms. Table 1 summarizes patient characteristics. In certain cases, patients checked more than one answer or did not answer; these discrepancies are noted where applicable. Thirty-four patients self-identified as Caucasian (n = 34, 72.3%). The mean age of patients was 37 years (standard deviation ± 6.6), with a mean BMI of 26 (± 6.0kg/m 2 ). The average age at the time of diagnosis was 32 years (± 7.3) and the delay from symptom onset to diagnosis was 8.7 years (± 8.0). The median number of previous pregnancies (gravida) was 1 (range: 0–5) and median number of live births (parity) was 0 (range 0–3). Fifty-four percent (n = 24) of patients reported a history of infertility. Thirty-five patients (80%) presented with deep endometriosis, 4 (9%) with ovarian endometriomas, and 5 (11%) with superficial endometriosis. Table 1 Study patient characteristics (N = 44) Characteristics Mean (SD) Age 37.11 (6.61) BMI 25.90 (6.02) Age at endometriosis diagnosis a Diagnosis delay a 32.44 (7.27) 8.71 (7.98) Median (range) Gravidity 1 (0–5) Parity 0 (0–3) N (%) Infertility 24 (54.5) Type of endometriosis Superficial 5 (11.4) Ovarian/endometrioma 4 (9.09) Deep 35 (79.5) Abuse type None 19 (43.2) Physical Abuse 19 (43.2) Sexual Abuse 19 (43.2) Physical and Sexual Abuse 13 (29.5) Physical and/or Sexual Abuse 25 (56.8) Ethnicity (self-identified) b White 34 (72.3) Black 2 (4.26) Asian / Pacific / Oriental 2 (4.26) Mixed ethnicity 1 (2.13) Other 8 (17.0) Cigarette smoking c 6 (15.0) Alcohol consumption 28 (63.6) Marital status d Married 22 (44.9) Separated 4 (8.16) Committed relationship 12 (24.5) Single 4 (8.16) Divorced 7 (14.3) Education level Less than 12 years 1 (2.27) High school graduate 4 (9.09) College degree 22 (50.0) Postgraduate degree 17 (38.6) Some patients did not answer: a n = 42, c n = 40. Some patients selected more than one answer: b n = 47, d n = 49. SD: standard deviation. Twenty-five patients (57%) reported a history of abuse (sexual, physical, or both); of these 19 patients (43%) reported a history of physical abuse, and 19 patients (43%) reported a history of sexual abuse. Patients with a history of physical abuse had a significantly higher mean age (40.16 ± 5.66 vs 34.80 ± 6.44, p = 0.006) and patients with a history of sexual abuse were more likely to be of Caucasian ethnicity than those without a history of sexual abuse (85% vs 63%) (Table 2). Table 2 Patient characteristics according to abuse history Characteristics Groups No sexual abuse (n = 25) Sexual abuse (n = 19) p -value No physical abuse (n = 25) Physical abuse (n = 19) p -value Age, Mean (SD) 35.76 (7.44) 38.89 (4.98) 0.102 34.80 (6.44) 40.16 (5.66) 0.006 BMI, Mean (SD) 25.67 (5.69) 26.21 (6.58) 0.774 26.39 (6.09) 25.26 (6.03) 0.543 Parity, Median (range) 0 (0–2) 0 (0–3) 0.482 0 (0–2) 1 (0–3) 0.062 Ethnicity (self-identified), N (%) c White 17 (62.96) a 17 (85.00) b 20 (74.07) a 14 (70.00) b Black 1 (3.70) a 1 (5.00) b 0 (0.00) a 2 (10.00) b Asian / Pacific / Oriental 2 (7.41) a 0 (0.00) b 2 (7.41) a 0 (0.00) b Mixed ethnicity 1 (3.70) a 0 (0.00) b 0 (0.00) a 1 (5.00) b Other 6 (22.22) a 2 (10.00) b 5 (18.52) a 3 (15.00) b Education level, N (%) 0.875 0.439 Less than 12 years 0 (0.00) 1 (5.26) 1 (4.00) 0 (0.00) High school graduate 3 (12.00) 1 (5.26) 3 (12.00) 1 (5.26) College degree 12 (48.00) 10 (52.63) 9 (36.00) 13 (68.42) Postgraduate degree 10 (40.00) 7 (36.84) 12 (48.00) 5 (26.32) Some patients selected more than one answer: a n = 27, b n=20. c A p-value was not calculated for ethnicity given the numerous groups that led to a very small sample size in each group. SD: standard deviation. There was no significant difference between patients with a history of sexual abuse and those with no history of sexual abuse in the prevalence of general non-cyclic pain (74% vs 64%, p = 0.495), dyschezia (71% vs 82%, p = 0.409), dyspareunia (79% vs 96%, p = 0.096), dysuria (44% vs 50%, p = 0.726), and severe dysmenorrhea (83% vs 64%, p = 0.163). Similarly, there was no significant difference between patients with a history of physical abuse and those with no history of physical abuse in the prevalence of general non-cyclic pain (68% vs 68%, p = 0.976), dyschezia (67% vs 86%, p = 0.324), dyspareunia (84% vs 91%, p = 0.480), dysuria (38% vs 54%, p = 0.159), and severe dysmenorrhea (74% vs 71%, p = 0.836)(Table 3 ). There was no significant difference between patients with a history of sexual abuse and those with no history of abuse in terms of severity of dysmenorrhea when the pain was at its worst (9.11 vs 8.46, p = 0.318), dyspareunia (7.33 vs 6.80, p = 0.755), and general non-cyclic pain (8.85 vs 8.56, p = 0.589); no difference between patients with a history of physical abuse and those with no abuse in the severity of dysmenorrhea when the pain was at its worst (8.79 vs 8.70, p = 0.765), dyspareunia (7.44 vs 6.68, p = 0.481), and general non-cyclic pain (8.77 vs 8.63, p = 0.846)(Table 4 ). Table 3 Prevalence of different types of pelvic pain according to abuse history Type of pelvic pain No sexual abuse (n = 25), % of patients Sexual abuse (n = 19), % of patients p-value No physical abuse (n = 25), % of patients Physical abuse (n = 19), % of patients p -value General non-cyclic 64.00 73.68 0.495 68.00 68.42 0.976 Dyschezia 81.82 a 70.59 c 0.409 85.71 e 66.67 d 0.324 Dyspareunia 95.65 b 78.95 0.096 91.3 b 84.21 0.480 Dysuria 50.00 a 44.44 d 0.726 54.54 a 38.49 d 0.159 Dysmenorrhea 0.163 g 0.836 g Mild 8.00 0.00 d 4.17 f 5.26 Moderate 28.00 16.67 d 25.00 f 21.05 Severe 64.00 83.33 d 70.83 f 73.68 Some patients did not answer: a n = 22, b n = 23, c n = 17, d n = 18, e n = 21, f n = 24. g = when calculating the p-value, mild and moderate dysmenorrhea were classified under the value of 0 and severe dysmenorrhea was classified under the value of 1 Mild dysmenorrhea defined as medication never or rarely needed. Moderate dysmenorrhea defined as medication usually needed. Severe dysmenorrhea defined as medication and bed rest needed. Table 4 Severity of pelvic pain when it was at its worst according to abuse history Type of pelvic pain No sexual abuse (n = 25), mean ± SD Sexual abuse (n = 19), mean ± SD p -value No physical abuse (n = 25), mean ± SD Physical abuse (n = 19), mean ± SD p -value Dysmenorrhea a 8.46 ± 2.15 b 9.11 ± 1.28 e 0.318 8.70 ± 1.87 h 8.79 ± 1.84 0.765 Dyspareunia a 6.80 ± 2.61 c 7.33 ± 1.84 f 0.755 6.68 ± 2.52 i 7.44 ± 2.00 d 0.481 General non-cyclic a 8.56 ± 1.55 d 8.85 ± 1.57 g 0.589 8.63 ± 1.59 d 8.77 ± 1.54 g 0.846 a Severity ranges from 0 to 10. Some patients did not answer: b n = 24, c n = 20, d n = 16, e n = 18, f n = 15, g n = 13, h n = 23, i n = 19. SD: standard deviation. The analysis of covariance assessing severity of dysmenorrhea, dyspareunia, and non-cyclic pain in patients with a history of sexual abuse and no sexual abuse and in patients with a history of physical abuse and no physical abuse, respectively, showed no significant difference when controlling for depression, anxiety, mental quality of life, and physical quality of life (p > 0.05)(Table 5 ). Table 5 Analysis of covariance comparing the severity of types of pain according to abuse history Type of pelvic pain No sexual abuse (n = 25), Group mean ± SD Sexual abuse (n = 19), Group mean ± SD p-value No physical abuse (n = 25), Group mean ± SD Physical abuse (n = 19), Group mean ± SD p-value Dysmenorrhea a 8.64 ± 0.40 b 8.85 ± 0.47 e 0.757 8.85 ± 0.39 h 8.59 ± 0.42 0.644 Dyspareunia a 7.17 ± 0.60 c 6.99 ± 0.72 f 0.860 6.88 ± 0.60 i 7.31 ± 0.62 d 0.638 General non-cyclic a 8.50 ± 0.50 d 8.72 ± 0.57 g 0.799 8.39 ± 0.47 d 8.81 ± 0.49 g 0.578 a Severity ranges from 0 to 10. Some patients did not answer: b n = 24, c n = 20, d n = 16, e n = 18, f n = 15, g n = 13, h n = 23, i n = 19. SD: standard deviation. In our study population, rates of anxiety were significantly higher among patients with a history of sexual abuse (58%) than those without (12%) (p = 0.001). Rates of depression were also significantly higher among patients with a history of sexual abuse (53%) than those with no history of sexual abuse (16%) (p = 0.012). There was no significant difference in rates of anxiety (p = 0.202) or depression (p = 0.054) between those patients with a history of physical abuse and those without (Table 6 ). When controlling for age, BMI, and parity with a binary logistic regression, a statistically significant effect of a history of sexual abuse on anxiety and depression was demonstrated, with persons reporting no history of sexual abuse being less likely to have anxiety (OR = 0.10, 95%CI = 0.02–0.48; p = 0.004) or depression (OR = 0.18, 95%CI = 0.04–0.77; p = 0.020). Whereas, in patient a history of physical abuse, no statistically significant effect was seen on anxiety (OR = 0.43, 95%CI = 0.10–1.82; p = 0.251) and on depression (OR = 0.26, 95%CI = 0.06–1.17; p = 0.079)(Table 7 ). Table 6 Anxiety and depression prevalence and summary component scores according to abuse history No sexual abuse (n = 25) Sexual abuse (n = 19) p-value No physical abuse (n = 25) Physical abuse (n = 19) p-value Psychiatric conditions Anxiety, N (%) 3 (12%) 11 (57.89%) 0.001 6 (24%) 8 (42.10%) 0.202 Depression, N (%) 4 (16%) 10 (52.63%) 0.012 5 (20%) 9 (47.37%) 0.054 Summary component scores a MCS, mean ± SD 42.31 ± 12.52 b 34.23 ± 14.08 c 0.028 41.78 ± 13.33 d 35.30 ± 13.54 0.063 PCS, mean ± SD 43.05 ± 10.85 b 41.85 ± 11.52 c 0.366 43.48 ± 10.41 d 41.40 ± 11.90 0.275 a Scores range from 0 to 100, with higher scores indicating better health. Some patients did not answer: b n = 24, c n = 18, d n = 23 MCS: mental component summary; PCS: physical component summary; SD: standard deviation. Table 7 Binary logistic regression comparing mental health conditions according to abuse history Psychiatric conditions History of sexual abuse History of physical abuse Odds ratio 95% CI p-value Odds ratio 95% CI p-value Anxiety 0.098 0.020–0.475 0.004 0.429 0.101–1.819 0.251 Depression 0.182 0.043–0.767 0.020 0.262 0.059–1.167 0.079 Patients with a history of sexual abuse had a significantly lower mean mental component summary score than patients with no history of sexual abuse (34.2 ± 14.1 vs 42.3 ± 12.5, p = 0.028); this difference was not significant for history of physical abuse (p = 0.063). No between group differences were observed for physical component summary scores (Table 6 ). Discussion In patients with endometriosis and pelvic pain, pelvic pain symptoms and severity were similar in patients with and without a history of abuse. Moreover, there was also no significant difference when controlling for confounders including depression, anxiety, mental quality of life, and physical quality of life. This suggests that there is no apparent association between the prevalence or severity of different types of pelvic pain and a history of physical or sexual abuse in an endometriosis population. This is consistent with previously published literature in patients with chronic pelvic pain [ 42 – 44 ], whereby there is no association with increased pain severity in patients with chronic pelvic pain with a history of abuse compared to non-abused controls. Furthermore, our data suggests there is no difference in the type of pain between abused and non-abused patients with endometriosis. Harris et al. observed an association between the incidence of laparoscopically-confirmed endometriosis and a history of abuse in a dose-responsive manner and noted a strong association between early life abuse and endometriosis-associated pain. However, their population also included a pain-free subset that presented with infertility that did not show this same relationship [ 29 ]. Our study presents data on a homogenous population of patients with endometriosis and pain symptoms, which indicates that factors influencing pain severity likely relate to unmeasured confounding factors. This is consistent with other studies that have identified an association between early life abuse and chronic pain in general, rather than a causal relationship to pelvic pain specifically [ 42 , 55 , 56 ]. Physiologically, endometriotic lesions account for only one component of the mechanisms that contribute to pain in patients with endometriosis, which also includes chronic inflammation, dysregulation of central stress response systems, peripheral sensitization, and neuroangiogenesis [ 1 , 57 , 58 ]. As such, it is important to consider a multifactorial approach to management of pain in endometriosis patients regardless of abuse history [ 59 , 60 ]. Previous studies have shown that women with endometriosis often have high rates of anxiety and depression [ 16 ] and overall low mental quality of life [ 14 , 15 ]. In our study, these findings were worse in patients with endometriosis who also have a history of sexual abuse, with even higher reported rates of anxiety and depression and lower overall mental quality of life. The difference in anxiety and depression remained statistically significant after controlling for age, BMI, and parity and there was no significant difference of pain type or severity between groups. These findings demonstrate the need to screen for mental health as well as abuse history, and the importance of being able to advocate for accessibility of mental health support in an endometriosis population. Ideally, health care resources for mental health services should be incorporated as part of comprehensive endometriosis care and be readily available if needed. An unanticipated finding of this study was the incidence of abuse in our population. Fifty seven percent of our population reported a history of any abuse, with 