Influential Factors on Sexual Function in Infertile Women with Endometriosis: A Path Analysis

Influential Factors on Sexual Function in Infertile Women with Endometriosis: A Path Analysis | 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 Influential Factors on Sexual Function in Infertile Women with Endometriosis: A Path Analysis samaneh youseflu(Former Corresponding Author), Shahideh Jahanian Sadatmahalleh(New Corresponding Author), and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.2.21328/v2 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 May, 2020 Read the published version in BMC Women's Health → Version 2 posted 9 You are reading this older preprint version Read the latest preprint version → Show more versions Abstract Background: Endometriosis have a negative influence on women’s sexual life. The aim of the current study was to test a conceptual model considering the interrelated role of anxiety, depression, sleep quality, physical activity, BMI, stage of endometriosis, the intensity of dyspareunia and pelvic pain on sexual function (SF) in infertile women with endometriosis. Also test the mediating role of sleep quality, anxiety, and depression. Method: In the present cross-sectional study, 220 infertile women with a laparoscopically confirmed endometriosis were recruited. Data were collected using a socio-demographic checklist, Female Sexual Function Index (FSFI), Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Visual Analog Scale (VAS). Results: We found that anxiety, depression, sleep quality, BMI, level of education, stage of endometriosis, and dyspareunia have a direct effect on women’s SF. In our study, sleep quality, anxiety, pelvic pain, and depression were the four major mediators that the higher scores lead to a decrease in the SF of endometriosis patients. The intensity of pelvic pain with an effect on sleep quality and dyspareunia change women’s SF. The lower level of physical activity, and higher BMI with indirect effect thorough anxiety, and sleep quality can worsen SF. Also, a higher level of anxiety leads to poor sleep quality and depression. Anxiety with both direct and indirect effect impress women’s SF. Conclusion: It seems that the main risk factors for sexual dysfunction in women with endometriosis are higher rates of anxiety, depression, poor sleep quality, pelvic pain, and dyspareunia. In the care of women with endometriosis, not only laparoscopy and medical treatment should be performed but also psychotherapeutic and psychosexual help should be offered. Preventive Medicine Internal Medicine Endometriosis sexual function path model sleep quality HADS pain intensity Figures Figure 1 Introduction Endometriosis, affecting up to 10% of reproductive age women, is one of the most common gynecological diseases (1). Pelvic pain and infertility are prevalent in 35–50% of affected women (2). These women may also suffer from low self-esteem, psychological distress including stress, anxiety, and depression and poor social support (3, 4). They may struggle with economic problems due to costs of diagnosis and treatment of chronic pelvic pain or infertility. These altogether are known risk factors for sexual dysfunction (5-10) . Most of the previous studies indicated that sexual dysfunction is higher in endometriosis women in comparison with healthy individuals (5, 8, 9, 11, 12). Sexual function is an essential and integral aspect of reproductive health and quality of life that is influenced by medical conditions, physical, interpersonal, psychological, and sociocultural factors (13). A biopsychosocial approach is necessary to guide research and clinical care regarding women’s SF. The bio-psycho-social impact of endometriosis has a negative impact on female SF (14). Sexual dysfunction may lead to reduced quality of life ‎‎(QOL), increased psychological disorder, interpersonal and marital difficulties (15, 16). On the other hand, psychological issues play an important role in sexual dysfunction (15). In women with major depressive disorder decreased desire, diminished arousal, and difficulty achieving orgasm are most common (17). in addition, physical discomfort (such as dyspareunia or pelvic pain) can engender psychological problems (18, 19). The purpose of the current study was to test a conceptual model considering the interrelated role of