Comparison of Enzian and rASRM classifications in predicting symptoms of sexual dysfunction in endometriosis

Paula Norinho, Rosa Zulmira Vaz de Macedo, Mariana M Martins, Mariana V. Martins, Hélder Ferreira
The journal of sexual medicine · 2025 · vol. 22(7) , pp. 1147–1157 · doi:10.1093/jsxmed/qdaf086 · PMID:40349207 · W4410312410
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study found that the Enzian classification system, but not the rASRM system, showed a possible association between sexual dysfunction and deep infiltrating endometriosis involving the sacrouterine ligaments, cardinal ligaments, or pelvic sidewall.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

The paper compared the Enzian classification and the revised American Society for Reproductive Medicine (rASRM) staging system for their ability to predict symptoms of sexual dysfunction in people with endometriosis. It used a high-level classification-based analysis linking endometriosis lesion extent and stage to reported sexual dysfunction outcomes, and found that the two systems performed differently in predicting these symptoms. The authors note limitations including the reliance on classification categories and the need to interpret findings in the context of study design and available symptom measurement. This paper is centrally about endometriosis — it evaluates how Enzian versus rASRM classifications predict sexual dysfunction symptoms.

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Abstract

BACKGROUND: Endometriosis is known to negatively impact sexual function; however, limited research has explored whether classification systems can help pinpoint specific anatomical locations associated with sexual dysfunction. This study was necessitated by the paucity of literature on classification systems that allow clinicians to associate specific symptoms of sexual dysfunction with particular locations of deep infiltrating endometriosis (DIE). AIM: This study aimed to investigate whether the Enzian and revised American Society for Reproductive Medicine (rASRM) classification systems can predict sexual dysfunction based on the localization and extent of DIE. METHODS: A clinical study was conducted with 77 women with histologically confirmed DIE. Data were collected from gynecological consultations and surgical reports classified using the rASRM and Enzian systems. Sexual function was assessed using the Female Sexual Function Index. Statistical analyses included Fisher's exact test, Mann-Whitney test, and Student's t-test. OUTCOMES: The primary outcome was to examine the relationship between endometriosis localization, disease extent, and sexual dysfunction as indicated by the two classification systems under investigation. RESULTS: A possible association was identified between sexual dysfunction and Enzian B classification (p = 0.013*), implicating involvement of the sacrouterine ligaments, cardinal ligaments, or pelvic sidewall. No significant association was found between sexual dysfunction and rASRM scores. A correlation between the number of endometriosis locations and the presence of sexual dysfunction was also observed (p = 0.015*). However, it is important to note that patients classified as Enzian B may have had additional, undocumented lesions in other locations not identified through available medical records, imaging, or surgical reports. These unidentified lesions could have influenced their sexual dysfunction, representing a potential confounding factor in our analysis. CLINICAL IMPLICATIONS: These findings suggest that the localization of DIE may contribute to sexual dysfunction, but further validation is required before drawing clinical conclusions regarding surgical interventions. STRENGTHS & LIMITATIONS: This is the first study to explore the ability of a classification system to pinpoint sexual dysfunction in endometriosis to a particular anatomical location, providing novel insights into DIE's impact on sexual health. However, variability in referral sources, the potential for undocumented lesions, and a small sample size for cases of sexual dysfunction may limit the generalizability of these findings. CONCLUSION: Disease localization, particularly in the uterosacral ligaments and pelvic sidewall, may contribute to sexual dysfunction, offering potential guidance for clinical evaluation. However, further research is necessary to validate these associations while accounting for potential confounding factors.

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Outcome instruments

rASRM Enzian

Condition tags

mesh:D004715endometriosisdie_deep_infiltrating

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (29)

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