43% reporting a history of physical abuse, and 43% reporting a history of sexual abuse, and a 68% overlap between both groups. Canadian rates for child and adult abuse in women have been reported as 12% and 30% respectively for sexual abuse, and 22% and 26% respectively for physical abuse [ 61 , 62 ]. As such, our study reports a higher prevalence of abuse history than what is reported in the general population. This is consistent with other published literature demonstrating that history of abuse ranges from 45–65% in chronic pain populations in general, with no difference between types of chronic pain conditions [ 63 – 66 ]. There is an established link between adverse childhood adverse events, such as abuse, and poor mental and physical health [ 67 ]. Our study was not designed to ascertain the reason for this discrepancy, but given these findings addressing a history of abuse should be a part of any assessment for patients with endometriosis. Limitations There are a number of methodologic limitations in this study. A key limitation is the small sample size. A larger sample size might have shown a significant difference in depression rates and the mental component summary scores when comparing women with a history of physical abuse and no history of physical abuse, whereas in our population there was only a trend towards significance. Previous studies have found an association between a history of physical abuse and higher rates of anxiety and depression as well as lower quality of life in the general population [ 68 – 70 ]. Confounders were controlled by using depression, anxiety, mental quality of life, and physical quality of life as covariates for the analysis of covariance of pelvic pain severity according to abuse history. Also, demographics such as age, BMI and parity were used as control variables in the logistic regression evaluation abuse history on rates of anxiety and depression. Another limitation of the study is generalizability, as our patients were recruited from a tertiary care center and most presented with deep endometriosis. However, our quality of life values are similar to those of a national survey of Canadian women with endometriosis and therefore comparable to non-tertiary centers [ 14 ]. Further, the history of abuse and degree of pain when it was at its worst are subject to recall bias. Many studies have examined the validity of retrospective pain assessments, and the results are mixed ranging from underestimation to often overestimation [ 71 , 72 ]. Another study showed that childhood sexual abuse was underreported, and therefore likely underestimated [ 73 ]. Of note, the IPPS-PPA questionnaire includes the patient’s life being seriously threatened by another as one of the statements under physical abuse, which is not included in the revised Conflict Tactics Scale [ 74 ] or Childhood Trauma Questionnaire [ 75 ] used for the evaluation of physical abuse in other studies. However, patients that were included in the physical abuse group under these criteria only account for two out of the nineteen patients that reported physical abuse and therefore does not change the high rate of abuse. Finally, there was a proportion of our population that did not receive pathologic confirmation of a diagnosis of endometriosis. Although the cause of these patients’ pelvic pain could be due to other factors, these individuals have forgone surgical intervention diagnosis of endometriosis as they responded to specific treatment for this condition, thereby allowing the omission of an invasive procedure [ 3 – 5 ]. Conclusions In this study, no difference was observed between severity and type of pain symptoms in patients with endometriosis and a history of sexual or physical abuse compared to patients with endometriosis and no history of abuse. This brings into question a biological association between endometriosis symptom severity and abuse, and offers potential for future avenues of research. However, more than 40% of women with endometriosis in our population had a history of sexual abuse which is higher than rates in the general population. Furthermore, 57% of women in this population reported some form of abuse (sexual, physical, or both). Therefore, mental health and abuse screening in patients with endometriosis is critical to providing comprehensive care. The findings of this study call attention to the need for mental health resources in an endometriosis population to address patients’ psychosocial as well as physical needs as early and effectively as possible to provide the highest level of care. Our findings may assist healthcare professionals and patients to act as advocates to obtain additional funding for research and for programs that focus on comprehensive women’s health. Abbreviations EPHect Endometriosis Phenome and Biobanking Harmonization Project IPPS-PPA International Pelvic Pain Society Pelvic Pain Assessment SF-36 Medical Outcome Survey IBS irritable bowel syndrome BMI body mass index OR odds ratio Declarations Ethics approval and consent to participate : Ethics approval was obtained by the Ottawa Health Science Network Research Ethics Board (OHSN-REB 2017007701H). Informed consent was obtained from all participants in this study. Consent for publication: Not applicable Availability of data and materials: Data available on request. Subject to local institutional privacy/ethical restrictions. Please contact Dr Lortie for any request. Competing Interests: SSS has no conflicts of interest to declare. He reports grants and personal fees from Abbvie, grants and personal fees from Bayer outside the submitted work. The other authors declare that they have no competing interests. Funding : This study has not received any funding. Authors’ contributions: AG, CAJ, and TF contributed to conception and design, data analysis and interpretation, and drafting and critical revision of the article. KL contributed to conception and design. CAJ, TF, SSS, and KL contributed to data acquisition. KL and SSS provided critical revisions for the article. All authors have provided final approval for the article to be published and agree to act as guarantors for the work. Acknowledgements: The authors would like to acknowledge Dr. Arendas and Dr. Chen as well as the Minimally Invasive Gynecology Research Group at The Ottawa Hospital for their contributions in patient recruitment and data collection. References Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020 Mar 26;382(13):1244-56. doi:10.1056/NEJMra1810764. Leyland N, Casper R, Laberge P, Singh SS; SOGC. Endometriosis: diagnosis and management. J Obstet Gynaecol Can. 2010 Jul;32(7 Suppl 2):S1-32. Agarwal SK, Chapron C, Giudice LC, Laufer MR, Leyland N, Missmer SA, Singh SS, Taylor HS. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019 Apr;220(4):354.e1-354.e12. doi:10.1016/j.ajog.2018.12.039. Barcellos MB, Lasmar B, Lasmar R. Agreement between the preoperative findings and the operative diagnosis in patients with deep endometriosis. Arch Gynecol Obstet. 2016 Apr;293(4):845-50. doi:10.1007/s00404-015-3892-x. Taylor HS, Adamson GD, Diamond MP, Goldstein SR, Horne AW, Missmer SA, Snabes MC, Surrey E, Taylor RN. An evidence-based approach to assessing surgical versus clinical diagnosis of symptomatic endometriosis. Int J Gynaecol Obstet. 2018 Aug;142(2):131-142. doi: 10.1002/ijgo.12521. Shafrir A, Farland L, Shah D, Harris H, Kvaskoff M, Zondervan K, Missmer SA. Risk for and consequences of endometriosis: a critical epidemiologic review. Best Prac Res Clin Obstet Gynaecol. 2018 Aug;51:1-15. doi:10.1016/j.bpobgyn.2018.06.001. Fuldeore MJ, Soliman AM. Prevalence and symptomatic burden of diagnosed endometriosis in the United States: national estimates from a cross-sectional survey of 59,411 women. Gynecol Obstet Invest. 2017;82(5):453-61. doi:10.1159/000452660. Singh S, Soliman AM, Rahal Y, Robert C, Defoy I, Nisbet P, Leyland N. Prevalence, symptomatic burden, and diagnosis of endometriosis in Canada: cross-sectional survey of 30 000 women. J Obstet Gynaecol Can. 2020 Jul;42(7):829-38. doi:10.1016/j.jogc.2019.10.038. Hudelist G, Fritzer N, Thomas A, Niehues C, Oppelt P, Haas D, TammaaA, Salzer H. Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod. 2012 Dec;27(12):3412-6. doi:10.1093/humrep/des316. Moradi M, Parker M, Sneddon A, Lopez V, Ellwood D. Impact of endometriosis on women's lives: a qualitative study. BMC Womens Health. 2014 Oct 4;14:123. doi:10.1186/1472-6874-14-123. Staal AH, van der Zanden M, Nap AW. Diagnostic delay of endometriosis in the Netherlands. Gynecol Obstet Invest. 2016;81(4):321-4. doi:10.1159/000441911. Pugsley Z, Ballard K. Management of endometriosis in general practice: the pathway to diagnosis. Br J Gen Pract. 2007 Jun;57(539):470-6. Soliman AM, Fuldeore M, Snabes MC. Factors associated with time to endometriosis diagnosis in the United States. J Womens Health (Larchmt). 2017 Jul;26(7):788-97. doi:10.1089/jwh.2016.6003. Soliman AM, Singh S, Rahal Y, Robert C, Defoy I, Nisbet P, Leyland N. Cross-sectional survey of the impact of endometriosis symptoms on health-related quality of life in Canadian women. J Obstet Gynaecol Can. 2020 Nov;42(11):1330-8. doi:10.1016/j.jogc.2020.04.013. Verket NJ, Uhlig T, Sandvik L, Andersen MH, Tanbo TG, Qvigstad E. Health-related quality of life in women with endometriosis, compared with the general population and women with rheumatoid arthritis. Acta Obstet Gynecol Scand. 2018 Nov;97(11):1339-48. doi:10.1111/aogs.13427. Chen LC, Hsu JW, Huang KL, et al. Risk of developing major depression and anxiety disorders among women with endometriosis: A longitudinal follow-up study. J Affect Disord. 2016;190:282-285. doi:10.1016/j.jad.2015.10.030 Nnoaham KE, Hummelshoj L, Webster P, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011;96(2):366-373.e8. doi:10.1016/j.fertnstert.2011.05.090 De Graaff AA, D'Hooghe TM, Dunselman GA, et al. The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey. Hum Reprod. 2013;28(10):2677-2685. doi:10.1093/humrep/det284 Ballard KD, Seaman HE, de Vries CS, Wright JT. Can symptomatology help in the diagnosis of endometriosis? Findings from a national case-control study--part 1. BJOG. 2008 Oct;115(11):1382‐91. doi:10.1111/j.1471-0528.2008.01878.x. Sinaii N, Plumb K, Cotton L, Lambert A, Kennedy S, Zondervan K, Stratton P. Differences in characteristics among 1,000 women with endometriosis based on extent of disease. Fertil Steril. 2008 Mar;89(3):538‐45. doi:10.1016/j.fertnstert.2007.03.069. Schliep KC, Mumford SL, Peterson CM, et al. Pain typology and incident endometriosis. Hum Reprod. 2015;30(10):2427-2438. doi:10.1093/humrep/dev147 Ross CA. Childhood sexual abuse and psychosomatic symptoms in irritable bowel syndrome. J Child Sex Abus. 2005;14(1):27-38. doi:10.1300/J070v14n01_02 Heim C, Nater UM, Maloney E, Boneva R, Jones JF, Reeves WC. Childhood trauma and risk for chronic fatigue syndrome: association with neuroendocrine dysfunction. Arch Gen Psychiatry. 2009;66(1):72-80. doi:10.1001/archgenpsychiatry.2008.508 Cichowski SB, Dunivan GC, Komesu YM, Rogers RG. Sexual abuse history and pelvic floor disorders in women. South Med J. 2013;106(12):675-678. doi:10.1097/SMJ.0000000000000029 Collett BJ, Cordle CJ, Stewart CR, Jagger C. A comparative study of women with chronic pelvic pain, chronic nonpelvic pain and those with no history of pain attending general practitioners. Br J Obstet Gynaecol. 1998;105(1):87-92. doi:10.1111/j.1471-0528.1998.tb09356.x Lampe A, Sölder E, Ennemoser A, Schubert C, Rumpold G, Söllner W. Chronic pelvic pain and previous sexual abuse. 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Childhood maltreatment and migraine (part III). Association with comorbid pain conditions. Headache. 2010;50(1):42-51. doi:10.1111/j.1526-4610.2009.01558.x Schliep KC, Mumford SL, Johnstone EB, et al. Sexual and physical abuse and gynecologic disorders. Hum Reprod. 2016;31(8):1904-1912. doi:10.1093/humrep/dew153 Bourdon M, Antoine V, Combes U, et al. Severe pelvic pain is associated with sexual abuse experienced during childhood and/or adolescence irrespective of the presence of endometriosis. Hum Reprod. 2023;38(8):1499-1508. doi:10.1093/humrep/dead119 Coelho R, Viola TW, Walss-Bass C, Brietzke E, Grassi-Oliveira R. Childhood maltreatment and inflammatory markers: a systematic review. Acta Psychiatr Scand. 2014;129(3):180-192. doi:10.1111/acps.12217 Cuevas M, Flores I, Thompson KJ, Ramos-Ortolaza DL, Torres-Reveron A, Appleyard CB. Stress exacerbates endometriosis manifestations and inflammatory parameters in an animal model. 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Subst Use Misuse. 2021;56(1):87-92. doi:10.1080/10826084.2020.1840590 As-Sanie S, Clevenger LA, Geisser ME, Williams DA, Roth RS. History of abuse and its relationship to pain experience and depression in women with chronic pelvic pain. Am J Obstet Gynecol. 2014;210(4):317.e1-317.e8. doi:10.1016/j.ajog.2013.12.048 Poleshuck EL, Dworkin RH, Howard FM, et al. Contributions of physical and sexual abuse to women's experiences with chronic pelvic pain. J Reprod Med. 2005;50(2):91-100. Toomey TC, Hernandez JT, Gittelman DF, Hulka JF. Relationship of sexual and physical abuse to pain and psychological assessment variables in chronic pelvic pain patients. Pain. 1993;53(1):105-109. doi:10.1016/0304-3959(93)90062-T Yosef A, Allaire C, Williams C, et al. Multifactorial contributors to the severity of chronic pelvic pain in women. Am J Obstet Gynecol. 