anxiety, depression, sleep quality, physical activity, endometriosis stage, the intensity of dyspareunia and pelvic pain on sexual dysfunction of women with endometriosis. Also test the mediating role of sleep quality, anxiety, and depression. According to the above objectives, our study proposes the following hypotheses (Hypotheses 1–5): Hypothesis 1: The intensity of chronic pain and dyspareunia of patients with endometriosis predict sexual dysfunction, psychological problems and poor sleep quality (the pain hypothesis). Hypothesis 2: The negative impact of endometriosis like depression and anxiety predict sexual dysfunction (the mental health hypothesis). Hypothesis 3: The degree of endometriosis found in laparoscopy predicts SF. Hypothesis 4: A higher level of education and physical activity will be associated with improved SF in women with endometriosis. Hypothesis 5: A higher BMI will be associated with sexual dysfunction, and worsens sleep quality. Material And Method Design and Data Collection This study was a cross-sectional study of endometriosis women who attended the Infertility Clinic of Arash Hospital in Tehran in the period from May 2016 to February 2017. In this period, the total number of currently infertile women (400 women) who underwent diagnostic laparoscopy was selected. Based on laparoscopic findings, we exclude women with abnormalities other than endometriosis. The subjects included 220 infertile women with a laparoscopic and/or histological diagnosis of endometriosis. Endometriosis stage was scored based on the revised classification of the American Fertility Society (20). Inclusion criteria included age range of 15-45 years, absence of the history of chronic diseases or condition resulting in sexual dysfunction (such as cardiovascular disease, diabetes, hysterectomy, ‎premature ovarian failure etc.), not using any drugs affecting ‎sexual response cycle, married and living with husband, and having sexual intercourse in the past 4 weeks.‎ Ethics This study was approved by the ethics committee of Tarbiat Modares University of Medical Sciences (IR.TMU.REC.1395.358). After explaining the study's purposes, written consent and verbal assent was collected from all participants and women were informed that their participation was voluntary, confidential, and anonymous. Measures Socio-demographic and anthropometric characteristics including women’ and spouses’ age, age at marriage, BMI, educational level, income, occupational status were collected for all participants. Participants were asked to report their exercise hours/week. Sexual Function: SF during a four-week period was assessed by the Persian version of the Female Sexual Function Index (FSFI), which has been previously validated by Mohammadi et al. (21). The FSFI is a 19-item questionnaire that includes six main aspects of SFs including sexual desire (two items), arousal (four items), lubrication (four items), orgasm (three items), satisfaction (three items) and pain (three items). The score for all items ranges between 0–5 except for items 1, 2, 15, and 16 (ranging 1–5). The sum score of each domain was multiplied in its certain factor. This factor was 0.6 for desire, 0.3 for arousal and lubrication, and 0.4 for orgasm, satisfaction, and pain. The total score was calculated by adding the six domain scores, which higher scores indicating better SF. Depression and Anxiety: For detecting and classifying the severity of anxiety and depression, Hospital Anxiety and Depression Scale (HADS) was used. The instrument contains 14 questions and consists of two subscales including anxiety (HADS-A) and depression (HADS-D). Each question was rated on a 4-point Likert-type scale (0=never, 1=seldom, 2=sometimes & 3= always). Total scores less than 8 indicate normal range; scores 8-10 reflect mild alterations and scores more than 11 indicate clinically significant levels of anxiety/depression. The validity and reliability of this questionnaire were confirmed by Montazeri et al. (22) . Pelvic pain and dyspareunia: The intensity of pelvic pain and dyspareunia was measured based on the Visual Analog Scale (VAS). This scale consists of a straight line that ranges from zero (no pain) to ten (the most severe pain possible). Subjects were asked to score their pain severity on a scale from 0 to 10. Sleep Quality: Multiple aspects of sleep quality during the previous month was assessed using the valid and reliable Persian version of the Pittsburgh Sleep Quality Index (PSQI) (23). This questionnaire contains 19 items in seven domains (sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction) on a scale from 0 to 3; so the total score of PSQI is from 0 to 21. A total score higher than 5 identifies poor sleep quality and scores lower than 5 show absence of sleep disorder. All participants answered all questionnaires. 