2016;215(6):760.e1-760.e14. doi:10.1016/j.ajog.2016.07.023 Vitonis AF, Vincent K, Rahmioglu N, et al. World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonization Project: II. Clinical and covariate phenotype data collection in endometriosis research. Fertil Steril. 2014;102(5):1223-1232. doi:10.1016/j.fertnstert.2014.07.1244 International Pelvic Pain Society. Burnsville (MN). https://www.pelvicpain.org/. Accessed 3 May 2021. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473-83. Ware JE. Advantages of norm-based scoring. https://www.optum.com/content/dam/optum/resources/Manual%20Excerpts/Norm-based%20Scoring%20(NBS).pdf. Accessed 22 May 2021. Leserman, J, Drossman D, Li Z. The reliability and validity of a sexual and physical abuse history questionnaire in female patients with gastrointestinal disorders. Behav Med. 1995;21(3):141-50. doi: 10.1080/08964289.1995.9933752. Becker CM, Laufer MR, Stratton P, et al. World Endometriosis Research Foundation Phenome and Biobanking Harmonization Project: I. Surgical phenotype data collection in endometriosis research. Fertil Steril. 2014 Nov;102(5):1213–22. doi:10.1016/j.fertnstert.2014.07.709. Guerriero S, Condous G, van den Bosch T, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016;48(3):318-332. doi:10.1002/uog.15955 Fraser MA, Agarwal S, Chen I, Singh SS. Routine vs. expert-guided transvaginal ultrasound in the diagnosis of endometriosis: a retrospective review. Abdom Imaging. 2015 Mar;40(3):587-94. doi:10.1007/s00261-014-0243-5. Reid S, Leonardi M, Lu C, Condous G. The association between ultrasound-based 'soft markers' and endometriosis type/location: a prospective observational study. Eur J Obstet Gynecol Reprod Biol. 2019 Mar;234:171-8. doi:10.1016/j.ejogrb.2019.01.018. Rapkin AJ, Kames LD, Darke LL, Stampler FM, Naliboff BD. History of physical and sexual abuse in women with chronic pelvic pain. Obstet Gynecol. 1990;76(1):92-96. Walling MK, Reiter RC, O'Hara MW, Milburn AK, Lilly G, Vincent SD. Abuse history and chronic pain in women: I. Prevalences of sexual abuse and physical abuse. Obstet Gynecol. 1994;84(2):193-199. Morotti M, Vincent K, Becker CM. Mechanisms of pain in endometriosis. Eur J Obstet Gynecol Reprod Biol. 2017;209:8-13. doi:10.1016/j.ejogrb.2016.07.497 Maddern J, Grundy L, Castro J, Brierley SM. Pain in Endometriosis. Front Cell Neurosci. 2020;14:590823. Published 2020 Oct 6. doi:10.3389/fncel.2020.590823 Lamvu G, Williams R, Zolnoun D, et al. Long-term outcomes after surgical and nonsurgical management of chronic pelvic pain: one year after evaluation in a pelvic pain specialty clinic. Am J Obstet Gynecol. 2006;195(2):591-600. doi:10.1016/j.ajog.2006.03.081 Opoku-Anane J, Orlando MS, Lager J, et al. The development of a comprehensive multidisciplinary endometriosis and chronic pelvic pain center. Journal of Endometriosis and Pelvic Pain Disorders. 2020;12(1):3-9. doi:10.1177/2284026519899015 Burczycka M, Conroy, S. Family violence in Canada: A statistical profile, 2015. Ottawa (ON): Statistics Canada. 2017. https://www150.statcan.gc.ca/n1/en/pub/85-002-x/2017001/article/14698-eng.pdf?st=X3a8yZ3Z. Accessed 8 April 2021. Cotter A, Savage L. Gender-based violence and unwanted sexual behaviour in Canada 2018 : Initial findings from the Survey of Safety in Public and Private Spaces. Ottawa (ON): Statistics Canada. 2019. https://www150.statcan.gc.ca/n1/en/pub/85-002-x/2019001/article/00017-eng.pdf?st=ido2xSBe. Accessed 8 April 2021. Linton SJ, Lardén M, Gillow AM. Sexual abuse and chronic musculoskeletal pain: prevalence and psychological factors. Clin J Pain. 1996;12(3):215-221. doi:10.1097/00002508-199609000-00009 Toomey TC, Seville JL, Mann JD, Abashian SW, Grant JR. Relationship of sexual and physical abuse to pain description, coping, psychological distress, and health-care utilization in a chronic pain sample. Clin J Pain. 1995;11(4):307-315. doi:10.1097/00002508-199512000-00008 Fillingim RB, Wilkinson CS, Powell T. Self-reported abuse history and pain complaints among young adults. Clin J Pain. 1999;15(2):85-91. doi:10.1097/00002508-199906000-00004 Krantz TE, Andrews N, Petersen TR, et al. Adverse Childhood Experiences Among Gynecology Patients With Chronic Pelvic Pain. Obstet Gynecol. 2019;134(5):1087-1095. doi:10.1097/AOG.0000000000003533 Poli-Neto OB, Tawasha KAS, Romão APMS, et al. History of childhood maltreatment and symptoms of anxiety and depression in women with chronic pelvic pain. J Psychosom Obstet Gynaecol. 2018;39(2):83-89. doi:10.1080/0167482X.2017.1306515 Fraga S, Soares J, Melchiorre MG, et al. Lifetime abuse and quality of life among older people. Health Soc Work. 2017 Nov 1;42(4):215-22. doi:10.1093/hsw/hlx036. Lin HS, Naimi AI, Brooks MM, Richardson GA, Burke JG, Bromberger JT. Life-course impact of child maltreatment on midlife health-related quality of life in women: longitudinal mediation analysis for potential pathways. Ann Epidemiol. 2020 Mar;43:58-65. doi:10.1016/j.annepidem.2020.01.005. Draper B, Pfaff JJ, Pirkis J, et al. Long-term effects of childhood abuse on the quality of life and health of older people: results from the Depression and Early Prevention of Suicide in General Practice Project. J Am Geriatr Soc. 2008 Feb;56(2):262-71. doi:10.1111/j.1532-5415.2007.01537.x. Feine JS, Lavigne GJ, Dao TTT, Morin C, Lund JP. Memories of chronic pain and perceptions of relief. Pain. 1998;77(2):137-141. doi:10.1016/S0304-3959(98)00089-X. Linton SJ. Memory for chronic pain intensity: correlates of accuracy. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-3889054\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":271016173,\"identity\":\"1d3e30cf-6c05-4050-ba0a-048dff540cae\",\"order_by\":0,\"name\":\"Alyssa Gaerke\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Children’s Hospital of Eastern Ontario\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Alyssa\",\"middleName\":\"\",\"lastName\":\"Gaerke\",\"suffix\":\"\"},{\"id\":271016174,\"identity\":\"f544768b-6753-4e96-ab66-f5670b11b8ab\",\"order_by\":1,\"name\":\"Caitlin Anne Jago\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Calgary\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Caitlin\",\"middleName\":\"Anne\",\"lastName\":\"Jago\",\"suffix\":\"\"},{\"id\":271016175,\"identity\":\"51615414-8d30-4ef8-9b47-523a6c536a7d\",\"order_by\":2,\"name\":\"Teresa Flaxman\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Ottawa\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Teresa\",\"middleName\":\"\",\"lastName\":\"Flaxman\",\"suffix\":\"\"},{\"id\":271016176,\"identity\":\"21494532-ab8e-42c6-9c50-5fd2b9eed866\",\"order_by\":3,\"name\":\"Sukhbir S. 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The gold standard for definitive diagnosis has traditionally been laparoscopy with histologic confirmation [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e], however with improved attention to history, physical examination, and expert guided imaging, it can also be diagnosed clinically [\\u003cspan additionalcitationids=\\\"CR4\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. Endometriosis affects an estimated 1 in 10 women of reproductive age [6 \\u0026minus;\\u0026thinsp;8]. Despite multiple theories and on-going investigations, the etiology remains largely undetermined [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e] and diagnosis may be delayed for 4\\u0026ndash;10 years after onset of pain symptoms [\\u003cspan additionalcitationids=\\\"CR9 CR10 CR11 CR12\\\" citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Endometriosis has a negative impact on quality of life [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e], affecting mental health [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e], work productivity [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e], and social and intimate relationships [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. While symptoms vary, pelvic pain is a key clinical feature including dysmenorrhea, dyspareunia, dyschezia, dysuria, and non-cyclic pelvic pain. If left untreated, endometriosis-related pain may progress to chronic pelvic pain [\\u003cspan additionalcitationids=\\\"CR20\\\" citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eMany studies have suggested that early life stressors such as childhood sexual and physical abuse are associated with pain conditions such as endometriosis, chronic pelvic pain, fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome (IBS) [\\u003cspan additionalcitationids=\\\"CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31\\\" citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]. Specifically, several studies have linked a history of childhood abuse to endometriosis, although results have been conflicting [\\u003cspan additionalcitationids=\\\"CR30 CR31 CR32 CR33\\\" citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e]. In one study, Harris et al. (n\\u0026thinsp;=\\u0026thinsp;60 595) showed that there is a higher rate of laparoscopically-confirmed endometriosis in women with a history of childhood sexual or physical abuse, and severity and chronicity of abuse showed a dose-response association with endometriosis risk [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]. A study by Thomas et al. (n\\u0026thinsp;=\\u0026thinsp;98) found significantly higher rates of sexual abuse history but not physical abuse history when comparing women with concurrent chronic pelvic pain and endometriosis to pain-free controls [\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]. This is supported by Liebermann et al. (n\\u0026thinsp;=\\u0026thinsp;842) who report higher prevalence of childhood sexual abuse in women with endometriosis compared to the general population control group [\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]. In contrast, other reports of abuse history in women with endometriosis found only significant associations with physical abuse [\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e] or no associations at all with history of physical or sexual abuse [\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e]. To date there is no causal link between history of abuse and diagnosis of endometriosis, although possible explanations have been proposed [\\u003cspan additionalcitationids=\\\"CR36 CR37\\\" citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eIn certain pain conditions such as IBS and fibromyalgia, childhood abuse is associated with increased pain severity [\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]. This association of pain severity and childhood abuse was also shown in patients with substance use disorders and chronic pain [\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]; this association with pain severity has not been shown in the chronic pelvic pain population [\\u003cspan additionalcitationids=\\\"CR43 CR44\\\" citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e]. To date, no studies have looked specifically at the relationship between pain severity and history of childhood abuse in an endometriosis population.\\u003c/p\\u003e \\u003cp\\u003eAs such, the primary purpose of our research was to assess whether there is a difference in severity and type of pain symptoms in patients with endometriosis that report a history of sexual and/or physical abuse compared to patients with no abuse history. Secondary objectives are to characterize any differences in quality of life and mental health in patients with concurrent pelvic pain and endometriosis between individuals with a history of physical and sexual abuse and those without.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy design\\u003c/h2\\u003e \\u003cp\\u003eThis is a cross-sectional cohort questionnaire study.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy population\\u003c/h2\\u003e \\u003cp\\u003eSeventy-two patients were recruited from a Canadian tertiary care gynecology clinic, specializing in endometriosis and pelvic pain, between May 2017 to May 2018. All patients presenting with suspected or confirmed endometriosis were eligible for inclusion. Inclusion criteria included age of 18 years or older, pre-menopausal, and capable of filling out the questionnaire. Patients were excluded from the study if they continued to surgical intervention and endometriosis was not confirmed by histology, and if they did not complete the study questionnaires.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eData collection\\u003c/h2\\u003e \\u003cp\\u003ePatients who consented to be part of the study completed a set of questionnaires about their medical and surgical history as well as their quality of life as it related to endometriosis. The set of questionnaires included: the Endometriosis Phenome and Biobanking Harmonization Project (EPHect) Clinical Questionnaire [\\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e], the International Pelvic Pain Society (IPPS) Pelvic Pain Assessment (IPPS-PPA) Form [\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e], and the Medical Outcome Survey (SF-36) [\\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e]. Patient reported demographics, pelvic pain symptoms, and medical and surgical history were extracted from EPHect and IPPS-PPA questionnaires. Demographic variables included age, body mass index (BMI), parity, gravidity, ethnicity, cigarette smoking, alcohol consumption, marital status, and education level.\\u003c/p\\u003e \\u003cp\\u003ePelvic pain symptoms included: history of dysmenorrhea, dysuria, dyschezia, dyspareunia, and non-cyclic pelvic pain. Dysmenorrhea was separated into categories including mild (medication never or rarely needed), moderate (medication usually needed), and severe (medications and bed rest needed). Severity of pain was defined in the standardized EPHect questionnaire as a time in the patient\\u0026rsquo;s life when the pelvic pain was at its worst and quantified on a numeric rating scale of 0 to 10 (0\\u0026thinsp;=\\u0026thinsp;no pain; 10\\u0026thinsp;=\\u0026thinsp;worst imaginable pain). Medical and surgical history included medical co-morbidities (including depression and anxiety), age of endometriosis diagnosis, age symptoms started, and previous abdominal surgeries. The SF-36 was used to quantify mental and physical quality of life using the mental component summary (MCS) and physical component summary (PCS) scores from SF-36, respectively, as described by Ware et al [\\u003cspan citationid=\\\"CR49\\\" class=\\\"CitationRef\\\"\\u003e49\\u003c/span\\u003e]. On the SF-36, a lower score is representative of reduced quality of life in each domain. Patient reports of sexual and physical abuse were extracted from the IPPS-PAA using validated questions from Leserman et al [\\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e]. Physical abuse was defined as having someone hit, kick, beat, or seriously threaten the life of the respondent. Sexual abuse was defined as any act that ranged from unwanted exposure to rape.\\u003c/p\\u003e \\u003cp\\u003ePatients were also classified into three groups based on their endometriosis type: superficial endometriosis, ovarian endometriomas, or deep endometriosis [\\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e51\\u003c/span\\u003e]. Endometriosis type was determined using surgical diagnosis or radiological imaging performed at a tertiary care centre with expertise in endometriosis imaging, using the International Deep Endometriosis Analysis group guidelines [\\u003cspan citationid=\\\"CR52\\\" class=\\\"CitationRef\\\"\\u003e52\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR53\\\" class=\\\"CitationRef\\\"\\u003e53\\u003c/span\\u003e]. If patients had no previous surgical diagnosis and if imaging was negative, their endometriosis was classified as superficial based on history and clinical presentation, as superficial endometriosis is difficult to detect on imaging such as ultrasound [\\u003cspan citationid=\\\"CR54\\\" class=\\\"CitationRef\\\"\\u003e54\\u003c/span\\u003e].\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical analysis\\u003c/h2\\u003e \\u003cp\\u003eThe data were summarized using descriptive statistics. The number (percentage) of patients with a history of sexual and/or physical abuse was calculated based on a patient reporting \\u0026ldquo;yes\\u0026rdquo; to any of the statements or questions in the sexual and physical abuse section of the IPPS-PPA form [\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e]. Pelvic pain prevalence and severity, rate of depression and anxiety, quality of life, and demographics were compared between patients with a history of sexual abuse and patients with no history of sexual abuse. Similarly, these variables were compared between patients with a history of physical abuse and patients without a history of physical abuse. Group comparisons were examined using Chi square tests for categorical variables, independent t-tests for continuous variables, and Mann Whitney U test for non-normal distribution variables (parity, education level and pain severity).\\u003c/p\\u003e \\u003cp\\u003eWhen comparing the prevalence of different severity of dysmenorrhea, mild and moderate dysmenorrhea were classified under the value of 0 and severe dysmenorrhea was classified under the value of 1. The education level data was converted to ordinate data from 1\\u0026ndash;4 with 1 being less than 12 years of education and 4 being a postgraduate degree. To control for potential confounding factors of age, BMI, and parity, a binary logistic regression was conducted to evaluate the association between the outcomes of anxiety and depression, and a history of sexual and physical abuse (predictor, with no history as the reference category). An analysis of covariance for pain severity (outcome) compared in patients with and without a history of abuse (predictor) was conducted controlling for independent risk factors including depression, anxiety, mental quality of life, and physical quality of life. A p-value of 0.05 was considered statistically significant. Statistical analysis was performed using SPSS (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.).\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eOf the 72 patients recruited, 44 (61%) were included in the final analyses. Reasons for exclusion were no response (n\\u0026thinsp;=\\u0026thinsp;17, 24%), incomplete questionnaires (n\\u0026thinsp;=\\u0026thinsp;9, 12%), and histological confirmation of no endometriosis at time of surgery (n\\u0026thinsp;=\\u0026thinsp;2, 3%). Diagnosis of endometriosis was surgically confirmed in 30/44 (68%) patients; 12/44 patients (27%) were diagnosed by ultrasound and 2/44 (5%) were diagnosed based on clinical symptoms.\\u003c/p\\u003e \\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e summarizes patient characteristics. In certain cases, patients checked more than one answer or did not answer; these discrepancies are noted where applicable. Thirty-four patients self-identified as Caucasian (n\\u0026thinsp;=\\u0026thinsp;34, 72.3%). The mean age of patients was 37 years (standard deviation\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.6), with a mean BMI of 26 (\\u0026plusmn;\\u0026thinsp;6.0kg/m\\u003csup\\u003e2\\u003c/sup\\u003e). The average age at the time of diagnosis was 32 years (\\u0026plusmn;\\u0026thinsp;7.3) and the delay from symptom onset to diagnosis was 8.7 years (\\u0026plusmn;\\u0026thinsp;8.0). The median number of previous pregnancies (gravida) was 1 (range: 0\\u0026ndash;5) and median number of live births (parity) was 0 (range 0\\u0026ndash;3). Fifty-four percent (n\\u0026thinsp;=\\u0026thinsp;24) of patients reported a history of infertility. Thirty-five patients (80%) presented with deep endometriosis, 4 (9%) with ovarian endometriomas, and 5 (11%) with superficial endometriosis.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e Study patient characteristics (N\\u0026thinsp;=\\u0026thinsp;44)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"2\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCharacteristics\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMean (SD)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e37.11 (6.61)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBMI\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25.90 (6.02)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge at endometriosis diagnosis\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003cp\\u003eDiagnosis delay\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e32.44 (7.27)\\u003c/p\\u003e \\u003cp\\u003e8.71 (7.98)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMedian (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGravidity\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (0\\u0026ndash;5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eParity\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0 (0\\u0026ndash;3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eN (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eInfertility\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e24 (54.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eType of endometriosis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSuperficial\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5 (11.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOvarian/endometrioma\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4 (9.09)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDeep\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e35 (79.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAbuse type\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNone\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e19 (43.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePhysical Abuse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e19 (43.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSexual Abuse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e19 (43.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePhysical and Sexual Abuse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e13 (29.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePhysical and/or Sexual Abuse\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25 (56.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEthnicity (self-identified)\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWhite\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e34 (72.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBlack\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2 (4.26)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAsian / Pacific / Oriental\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2 (4.26)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMixed ethnicity\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (2.13)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOther\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8 (17.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCigarette smoking\\u003csup\\u003ec\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6 (15.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAlcohol consumption\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e28 (63.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMarital status\\u003csup\\u003ed\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMarried\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e22 (44.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSeparated\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4 (8.16)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCommitted relationship\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e12 (24.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSingle\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4 (8.16)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDivorced\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e7 (14.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEducation level\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLess than 12 years\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (2.27)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHigh school graduate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4 (9.09)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCollege degree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e22 (50.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePostgraduate degree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e17 (38.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eSome patients did not answer: \\u003csup\\u003ea\\u003c/sup\\u003en = 42, \\u003csup\\u003ec\\u003c/sup\\u003en = 40.\\u003c/p\\u003e \\u003cp\\u003eSome patients selected more than one answer: \\u003csup\\u003eb\\u003c/sup\\u003en = 47, \\u003csup\\u003ed\\u003c/sup\\u003en = 49.\\u003c/p\\u003e \\u003cp\\u003eSD: standard deviation.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eTwenty-five patients (57%) reported a history of abuse (sexual, physical, or both); of these 19 patients (43%) reported a history of physical abuse, and 19 patients (43%) reported a history of sexual abuse.\\u003c/p\\u003e \\u003cp\\u003ePatients with a history of physical abuse had a significantly higher mean age (40.16\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;5.66 vs 34.80\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.44, p\\u0026thinsp;=\\u0026thinsp;0.006) and patients with a history of sexual abuse were more likely to be of Caucasian ethnicity than those without a history of sexual abuse (85% vs 63%) (Table\\u0026nbsp;2).