11 questionnaires have not been analyzed due to incomplete data. The risk factors of sexual dysfunction were assessed by path analysis. Statistical analysis: Data analysis was performed using the SPSS Software (version 21) and LISREL software (version 8.8). Bivariate correlations and descriptive analysis were used to analyze the degree of correlation between the SF of endometriosis women with sleep quality, anxiety, depression, endometriosis stage, the intensity of pelvic pain and dyspareunia. A path model was used to evaluate the predictive effects of independent variables on SF in women with endometriosis. Path analysis is a kind of multiple regression statistical analysis that is utilized to asses causal models by testing a specific pattern of relationship between some variables. Direct, indirect, and total effects of causal relations between variables were found by path analysis. We used the lisrel statistical program to fit the path model, which we hypothesized. For evaluation of the model fitness, RMSEA (Root mean square error of approximation), AGFI (adjusted goodness of fit index), CFI (Confirmatory Factor Analytic), and Chi-square/df were used. RMSEA values less than 0.07, Chi-square/df lower than 3, AGFI more than 0.9, and CFI more than 0.95 are indicative of a good fitting model. T-value greater than +2 or less than – 2 were considered statistically significant. Results Table 1 describes the demographic characteristics of the subjects. The means and standard deviations (SD) of the age and partner age were 32.10(5.44) and 36.63(5.59) years, respectively. Their mean BMI were 27.44 (4.66). Endometriosis was staged as 29.2% minimal (stage I), 22% mild (stage II), 25.4% moderate (stage III) and 23.4% severe (stage IV). Less than half of participants (43.06%) had academic degrees and about 23.4% of them were employed. Their mean BMI was 27.44 (4.66). Table 2 demonstrates the Correlation (bivariate analysis) between all variables submitted to the path model. Results showed that SF was associated with anxiety (r=-0.45, p<0.001), depression (r=-0.39, p<0.001), BMI (r=-0.42, p<0.001), pelvic pain (r= -0.36, p<0.001), dyspareunia (r= -0.36, p<0.001), endometriosis stage (r=-0.28, p<0.001), sleep quality (r=-0.44, p<0.001). Based on the conceptual model, the predictors of SF had good fitness indices (P-value=0.09; chi2= 32.03; DF=23; chi2/df=1.39; RMSEA=0.04; CFI=0.98; AGFI=0.93) (Table 3). Findings from the path analysis indicating the direct, indirect and total effects from the predictors on SF are reported in Table 4 and illustrated in Figure 1. We found that anxiety (β = -0.22), depression (β = -0.20), sleep quality (β = -0.29), BMI (β = -0.22), level of education (β = 0.14), stage of endometriosis (β = -0. 16), and dyspareunia (β = -0.23) have a direct effect on women’s SF. In our study, sleep quality, anxiety, pelvic pain, and depression were the four major mediators that the higher scores lead to a decrease in the SF of endometriosis patients. The intensity of pelvic pain with effect on sleep quality (β = 0.13), and dyspareunia (β = 0.46) change women’s SF. The lower level of physical activity, and higher BMI with indirect effect thorough anxiety, and sleep quality can worsen SF. Also, a higher level of anxiety leads to poor sleep quality (β = 0.22) and depression (β = 0.24). Anxiety with both direct (β = -0.23) and indirect effect (β = -0.11) impress women’s SF. Discussion The study uses a so-called pathway analysis in which all possible factors are put in to find out that indeed all factors contribute to different functions assessed in the FSFI. Recently, several studies were conducted to explore the factors affecting the SF of women with endometriosis (6, 11, 12, 24). There is controversy regarding the strength of the relationship between physical and psychological variables and women's SF due to uncontrolled