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"No\\\" id=\\\"Taba\\\" border=\\\"1\\\"\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eTable\\u0026nbsp;2 Patient characteristics according to abuse history\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCharacteristics\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c6\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eGroups\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo sexual abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;25)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSexual abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;19)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ep -value\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eNo physical abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;25)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ePhysical abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;19)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep -value\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge, Mean (SD)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e35.76 (7.44)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e38.89 (4.98)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.102\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e34.80 (6.44)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e40.16 (5.66)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.006\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBMI, Mean (SD)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25.67 (5.69)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e26.21 (6.58)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.774\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e26.39 (6.09)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e25.26 (6.03)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.543\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eParity, Median (range)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0 (0\\u0026ndash;2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0 (0\\u0026ndash;3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.482\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0 (0\\u0026ndash;2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1 (0\\u0026ndash;3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.062\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEthnicity (self-identified), N (%)\\u003csup\\u003ec\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWhite\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e17 (62.96)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17 (85.00)\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e20 (74.07)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e14 (70.00)\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBlack\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (3.70)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1 (5.00)\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0 (0.00)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2 (10.00)\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAsian / Pacific / Oriental\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2 (7.41)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0 (0.00)\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2 (7.41)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0 (0.00)\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMixed ethnicity\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (3.70)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0 (0.00)\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0 (0.00)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1 (5.00)\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOther\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6 (22.22)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2 (10.00)\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5 (18.52)\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e3 (15.00)\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEducation level, N (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.875\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.439\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eLess than 12 years\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0 (0.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1 (5.26)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1 (4.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0 (0.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHigh school graduate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3 (12.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1 (5.26)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3 (12.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1 (5.26)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eCollege degree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e12 (48.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10 (52.63)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e9 (36.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e13 (68.42)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePostgraduate degree\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10 (40.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7 (36.84)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e12 (48.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e5 (26.32)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"6\\\" nameend=\\\"c6\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eSome patients selected more than one answer: \\u003csup\\u003ea\\u003c/sup\\u003en = 27, \\u003csup\\u003eb\\u003c/sup\\u003en=20.\\u003c/p\\u003e \\u003cp\\u003e\\u003csup\\u003ec\\u003c/sup\\u003eA p-value was not calculated for ethnicity given the numerous groups that led to a very small sample size in each group.\\u003c/p\\u003e \\u003cp\\u003eSD: standard deviation.\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eThere was no significant difference between patients with a history of sexual abuse and those with no history of sexual abuse in the prevalence of general non-cyclic pain (74% vs 64%, p\\u0026thinsp;=\\u0026thinsp;0.495), dyschezia (71% vs 82%, p\\u0026thinsp;=\\u0026thinsp;0.409), dyspareunia (79% vs 96%, p\\u0026thinsp;=\\u0026thinsp;0.096), dysuria (44% vs 50%, p\\u0026thinsp;=\\u0026thinsp;0.726), and severe dysmenorrhea (83% vs 64%, p\\u0026thinsp;=\\u0026thinsp;0.163). Similarly, there was no significant difference between patients with a history of physical abuse and those with no history of physical abuse in the prevalence of general non-cyclic pain (68% vs 68%, p\\u0026thinsp;=\\u0026thinsp;0.976), dyschezia (67% vs 86%, p\\u0026thinsp;=\\u0026thinsp;0.324), dyspareunia (84% vs 91%, p\\u0026thinsp;=\\u0026thinsp;0.480), dysuria (38% vs 54%, p\\u0026thinsp;=\\u0026thinsp;0.159), and severe dysmenorrhea (74% vs 71%, p\\u0026thinsp;=\\u0026thinsp;0.836)(Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e). There was no significant difference between patients with a history of sexual abuse and those with no history of abuse in terms of severity of dysmenorrhea when the pain was at its worst (9.11 vs 8.46, p\\u0026thinsp;=\\u0026thinsp;0.318), dyspareunia (7.33 vs 6.80, p\\u0026thinsp;=\\u0026thinsp;0.755), and general non-cyclic pain (8.85 vs 8.56, p\\u0026thinsp;=\\u0026thinsp;0.589); no difference between patients with a history of physical abuse and those with no abuse in the severity of dysmenorrhea when the pain was at its worst (8.79 vs 8.70, p\\u0026thinsp;=\\u0026thinsp;0.765), dyspareunia (7.44 vs 6.68, p\\u0026thinsp;=\\u0026thinsp;0.481), and general non-cyclic pain (8.77 vs 8.63, p\\u0026thinsp;=\\u0026thinsp;0.846)(Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e Prevalence of different types of pelvic pain according to abuse history\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eType of pelvic pain\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo sexual abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;25),\\u003c/p\\u003e \\u003cp\\u003e% of patients\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSexual abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;19),\\u003c/p\\u003e \\u003cp\\u003e% of patients\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ep-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eNo physical abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;25),\\u003c/p\\u003e \\u003cp\\u003e% of patients\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ePhysical abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;19),\\u003c/p\\u003e \\u003cp\\u003e% of patients\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep -value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGeneral non-cyclic\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e64.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e73.68\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.495\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e68.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e68.42\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.976\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDyschezia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e81.82\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e70.59\\u003csup\\u003ec\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.409\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e85.71\\u003csup\\u003ee\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e66.67\\u003csup\\u003ed\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.324\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDyspareunia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e95.65\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e78.95\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.096\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e91.3\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e84.21\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.480\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDysuria\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e50.00\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e44.44\\u003csup\\u003ed\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.726\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e54.54\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e38.49\\u003csup\\u003ed\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.159\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDysmenorrhea\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.163\\u003csup\\u003eg\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.836\\u003csup\\u003eg\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMild\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.00\\u003csup\\u003ed\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4.17\\u003csup\\u003ef\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e5.26\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eModerate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e28.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e16.67\\u003csup\\u003ed\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e25.00\\u003csup\\u003ef\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e21.05\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSevere\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e64.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e83.33\\u003csup\\u003ed\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e70.83\\u003csup\\u003ef\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e73.68\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"7\\\" nameend=\\\"c7\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eSome patients did not answer: \\u003csup\\u003ea\\u003c/sup\\u003en = 22, \\u003csup\\u003eb\\u003c/sup\\u003en = 23, \\u003csup\\u003ec\\u003c/sup\\u003en = 17, \\u003csup\\u003ed\\u003c/sup\\u003en = 18, \\u003csup\\u003ee\\u003c/sup\\u003en = 21, \\u003csup\\u003ef\\u003c/sup\\u003en = 24.\\u003c/p\\u003e \\u003cp\\u003e\\u003csup\\u003eg\\u003c/sup\\u003e= when calculating the p-value, mild and moderate dysmenorrhea were classified under the value of 0 and severe dysmenorrhea was classified under the value of 1\\u003c/p\\u003e \\u003cp\\u003eMild dysmenorrhea defined as medication never or rarely needed.\\u003c/p\\u003e \\u003cp\\u003eModerate dysmenorrhea defined as medication usually needed.\\u003c/p\\u003e \\u003cp\\u003eSevere dysmenorrhea defined as medication and bed rest needed.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e Severity of pelvic pain when it was at its worst according to abuse history\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eType of pelvic pain\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo sexual abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;25),\\u003c/p\\u003e \\u003cp\\u003emean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSexual abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;19),\\u003c/p\\u003e \\u003cp\\u003emean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ep -value\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eNo physical abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;25),\\u003c/p\\u003e \\u003cp\\u003emean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ePhysical abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;19),\\u003c/p\\u003e \\u003cp\\u003emean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep -value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDysmenorrhea\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8.46\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.15\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9.11\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.28\\u003csup\\u003ee\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.318\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e8.70\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.87\\u003csup\\u003eh\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e8.79\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.84\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.765\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDyspareunia\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6.80\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.61\\u003csup\\u003ec\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e7.33\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.84\\u003csup\\u003ef\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.755\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e6.68\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.52\\u003csup\\u003ei\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e7.44\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.00\\u003csup\\u003ed\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.481\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGeneral non-cyclic\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8.56\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.55\\u003csup\\u003ed\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8.85\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.57\\u003csup\\u003eg\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.589\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e8.63\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.59\\u003csup\\u003ed\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e8.77\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.54\\u003csup\\u003eg\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.846\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"7\\\" nameend=\\\"c7\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003csup\\u003ea\\u003c/sup\\u003eSeverity ranges from 0 to 10.\\u003c/p\\u003e \\u003cp\\u003eSome patients did not answer: \\u003csup\\u003eb\\u003c/sup\\u003en = 24, \\u003csup\\u003ec\\u003c/sup\\u003en = 20, \\u003csup\\u003ed\\u003c/sup\\u003en = 16, \\u003csup\\u003ee\\u003c/sup\\u003en = 18, \\u003csup\\u003ef\\u003c/sup\\u003en = 15, \\u003csup\\u003eg\\u003c/sup\\u003en = 13, \\u003csup\\u003eh\\u003c/sup\\u003en = 23, \\u003csup\\u003ei\\u003c/sup\\u003en = 19.\\u003c/p\\u003e \\u003cp\\u003eSD: standard deviation.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eThe analysis of covariance assessing severity of dysmenorrhea, dyspareunia, and non-cyclic pain in patients with a history of sexual abuse and no sexual abuse and in patients with a history of physical abuse and no physical abuse, respectively, showed no significant difference when controlling for depression, anxiety, mental quality of life, and physical quality of life (p\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05)(Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 5\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e Analysis of covariance comparing the severity of types of pain according to abuse history\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"8\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eType of pelvic pain\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo sexual abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;25),\\u003c/p\\u003e \\u003cp\\u003eGroup mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003eSexual abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;19),\\u003c/p\\u003e \\u003cp\\u003eGroup mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003ep-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eNo physical abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;25),\\u003c/p\\u003e \\u003cp\\u003eGroup mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ePhysical abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;19),\\u003c/p\\u003e \\u003cp\\u003eGroup mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003ep-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDysmenorrhea\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8.64\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.40\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8.85\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.47\\u003csup\\u003ee\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003e0.757\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e8.85\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.39\\u003csup\\u003eh\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e8.59\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.42\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.644\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDyspareunia\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e7.17\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.60\\u003csup\\u003ec\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e6.99\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.72\\u003csup\\u003ef\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003e0.860\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e6.88\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.60\\u003csup\\u003ei\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e7.31\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.62\\u003csup\\u003ed\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.638\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eGeneral non-cyclic\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8.50\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.50\\u003csup\\u003ed\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8.72\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.57\\u003csup\\u003eg\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003e0.799\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e8.39\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.47\\u003csup\\u003ed\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e8.81\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.49\\u003csup\\u003eg\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.578\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"8\\\" nameend=\\\"c8\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003csup\\u003ea\\u003c/sup\\u003eSeverity ranges from 0 to 10.\\u003c/p\\u003e \\u003cp\\u003eSome patients did not answer: \\u003csup\\u003eb\\u003c/sup\\u003en = 24, \\u003csup\\u003ec\\u003c/sup\\u003en = 20, \\u003csup\\u003ed\\u003c/sup\\u003en = 16, \\u003csup\\u003ee\\u003c/sup\\u003en = 18, \\u003csup\\u003ef\\u003c/sup\\u003en = 15, \\u003csup\\u003eg\\u003c/sup\\u003en = 13, \\u003csup\\u003eh\\u003c/sup\\u003en = 23, \\u003csup\\u003ei\\u003c/sup\\u003en = 19.\\u003c/p\\u003e \\u003cp\\u003eSD: standard deviation.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eIn our study population, rates of anxiety were significantly higher among patients with a history of sexual abuse (58%) than those without (12%) (p\\u0026thinsp;=\\u0026thinsp;0.001). Rates of depression were also significantly higher among patients with a history of sexual abuse (53%) than those with no history of sexual abuse (16%) (p\\u0026thinsp;=\\u0026thinsp;0.012). There was no significant difference in rates of anxiety (p\\u0026thinsp;=\\u0026thinsp;0.202) or depression (p\\u0026thinsp;=\\u0026thinsp;0.054) between those patients with a history of physical abuse and those without (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e). When controlling for age, BMI, and parity with a binary logistic regression, a statistically significant effect of a history of sexual abuse on anxiety and depression was demonstrated, with persons reporting no history of sexual abuse being less likely to have anxiety (OR\\u0026thinsp;=\\u0026thinsp;0.10, 95%CI\\u0026thinsp;=\\u0026thinsp;0.02\\u0026ndash;0.48; p\\u0026thinsp;=\\u0026thinsp;0.004) or depression (OR\\u0026thinsp;=\\u0026thinsp;0.18, 95%CI\\u0026thinsp;=\\u0026thinsp;0.04\\u0026ndash;0.77; p\\u0026thinsp;=\\u0026thinsp;0.020). Whereas, in patient a history of physical abuse, no statistically significant effect was seen on anxiety (OR\\u0026thinsp;=\\u0026thinsp;0.43, 95%CI\\u0026thinsp;=\\u0026thinsp;0.10\\u0026ndash;1.82; p\\u0026thinsp;=\\u0026thinsp;0.251) and on depression (OR\\u0026thinsp;=\\u0026thinsp;0.26, 95%CI\\u0026thinsp;=\\u0026thinsp;0.06\\u0026ndash;1.17; p\\u0026thinsp;=\\u0026thinsp;0.079)(Table\\u0026nbsp;\\u003cspan refid=\\\"Tab6\\\" class=\\\"InternalRef\\\"\\u003e7\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab5\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 6\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e Anxiety and depression prevalence and summary component scores according to abuse history\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo sexual abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;25)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSexual abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;19)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ep-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eNo physical abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;25)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ePhysical abuse\\u003c/p\\u003e \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;19)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003ePsychiatric conditions\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAnxiety, N (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3 (12%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11 (57.89%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e6 (24%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e8 (42.10%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.202\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDepression, N (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4 (16%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10 (52.63%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.012\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5 (20%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e9 (47.37%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.054\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c2\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003eSummary component scores\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMCS, mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e42.31\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;12.52\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e34.23\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.08\\u003csup\\u003ec\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.028\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e41.78\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.33\\u003csup\\u003ed\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e35.30\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;13.54\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.063\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePCS, mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e43.05\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.85\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e41.85\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.52\\u003csup\\u003ec\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.366\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e43.48\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;10.41\\u003csup\\u003ed\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e41.40\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;11.90\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.275\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"7\\\" nameend=\\\"c7\\\" namest=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003csup\\u003ea\\u003c/sup\\u003eScores range from 0 to 100, with higher scores indicating better health.\\u003c/p\\u003e \\u003cp\\u003eSome patients did not answer: \\u003csup\\u003eb\\u003c/sup\\u003en = 24, \\u003csup\\u003ec\\u003c/sup\\u003en = 18, \\u003csup\\u003ed\\u003c/sup\\u003en = 23\\u003c/p\\u003e \\u003cp\\u003eMCS: mental component summary; PCS: physical component summary; SD: standard deviation.\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab6\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 7\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e Binary logistic regression comparing mental health conditions according to abuse history\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003ePsychiatric conditions\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c4\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eHistory of sexual abuse\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c7\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003eHistory of physical abuse\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOdds ratio\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e95% CI\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ep-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eOdds ratio\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e95% CI\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003ep-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAnxiety\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.098\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.020\\u0026ndash;0.475\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.004\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.429\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.101\\u0026ndash;1.819\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.251\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDepression\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.182\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.043\\u0026ndash;0.767\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.020\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.262\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.059\\u0026ndash;1.167\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.079\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003ePatients with a history of sexual abuse had a significantly lower mean mental component summary score than patients with no history of sexual abuse (34.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.1 vs 42.3\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;12.5, p\\u0026thinsp;=\\u0026thinsp;0.028); this difference was not significant for history of physical abuse (p\\u0026thinsp;=\\u0026thinsp;0.063). No between group differences were observed for physical component summary scores (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e).