interrelationships with various effects of modifiers, mediators or confounding variables on SF of endometriosis women. To our knowledge, this survey is the first research that simultaneously evaluated the hypothesis that physical and psychological consequences of endometriosis are related to SF of women. The results of the present study indicated that sleep quality, the intensity of pelvic pain and dyspareunia, physical activity, stage of endometriosis, anxiety, and depression were significant impacting SF in women with endometriosis. In women with endometriosis, deep dyspareunia is a common symptom. Dyspareunia can be triggered by mechanical pressure on endometriotic lesion during intercourse or by traction of scarred and anelastic endometriotic lesion. Pain during intercourse can increase the risk of another type of sexual dysfunction (such as disorders in desire, lubrication, arousal, and orgasm) (25). In Evangelista et al.’s study, endometriosis women had more dyspareunia than healthy women. However, there was no significant relationship between total FSFI score in women with and without endometriosis (26). While in Tripoli et al study (9), chronic pelvic pain related to endometriosis or other gynecologic disorders led to a reduction in female SF (reduces the frequency of vaginal intercourse, orgasms, and sexual satisfaction) and QOL. Mauro Cozzolino et al. reported that there was no significant difference between mean FSFI scores of the two groups (with and without pain), only endometriotic lesions at the rectovaginal site, was associated with more impaired sexual activity and SF (27). The result from the Shum study demonstrated that worse sexual quality of life was associated with severe deep dyspareunia, severe superficial dyspareunia, increased depression, higher pain catastrophizing , bladder pain syndrome, and heterosexual orientation (5). In one qualitative study, endometriosis-related dyspareunia had a negative impact on women’s lives (such as avoiding sexual activity, reduced self-esteem, and quality of couple relationships) (28). In these patients, dyspareunia is not the only determinative factor of sexual health. Many factors such as chronic pelvic pain, advanced endometriosis stage and the presence of psychological and physical comorbidities, personality traits and women’s expectations affect women's SF (16). The result of the present study showed that anxiety and depression have more impact on the SF of women with endometriosis; a higher score indicates a more negative effects on women’s SF. Our results are inconsistent with the finding of some similar studies conducted in other countries (29-33). Graaff et al.’s study demonstrates, dyspareunia and depressive symptoms in women with endometriosis have a negative impact on SF, however, their male partner's SF is not affected by women's disease (34). The results of Finn et al.'s study on the level of sexual satisfaction in men and women with chronic pain demonstrates when psychological variables such as anxiety on sexual satisfaction are considered, variables of physical such as pain accounts for very low additional variance (35). Our findings further showed that physical activity was the variable that significantly affected the SF of women with endometriosis. In women, increased endocrine factors (such as estrogen, oxytocin, testosterone, and cortisol) and alpha-amylase level (as a marker of sympathetic nervous system activity) following exercise can improve physiological sexual arousal (36). In the other hand chronic exercise is related to the improvement of body image and psychological factors that increase sexual well-being (36, 37). To our knowledge, the influencing factors on sexual dysfunction in Iranian women with endometriosis have not been assessed before. The combination of the evaluated domains (anxiety, sleep, depression, pelvic pain, endometriosis stage) is the major strength of this study as endometriosis is already well known to show interactions with each domain separately. Other strengths of the current study include confirmed diagnosis through laparoscopy, a developed conceptual model (path diagram in Figure 1), and the use of validated questionnaires (eg, FSFI, HADS, VAS scale, PSQI, etc.). Despite the strengths of this study, the results have some limitations. One of the limitations of this study is that we