\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn patients with endometriosis and pelvic pain, pelvic pain symptoms and severity were similar in patients with and without a history of abuse. Moreover, there was also no significant difference when controlling for confounders including depression, anxiety, mental quality of life, and physical quality of life. This suggests that there is no apparent association between the prevalence or severity of different types of pelvic pain and a history of physical or sexual abuse in an endometriosis population.\\u003c/p\\u003e \\u003cp\\u003eThis is consistent with previously published literature in patients with chronic pelvic pain [\\u003cspan additionalcitationids=\\\"CR43\\\" citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e], whereby there is no association with increased pain severity in patients with chronic pelvic pain with a history of abuse compared to non-abused controls. Furthermore, our data suggests there is no difference in the type of pain between abused and non-abused patients with endometriosis.\\u003c/p\\u003e \\u003cp\\u003eHarris et al. observed an association between the incidence of laparoscopically-confirmed endometriosis and a history of abuse in a dose-responsive manner and noted a strong association between early life abuse and endometriosis-associated pain. However, their population also included a pain-free subset that presented with infertility that did not show this same relationship [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]. Our study presents data on a homogenous population of patients with endometriosis and pain symptoms, which indicates that factors influencing pain severity likely relate to unmeasured confounding factors. This is consistent with other studies that have identified an association between early life abuse and chronic pain in general, rather than a causal relationship to pelvic pain specifically [\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR55\\\" class=\\\"CitationRef\\\"\\u003e55\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR56\\\" class=\\\"CitationRef\\\"\\u003e56\\u003c/span\\u003e]. Physiologically, endometriotic lesions account for only one component of the mechanisms that contribute to pain in patients with endometriosis, which also includes chronic inflammation, dysregulation of central stress response systems, peripheral sensitization, and neuroangiogenesis [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR57\\\" class=\\\"CitationRef\\\"\\u003e57\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR58\\\" class=\\\"CitationRef\\\"\\u003e58\\u003c/span\\u003e]. As such, it is important to consider a multifactorial approach to management of pain in endometriosis patients regardless of abuse history [\\u003cspan citationid=\\\"CR59\\\" class=\\\"CitationRef\\\"\\u003e59\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR60\\\" class=\\\"CitationRef\\\"\\u003e60\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003ePrevious studies have shown that women with endometriosis often have high rates of anxiety and depression [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e] and overall low mental quality of life [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. In our study, these findings were worse in patients with endometriosis who also have a history of sexual abuse, with even higher reported rates of anxiety and depression and lower overall mental quality of life. The difference in anxiety and depression remained statistically significant after controlling for age, BMI, and parity and there was no significant difference of pain type or severity between groups. These findings demonstrate the need to screen for mental health as well as abuse history, and the importance of being able to advocate for accessibility of mental health support in an endometriosis population. Ideally, health care resources for mental health services should be incorporated as part of comprehensive endometriosis care and be readily available if needed.\\u003c/p\\u003e \\u003cp\\u003eAn unanticipated finding of this study was the incidence of abuse in our population. Fifty seven percent of our population reported a history of any abuse, with 43% reporting a history of physical abuse, and 43% reporting a history of sexual abuse, and a 68% overlap between both groups. Canadian rates for child and adult abuse in women have been reported as 12% and 30% respectively for sexual abuse, and 22% and 26% respectively for physical abuse [\\u003cspan citationid=\\\"CR61\\\" class=\\\"CitationRef\\\"\\u003e61\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR62\\\" class=\\\"CitationRef\\\"\\u003e62\\u003c/span\\u003e]. As such, our study reports a higher prevalence of abuse history than what is reported in the general population. This is consistent with other published literature demonstrating that history of abuse ranges from 45\\u0026ndash;65% in chronic pain populations in general, with no difference between types of chronic pain conditions [\\u003cspan additionalcitationids=\\\"CR64 CR65\\\" citationid=\\\"CR63\\\" class=\\\"CitationRef\\\"\\u003e63\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR66\\\" class=\\\"CitationRef\\\"\\u003e66\\u003c/span\\u003e]. There is an established link between adverse childhood adverse events, such as abuse, and poor mental and physical health [\\u003cspan citationid=\\\"CR67\\\" class=\\\"CitationRef\\\"\\u003e67\\u003c/span\\u003e]. Our study was not designed to ascertain the reason for this discrepancy, but given these findings addressing a history of abuse should be a part of any assessment for patients with endometriosis.\\u003c/p\\u003e\\n\\u003ch3\\u003eLimitations\\u003c/h3\\u003e\\n\\u003cp\\u003eThere are a number of methodologic limitations in this study. A key limitation is the small sample size. A larger sample size might have shown a significant difference in depression rates and the mental component summary scores when comparing women with a history of physical abuse and no history of physical abuse, whereas in our population there was only a trend towards significance. Previous studies have found an association between a history of physical abuse and higher rates of anxiety and depression as well as lower quality of life in the general population [\\u003cspan additionalcitationids=\\\"CR69\\\" citationid=\\\"CR68\\\" class=\\\"CitationRef\\\"\\u003e68\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR70\\\" class=\\\"CitationRef\\\"\\u003e70\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eConfounders were controlled by using depression, anxiety, mental quality of life, and physical quality of life as covariates for the analysis of covariance of pelvic pain severity according to abuse history. Also, demographics such as age, BMI and parity were used as control variables in the logistic regression evaluation abuse history on rates of anxiety and depression.\\u003c/p\\u003e \\u003cp\\u003eAnother limitation of the study is generalizability, as our patients were recruited from a tertiary care center and most presented with deep endometriosis. However, our quality of life values are similar to those of a national survey of Canadian women with endometriosis and therefore comparable to non-tertiary centers [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eFurther, the history of abuse and degree of pain when it was at its worst are subject to recall bias. Many studies have examined the validity of retrospective pain assessments, and the results are mixed ranging from underestimation to often overestimation [\\u003cspan citationid=\\\"CR71\\\" class=\\\"CitationRef\\\"\\u003e71\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR72\\\" class=\\\"CitationRef\\\"\\u003e72\\u003c/span\\u003e]. Another study showed that childhood sexual abuse was underreported, and therefore likely underestimated [\\u003cspan citationid=\\\"CR73\\\" class=\\\"CitationRef\\\"\\u003e73\\u003c/span\\u003e]. Of note, the IPPS-PPA questionnaire includes the patient\\u0026rsquo;s life being seriously threatened by another as one of the statements under physical abuse, which is not included in the revised Conflict Tactics Scale [\\u003cspan citationid=\\\"CR74\\\" class=\\\"CitationRef\\\"\\u003e74\\u003c/span\\u003e] or Childhood Trauma Questionnaire [\\u003cspan citationid=\\\"CR75\\\" class=\\\"CitationRef\\\"\\u003e75\\u003c/span\\u003e] used for the evaluation of physical abuse in other studies. However, patients that were included in the physical abuse group under these criteria only account for two out of the nineteen patients that reported physical abuse and therefore does not change the high rate of abuse.\\u003c/p\\u003e \\u003cp\\u003eFinally, there was a proportion of our population that did not receive pathologic confirmation of a diagnosis of endometriosis. Although the cause of these patients\\u0026rsquo; pelvic pain could be due to other factors, these individuals have forgone surgical intervention diagnosis of endometriosis as they responded to specific treatment for this condition, thereby allowing the omission of an invasive procedure [\\u003cspan additionalcitationids=\\\"CR4\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e].\\u003c/p\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eIn this study, no difference was observed between severity and type of pain symptoms in patients with endometriosis and a history of sexual or physical abuse compared to patients with endometriosis and no history of abuse. This brings into question a biological association between endometriosis symptom severity and abuse, and offers potential for future avenues of research. However, more than 40% of women with endometriosis in our population had a history of sexual abuse which is higher than rates in the general population. Furthermore, 57% of women in this population reported some form of abuse (sexual, physical, or both). Therefore, mental health and abuse screening in patients with endometriosis is critical to providing comprehensive care. The findings of this study call attention to the need for mental health resources in an endometriosis population to address patients\\u0026rsquo; psychosocial as well as physical needs as early and effectively as possible to provide the highest level of care. Our findings may assist healthcare professionals and patients to act as advocates to obtain additional funding for research and for programs that focus on comprehensive women\\u0026rsquo;s health.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eEPHect\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eEndometriosis Phenome and Biobanking Harmonization Project\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eIPPS-PPA\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eInternational Pelvic Pain Society Pelvic Pain Assessment\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eSF-36\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eMedical Outcome Survey\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eIBS\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eirritable bowel syndrome\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eBMI\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ebody mass index\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eOR\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eodds ratio\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e:\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eEthics approval was obtained by the Ottawa Health Science Network Research Ethics Board (OHSN-REB 2017007701H). Informed consent was obtained from all participants in this study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication:\\u0026nbsp;\\u003c/strong\\u003eNot applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials:\\u003c/strong\\u003e Data available on request. Subject to local institutional privacy/ethical restrictions. Please contact Dr Lortie for any request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting Interests:\\u0026nbsp;\\u003c/strong\\u003eSSS\\u0026nbsp;has no conflicts of interest to declare. He reports grants and personal fees from Abbvie, grants and personal fees from Bayer outside the submitted work. The other authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e: This study has not received any funding.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; contributions:\\u0026nbsp;\\u003c/strong\\u003eAG, CAJ, and TF contributed to conception and design, data analysis and interpretation, and drafting and critical revision of the article. KL contributed to conception and design. CAJ, TF, SSS, and KL contributed to data acquisition. KL and SSS provided critical revisions for the article. All authors have provided final approval for the article to be published and agree to act as guarantors for the work.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements:\\u0026nbsp;\\u003c/strong\\u003eThe authors would like to acknowledge Dr. Arendas and Dr. Chen as well as the Minimally Invasive Gynecology Research Group at The Ottawa Hospital for their contributions in patient recruitment and data collection.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eZondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020 Mar 26;382(13):1244-56. doi:10.1056/NEJMra1810764.\\u003c/li\\u003e\\n\\u003cli\\u003eLeyland N, Casper R, Laberge P, Singh SS; SOGC. Endometriosis: diagnosis and management. J Obstet Gynaecol Can. 2010 Jul;32(7 Suppl 2):S1-32.\\u003c/li\\u003e\\n\\u003cli\\u003eAgarwal SK, Chapron C, Giudice LC, Laufer MR, Leyland N, Missmer SA, Singh SS, Taylor HS. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019 Apr;220(4):354.e1-354.e12. doi:10.1016/j.ajog.2018.12.039.\\u003c/li\\u003e\\n\\u003cli\\u003eBarcellos MB, Lasmar B, Lasmar R. Agreement between the preoperative findings and the operative diagnosis in patients with deep endometriosis. Arch Gynecol Obstet. 2016 Apr;293(4):845-50. doi:10.1007/s00404-015-3892-x.\\u003c/li\\u003e\\n\\u003cli\\u003eTaylor HS, Adamson GD, Diamond MP, Goldstein SR, Horne AW, Missmer SA, Snabes MC, Surrey E, Taylor RN. An evidence-based approach to assessing surgical versus clinical diagnosis of symptomatic endometriosis. Int J Gynaecol Obstet. 2018 Aug;142(2):131-142. doi: 10.1002/ijgo.12521. \\u003c/li\\u003e\\n\\u003cli\\u003eShafrir A, Farland L, Shah D, Harris H, Kvaskoff M, Zondervan K, Missmer SA. Risk for and consequences of endometriosis: a critical epidemiologic review. Best Prac Res Clin Obstet Gynaecol. 2018 Aug;51:1-15. doi:10.1016/j.bpobgyn.2018.06.001.\\u003c/li\\u003e\\n\\u003cli\\u003eFuldeore MJ, Soliman AM. Prevalence and symptomatic burden of diagnosed endometriosis in the United States: national estimates from a cross-sectional survey of 59,411 women. Gynecol Obstet Invest. 2017;82(5):453-61. doi:10.1159/000452660.\\u003c/li\\u003e\\n\\u003cli\\u003eSingh S, Soliman AM, Rahal Y, Robert C, Defoy I, Nisbet P, Leyland N. Prevalence, symptomatic burden, and diagnosis of endometriosis in Canada: cross-sectional survey of 30 000 women. J Obstet Gynaecol Can. 2020 Jul;42(7):829-38. doi:10.1016/j.jogc.2019.10.038.\\u003c/li\\u003e\\n\\u003cli\\u003eHudelist G, Fritzer N, Thomas A, Niehues C, Oppelt P, Haas D, TammaaA, Salzer H. Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences. Hum Reprod. 2012 Dec;27(12):3412-6. doi:10.1093/humrep/des316.\\u003c/li\\u003e\\n\\u003cli\\u003eMoradi M, Parker M, Sneddon A, Lopez V, Ellwood D. Impact of endometriosis on women\\u0026apos;s lives: a qualitative study. BMC Womens Health. 2014 Oct 4;14:123. doi:10.1186/1472-6874-14-123.\\u003c/li\\u003e\\n\\u003cli\\u003eStaal AH, van der Zanden M, Nap AW. Diagnostic delay of endometriosis in the Netherlands. Gynecol Obstet Invest. 2016;81(4):321-4. doi:10.1159/000441911.\\u003c/li\\u003e\\n\\u003cli\\u003ePugsley Z, Ballard K. Management of endometriosis in general practice: the pathway to diagnosis. Br J Gen Pract. 2007 Jun;57(539):470-6.\\u003c/li\\u003e\\n\\u003cli\\u003eSoliman AM, Fuldeore M, Snabes MC. Factors associated with time to endometriosis diagnosis in the United States. J Womens Health (Larchmt). 2017 Jul;26(7):788-97. doi:10.1089/jwh.2016.6003.\\u003c/li\\u003e\\n\\u003cli\\u003eSoliman AM, Singh S, Rahal Y, Robert C, Defoy I, Nisbet P, Leyland N. Cross-sectional survey of the impact of endometriosis symptoms on health-related quality of life in Canadian women. J Obstet Gynaecol Can. 2020 Nov;42(11):1330-8. doi:10.1016/j.jogc.2020.04.013.\\u003c/li\\u003e\\n\\u003cli\\u003eVerket NJ, Uhlig T, Sandvik L, Andersen MH, Tanbo TG, Qvigstad E. Health-related quality of life in women with endometriosis, compared with the general population and women with rheumatoid arthritis. Acta Obstet Gynecol Scand. 2018 Nov;97(11):1339-48. doi:10.1111/aogs.13427.\\u003c/li\\u003e\\n\\u003cli\\u003eChen LC, Hsu JW, Huang KL, et al. Risk of developing major depression and anxiety disorders among women with endometriosis: A longitudinal follow-up study. J Affect Disord. 2016;190:282-285. doi:10.1016/j.jad.2015.10.030\\u003c/li\\u003e\\n\\u003cli\\u003eNnoaham KE, Hummelshoj L, Webster P, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011;96(2):366-373.e8. doi:10.1016/j.fertnstert.2011.05.090\\u003c/li\\u003e\\n\\u003cli\\u003eDe Graaff AA, D\\u0026apos;Hooghe TM, Dunselman GA, et al. The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey. Hum Reprod. 2013;28(10):2677-2685. doi:10.1093/humrep/det284\\u003c/li\\u003e\\n\\u003cli\\u003eBallard KD, Seaman HE, de Vries CS, Wright JT. Can symptomatology help in the diagnosis of endometriosis? Findings from a national case-control study--part 1. BJOG. 2008 Oct;115(11):1382‐91. doi:10.1111/j.1471-0528.2008.01878.x.\\u003c/li\\u003e\\n\\u003cli\\u003eSinaii N, Plumb K, Cotton L, Lambert A, Kennedy S, Zondervan K, Stratton P. Differences in characteristics among 1,000 women with endometriosis based on extent of disease. Fertil Steril. 2008 Mar;89(3):538‐45. doi:10.1016/j.fertnstert.2007.03.069.\\u003c/li\\u003e\\n\\u003cli\\u003eSchliep KC, Mumford SL, Peterson CM, et al. 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Subst Use Misuse. 2021;56(1):87-92. doi:10.1080/10826084.2020.1840590\\u003c/li\\u003e\\n\\u003cli\\u003eAs-Sanie S, Clevenger LA, Geisser ME, Williams DA, Roth RS. History of abuse and its relationship to pain experience and depression in women with chronic pelvic pain. Am J Obstet Gynecol. 2014;210(4):317.e1-317.e8. doi:10.1016/j.ajog.2013.12.048\\u003c/li\\u003e\\n\\u003cli\\u003ePoleshuck EL, Dworkin RH, Howard FM, et al. Contributions of physical and sexual abuse to women\\u0026apos;s experiences with chronic pelvic pain. J Reprod Med. 2005;50(2):91-100.\\u003c/li\\u003e\\n\\u003cli\\u003eToomey TC, Hernandez JT, Gittelman DF, Hulka JF. Relationship of sexual and physical abuse to pain and psychological assessment variables in chronic pelvic pain patients. Pain. 1993;53(1):105-109. doi:10.1016/0304-3959(93)90062-T\\u003c/li\\u003e\\n\\u003cli\\u003eYosef A, Allaire C, Williams C, et al. Multifactorial contributors to the severity of chronic pelvic pain in women. Am J Obstet Gynecol. 2016;215(6):760.e1-760.e14. doi:10.1016/j.ajog.2016.07.023\\u003c/li\\u003e\\n\\u003cli\\u003eVitonis AF, Vincent K, Rahmioglu N, et al. World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonization Project: II. Clinical and covariate phenotype data collection in endometriosis research. Fertil Steril. 2014;102(5):1223-1232. doi:10.1016/j.fertnstert.2014.07.1244\\u003c/li\\u003e\\n\\u003cli\\u003eInternational Pelvic Pain Society. Burnsville (MN). https://www.pelvicpain.org/. Accessed 3 May 2021.\\u003c/li\\u003e\\n\\u003cli\\u003eWare JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473-83.\\u003c/li\\u003e\\n\\u003cli\\u003eWare JE. Advantages of norm-based scoring. https://www.optum.com/content/dam/optum/resources/Manual%20Excerpts/Norm-based%20Scoring%20(NBS).pdf. Accessed 22 May 2021.\\u003c/li\\u003e\\n\\u003cli\\u003eLeserman, J, Drossman D, Li Z. The reliability and validity of a sexual and physical abuse history questionnaire in female patients with gastrointestinal disorders. Behav Med. 1995;21(3):141-50. doi: 10.1080/08964289.1995.9933752.\\u003c/li\\u003e\\n\\u003cli\\u003eBecker CM, Laufer MR, Stratton P, et al. World Endometriosis Research Foundation Phenome and Biobanking Harmonization Project: I. Surgical phenotype data collection in endometriosis research. Fertil Steril. 2014 Nov;102(5):1213\\u0026ndash;22. doi:10.1016/j.fertnstert.2014.07.709. \\u003c/li\\u003e\\n\\u003cli\\u003eGuerriero S, Condous G, van den Bosch T, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016;48(3):318-332. doi:10.1002/uog.15955\\u003c/li\\u003e\\n\\u003cli\\u003eFraser MA, Agarwal S, Chen I, Singh SS. Routine vs. expert-guided transvaginal ultrasound in the diagnosis of endometriosis: a retrospective review. Abdom Imaging. 2015 Mar;40(3):587-94. doi:10.1007/s00261-014-0243-5. \\u003c/li\\u003e\\n\\u003cli\\u003eReid S, Leonardi M, Lu C, Condous G. The association between ultrasound-based \\u0026apos;soft markers\\u0026apos; and endometriosis type/location: a prospective observational study. Eur J Obstet Gynecol Reprod Biol. 2019 Mar;234:171-8. doi:10.1016/j.ejogrb.2019.01.018.\\u003c/li\\u003e\\n\\u003cli\\u003eRapkin AJ, Kames LD, Darke LL, Stampler FM, Naliboff BD. History of physical and sexual abuse in women with chronic pelvic pain. Obstet Gynecol. 1990;76(1):92-96. \\u003c/li\\u003e\\n\\u003cli\\u003eWalling MK, Reiter RC, O\\u0026apos;Hara MW, Milburn AK, Lilly G, Vincent SD. Abuse history and chronic pain in women: I. 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Journal of Endometriosis and Pelvic Pain Disorders. 2020;12(1):3-9. doi:10.1177/2284026519899015\\u003c/li\\u003e\\n\\u003cli\\u003eBurczycka M, Conroy, S. Family violence in Canada: A statistical profile, 2015. Ottawa (ON): Statistics Canada. 2017. https://www150.statcan.gc.ca/n1/en/pub/85-002-x/2017001/article/14698-eng.pdf?st=X3a8yZ3Z. Accessed 8 April 2021.\\u003c/li\\u003e\\n\\u003cli\\u003eCotter A, Savage L. Gender-based violence and unwanted sexual behaviour in Canada 2018 : Initial findings from the Survey of Safety in Public and Private Spaces. Ottawa (ON): Statistics Canada. 2019. https://www150.statcan.gc.ca/n1/en/pub/85-002-x/2019001/article/00017-eng.pdf?st=ido2xSBe. Accessed 8 April 2021. \\u003c/li\\u003e\\n\\u003cli\\u003eLinton SJ, Lard\\u0026eacute;n M, Gillow AM. Sexual abuse and chronic musculoskeletal pain: prevalence and psychological factors. Clin J Pain. 1996;12(3):215-221. doi:10.1097/00002508-199609000-00009\\u003c/li\\u003e\\n\\u003cli\\u003eToomey TC, Seville JL, Mann JD, Abashian SW, Grant JR. Relationship of sexual and physical abuse to pain description, coping, psychological distress, and health-care utilization in a chronic pain sample. Clin J Pain. 1995;11(4):307-315. doi:10.1097/00002508-199512000-00008\\u003c/li\\u003e\\n\\u003cli\\u003eFillingim RB, Wilkinson CS, Powell T. Self-reported abuse history and pain complaints among young adults. Clin J Pain. 1999;15(2):85-91. doi:10.1097/00002508-199906000-00004\\u003c/li\\u003e\\n\\u003cli\\u003eKrantz TE, Andrews N, Petersen TR, et al. Adverse Childhood Experiences Among Gynecology Patients With Chronic Pelvic Pain. Obstet Gynecol. 2019;134(5):1087-1095. doi:10.1097/AOG.0000000000003533\\u003c/li\\u003e\\n\\u003cli\\u003ePoli-Neto OB, Tawasha KAS, Rom\\u0026atilde;o APMS, et al. 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Am J Psychiatry. 1994 Aug;151(8):1132-6. doi: 10.1176/ajp.151.8.1132.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Gynecology, women’s health, endometriosis, abuse, mental health, quality of life, depression, questionnaire study, pelvic pain\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-3889054/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-3889054/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eSexual and physical abuse are associated with endometriosis, but their relationship to pain in endometriosis patients has not been studied. The aim of this study was to characterize the prevalence of sexual and physical abuse history in an endometriosis population and its relationship to severity and type of pain symptoms.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eThis was a cross-sectional questionnaire study conducted from May 2017 to May 2018 at a tertiary care gynecology clinic. Women with clinically suspected or surgically confirmed endometriosis were included. Patients completed the Endometriosis Phenome and Biobanking Harmonization Project (EPHect) Clinical Questionnaire, the International Pelvic Pain Society Pelvic Pain Assessment Form, and the Medical Outcome Survey (SF-36). Relationships between history of sexual abuse or physical abuse, pelvic pain type and severity, anxiety/depression diagnosis, quality of life, and demographics were analysed using Chi square, independent t-tests, Mann-Whitney U test, and logistic regression models.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eForty-four women were surveyed. Severity and type of pain symptoms were similar in patients with and without a history of sexual or physical abuse. Forty-three percent (n\\u0026thinsp;=\\u0026thinsp;19) of patients with endometriosis reported history of physical abuse and 43% (n\\u0026thinsp;=\\u0026thinsp;19) reported history of sexual abuse with a 68% overlap between both groups. Patients with a history of sexual abuse had significantly higher rates of depression (53% vs 16%; p\\u0026thinsp;=\\u0026thinsp;0.012) and anxiety (58% vs 12%; p\\u0026thinsp;=\\u0026thinsp;0.001) than those reporting no history of sexual abuse and reported significantly lower mean SF-36 mental component summary scores (34\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14 vs 42\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;12, p\\u0026thinsp;=\\u0026thinsp;0.028).\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eNo differences in severity and type of pain symptoms in patients with a history of sexual or physical abuse were observed compared to those without. More than 40% (n\\u0026thinsp;=\\u0026thinsp;19) of patients with endometriosis reported a history of sexual abuse, with more anxiety and depression and lower mental quality of life scores compared to patients who reported no history of sexual abuse. This highlights the need for sexual abuse and mental health screening in an endometriosis population.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Prevalence of Abuse in Women with Endometriosis and Relationship to Pain Symptoms: A Cross-Sectional Questionnaire Study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-02-06 08:14:14\",\"doi\":\"10.21203/rs.3.rs-3889054/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"f06962fa-28af-4f36-ba21-ce20349763c3\",\"owner\":[],\"postedDate\":\"February 6th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-04-03T07:27:59+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-02-06 08:14:14\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-3889054\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-3889054\",\"identity\":\"rs-3889054\",\"version\":[\"v1\"]},\"buildId\":\"WvIrzKhiLBfengagbw6Ux\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC0","license_restricted":false}