did not consider the impact of other variables which can affect SF (such as hormonal level, love, Intimacy, partner violence, and intrapersonal relationship, etc.). It has been suggested that future studies consider these issues. The selection of patients who are all recruited from an infertility unit is another limitation of this study. Suffer from infertility itself is a risk factor of sexual dysfunction with complex dynamics depending on the duration of infertility, cause of infertility and chosen treatment with the invasiveness of the procedure, financial burden, etc. In many Asian countries, sexual issues are overlooked, ignored and considered taboo (38, 39). Regarding the religion and culture of Iranian women, talk about sexual behaviors are considered as stigma and embarrassment, thus there might be a social desirability bias among the subjects (40, 41). Also, we did not use a validated tool for the evaluation of physical activity. Our results only apply to married women as we excluded unmarried women. Conclusion Regarding the influence of endometriosis on women’s physical and mental health, it is not unlikely that the highest impact of endometriosis on sexual dysfunction is exerted by anxiety, depression, sleep quality, pelvic pain, and dyspareunia. Also, results suggest that despite the potentially impairing impacts of pelvic pain and dyspareunia, other factors such as endometriosis stage, educational status, physical activity, and BMI may affect SF. In the care of women with endometriosis, not only laparoscopy and medical treatment should be performed but also psychotherapeutic and psychosexual help should be offered. List Of Abbreviations FSFI: Female Sexual Function Index SF: sexual function PSQI: Pittsburgh Sleep Quality Index HADS: Hospital Anxiety and Depression Scale VAS: Visual Analog Scale QOL: Quality of Life Declarations Ethical approval The study was approved by the Tarbiat Modares University of Medical Sciences (IR.TMU.REC.1396.659). All procedures were in accordance with the ethical standards of the Regional research committee and with the Declaration of Helsinki 1964 and it later amendments. Informed consent Informed consent was obtained from all participants included in the current study. Contributors’ statements SH.J and S.Y contributed to the conception and design of the study; SY and SH.J did the literature search; M.N performed the statistical analysis; SY, SHJ, and M.B wrote the first draft of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version. conflict and interest The authors declare no conflict of interest. Funding None. Author agreement All authors have seen and approved the final version of the manuscript being submitted. All authors warrant that the article is the authors' original work, has not received the prior publication, and is not under consideration for publication elsewhere. Availability of data and materials The data sets used and analyzed during the current study are available from the corresponding author on reasonable request Acknowledgments This study was carried out with the kind collaboration of the participants. We would also like to appreciate the staff of Arash Hospital for their valuable contributions. This study is a part of research work done in Tarbiat Modares University, Tehran, Iran. There were no conflicts of interest. References 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. Gynecologic and obstetric investigation. 2017;82(5):453-61. Giudice LC, Kao LC. Endometriosis. Lancet (London, England). 2004;364(9447):1789-99. Melis I, Litta P, Nappi L, Agus M, Melis GB, Angioni S. Sexual function in women with deep endometriosis: correlation with quality of life, intensity of pain, depression, anxiety, and body image. International Journal of Sexual Health. 2015;27(2):175-85. Ferrero S, Esposito F, Abbamonte LH, Anserini P, Remorgida V, Ragni N. Quality of sex life in women with endometriosis and deep dyspareunia. Fertility and sterility. 2005;83(3):573-9. 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Characteristic 32.10±5.44 Age (years) * 36.63±5.59 Partner age * 27.44±4.66 BMI * 61(29.2) 46(22) 53(25.4) 49(23.4) Stage of endometriosis ** Stage1 Stage2 Stage3 Stage4 119(56.93) 90(43.06) Education ** Lower than university University 160(76.55) 49(23.44) Occupation 2 Housewife Employed * Values are given as mean ± SD, ** Values are given as number (%), BMI; Body Mass Index. Table 2. Correlations between sleep quality, anxiety, depression, pelvic pain, dyspareunia, BMI, endometriosis stage and sexual function. 1 2 3 4 5 6 7 1. Poor Sleep quality - - - - - - - 2. Anxiety 0.32 *** - - - - - - 3. Depression 0.16 * 0.21 ** - - - - - 4. Pelvic pain 0.21 ** 0.24 *** 0.23 *** - - - - 5. Dyspareunia 0.06 0.15* 0.18 * 0.45 *** - - - 6. BMI 0.30 *** 0.25 *** 0.11 0.14* 0.06 - - 7. Stage 0.10 0.05 0.06 0.22 * 0.10 0.13 - 8. Sexual function -0.44 *** -0.45 *** -0.39 *** -0.36*** -0.36 *** -0.42 *** -0.28 *** Values are given as Pearson coefficient (P-value) using Pearson correlation test. * P < 0.05; ** P < 0.01; *** P < 0.001. Table 3. The goodness of Fit Indices for the Models. P-value Chi-square/df ٭٭٭٭ df Chi-square RMSEA ٭٭٭ AGFI ٭٭ CFI* 0.09 1.39 23 32.03 0.04 0.93 0.98 Path N=209 *CFI: comparative fit index, ٭٭ AGFI: Adjusted goodness fit index, ٭٭٭ RMSEA: root mean square error of approximation, ٭٭٭٭ Chi-square/df: chi-square to the degree of freedom index. Table 4. Path coefficients for, anxiety, depression, physical activity, BMI, sleep quality, stage of endometriosis, the intensity of pelvic pain, dyspareunia and sexual function of women with endometriosis. Predictors Direct effect Indirect effect Total effect T-value FSFI BMI -0.22 -0.10 -0.32 -6.36 Depression -0.20 - -0.20 -3.96 Physical activity - 0.31 0.31 3.14 Dyspareunia -0.23 - - 0.23 -4.84 Pelvic pain - -0.19 - 0. 19 - 4.44 anxiety -0.23 -0.11 -0.34 -6.16 Poor sleep quality -0.29 - -0.29 -5.62 Stage -0.16 -0.10 -0.26 -3.86 Education 0.14 - 0.14 2.89 Anxiety BMI Physical activity 0.24 -0.15 - - 0.24 -0.15 3.61 -2.21 Depression Exercise BMI Anxiety - - 0.24 -0.18 -0.04 - -0.18 0.04 0.24 -1.88 2.54 3.58 Poor sleep quality Exercise BMI Stage Pelvic pain Anxiety -0.17 0.19 - 0.13 0.22 -0.14 0.04 0.09 - - -0.31 0.23 0.09 0.13 0.22 -3.06 3.72 1.70 2.04 3.29 Pelvic pain Stage 0.21 - 0.21 3.07 Dyspareunia Stage Pelvic pain - 0.46 0.25 - 0.25 0.46 2.83 7.39 Cite Share Download PDF Status: Published Journal Publication published 05 May, 2020 Read the published version in BMC Women's Health → Version 2 posted Editorial decision: Minor revision 01 Apr, 2020 Review # 2 received at journal 11 Mar, 2020 Review # 1 received at journal 09 Mar, 2020 Reviewer # 2 agreed at journal 08 Mar, 2020 Reviewer # 1 agreed at journal 07 Mar, 2020 Editor assigned by journal 06 Mar, 2020 Reviewers invited by journal 06 Mar, 2020 Editor invited by journal 05 Mar, 2020 Submission checks completed at journal 25 Feb, 2020 You are reading this older preprint version Read the latest preprint version → Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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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-11923","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":371747,"identity":"9646fcde-688a-4d68-96c2-5da4fbec3d3e","order_by":1,"name":"samaneh youseflu(Former Corresponding Author)","email":"","orcid":"https://orcid.org/0000-0002-8762-2157","institution":"Tarbiat Modares University Faculty of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"samaneh","middleName":"youseflu(Former Corresponding","lastName":"Author)","suffix":""},{"id":371748,"identity":"99d0f2ed-680b-472d-ae33-e43c45ebf3fe","order_by":2,"name":"Shahideh Jahanian Sadatmahalleh(New Corresponding Author)","email":"data:image/png;base64,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","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Shahideh","middleName":"Jahanian Sadatmahalleh(New Corresponding","lastName":"Author)","suffix":""},{"id":371749,"identity":"1e6b6df8-e945-4673-b34f-bf0611498a62","order_by":3,"name":"Mahnaz Bahri Khomami","email":"","orcid":"","institution":"Monash University Department of Epidemiology and Preventive Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mahnaz","middleName":"Bahri","lastName":"Khomami","suffix":""},{"id":371750,"identity":"4f1c830d-e7cc-4f46-b2da-e73e43bb32c2","order_by":4,"name":"Malihe Nasiri","email":"","orcid":"","institution":"Shaheed Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Malihe","middleName":"","lastName":"Nasiri","suffix":""}],"badges":[],"createdAt":"2020-01-16 15:47:24","currentVersionCode":2,"declarations":"","doi":"10.21203/rs.2.21328/v2","doiUrl":"https://doi.org/10.21203/rs.2.21328/v2","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-020-00941-7","type":"published","date":"2020-05-05T18:24:24+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":545286,"identity":"c8e463a6-040d-4895-a0fb-01c6da6783aa","added_by":"auto","created_at":"2020-02-25 18:48:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":35813,"visible":true,"origin":"","legend":"Path diagram for the predictors of sexual function.","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/e9925dec-b27b-4dc1-b050-fe85d97961c0/v2/1.png"},{"id":13490581,"identity":"0eac48be-c722-499f-8218-49f4a9f5598b","added_by":"auto","created_at":"2021-09-16 22:24:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":367013,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-11923/v2/f7f50f8a-47a9-483d-ac6c-4e7280007e38.pdf"}],"financialInterests":"","formattedTitle":"Influential Factors on Sexual Function in Infertile Women with Endometriosis: A Path Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEndometriosis, affecting up to 10% of reproductive age women, is one of the most common gynecological diseases (1). Pelvic pain and infertility are prevalent in 35\u0026ndash;50% of affected \u003cem\u003ewomen\u003c/em\u003e (2). These women may also suffer from low self-esteem, psychological distress including stress, anxiety, and depression and poor social support (3, 4). They may struggle with economic problems due to costs of diagnosis and treatment of chronic pelvic pain or infertility. These altogether are known risk factors for sexual dysfunction \u003cem\u003e(5-10)\u003c/em\u003e. Most of the previous studies indicated that sexual dysfunction is higher in endometriosis women in comparison with healthy individuals (5, 8, 9, 11, 12).\u003c/p\u003e\n\u003cp\u003eSexual function is an essential and integral aspect of reproductive health and quality of life that is influenced by medical conditions, physical, interpersonal, psychological, and sociocultural factors (13). A biopsychosocial approach is necessary to guide research and clinical care regarding women\u0026rsquo;s SF.\u003c/p\u003e\n\u003cp\u003eThe bio-psycho-social impact of endometriosis has a negative impact on female SF (14). Sexual dysfunction may lead to reduced quality of life \u0026lrm;\u0026lrm;(QOL), increased psychological disorder, interpersonal and marital difficulties (15, 16). On the other hand, psychological issues play an important role in sexual dysfunction (15). In women with major depressive disorder decreased desire, diminished arousal, and difficulty achieving orgasm are most common (17). in addition, physical discomfort (such as dyspareunia or pelvic pain) can engender psychological problems (18, 19).\u003c/p\u003e\n\u003cp\u003eThe purpose of the current study was to test a conceptual model considering the interrelated role of anxiety, depression, sleep quality, physical activity, endometriosis stage, the intensity of dyspareunia and pelvic pain on sexual dysfunction of women with endometriosis. Also test the mediating role of sleep quality, anxiety, and depression. According to the above objectives, our study proposes the following hypotheses (Hypotheses 1\u0026ndash;5):\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypothesis 1: \u003c/strong\u003eThe intensity of chronic pain and dyspareunia of patients with endometriosis predict sexual dysfunction, psychological problems and poor sleep quality (the pain hypothesis).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypothesis 2: \u003c/strong\u003eThe negative impact of endometriosis like depression and anxiety predict sexual dysfunction (the mental health hypothesis).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypothesis 3:\u003c/strong\u003e The degree of endometriosis found in laparoscopy predicts SF.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypothesis 4:\u003c/strong\u003e A higher level of education and physical activity will be associated with improved SF in women with endometriosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypothesis 5:\u003c/strong\u003e A higher BMI will be associated with sexual dysfunction, and worsens sleep quality.\u003c/p\u003e"},{"header":"Material And Method","content":"\u003cp\u003e\u003cstrong\u003eDesign and Data Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was a cross-sectional study of endometriosis women who attended the Infertility Clinic of Arash Hospital in Tehran in the period from May 2016 to February 2017. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this period, the total number of currently infertile women (400 women) who underwent diagnostic laparoscopy was selected. Based on laparoscopic findings, we exclude women with abnormalities other than endometriosis. The subjects included 220 infertile women with a laparoscopic and/or histological diagnosis of endometriosis. Endometriosis stage was scored based on the revised classification of the American Fertility Society (20).\u003c/p\u003e\n\u003cp\u003eInclusion criteria included age range of 15-45 years, absence of the history of chronic diseases or condition resulting in sexual dysfunction (such as cardiovascular disease, diabetes, hysterectomy, \u0026lrm;premature ovarian failure etc.), not using any drugs affecting \u0026lrm;sexual response cycle, married and living with husband, and having sexual intercourse in the past 4 weeks.\u0026lrm;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethics committee of Tarbiat Modares University of Medical Sciences (IR.TMU.REC.1395.358). After explaining the study's purposes, written consent and verbal assent was collected from all participants and women were informed that their participation was voluntary, confidential, and anonymous. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSocio-demographic and anthropometric characteristics including women\u0026rsquo; and spouses\u0026rsquo; age, age at marriage, BMI, educational level, income, occupational status were collected for all participants. Participants were asked to report their exercise hours/week.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSexual Function:\u003c/strong\u003e SF during a four-week period was assessed by the Persian version of the Female Sexual Function Index (FSFI), which has been previously validated by Mohammadi et al. (21). The FSFI is a 19-item questionnaire that includes six main aspects of SFs including sexual desire (two items), arousal (four items), lubrication (four items), orgasm (three items), satisfaction (three items) and pain (three items). The score for all items ranges between 0\u0026ndash;5 except for items 1, 2, 15, and 16 (ranging 1\u0026ndash;5). The sum score of each domain was multiplied in its certain factor. This factor was 0.6 for desire, 0.3 for arousal and lubrication, and 0.4 for orgasm, satisfaction, and pain. The total score was calculated by adding the six domain scores, which higher scores indicating better SF.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDepression and Anxiety:\u003c/strong\u003e For detecting and classifying the severity of anxiety and depression, Hospital Anxiety and Depression Scale (HADS) was used. The instrument contains 14 questions and consists of two subscales including anxiety (HADS-A) and depression (HADS-D). Each question was rated on a 4-point Likert-type scale (0=never, 1=seldom, 2=sometimes \u0026amp; 3= always). Total scores less than 8 indicate normal range; scores 8-10 reflect mild alterations and scores more than 11 indicate clinically significant levels of anxiety/depression. The validity and reliability of this questionnaire were confirmed by Montazeri \u003cem\u003eet al. \u003c/em\u003e\u003cem\u003e(22)\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePelvic pain and dyspareunia:\u003c/strong\u003e The intensity of pelvic pain and dyspareunia was measured based on the Visual Analog Scale (VAS). This scale consists of a straight line that ranges from zero (no pain) to ten (the most severe pain possible). Subjects were asked to score their pain severity on a scale from 0 to 10.\u003cem\u003e \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSleep Quality:\u003c/strong\u003e Multiple aspects of sleep quality during the previous month was assessed using the valid and reliable Persian version of the Pittsburgh Sleep Quality Index (PSQI) (23). This questionnaire contains 19 items in seven domains (sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction) on a scale from 0 to 3; so the total score of PSQI is from 0 to 21. A total score higher than 5 identifies poor sleep quality and scores lower than 5 show absence of sleep disorder.\u003c/p\u003e\n\u003cp\u003eAll participants answered all questionnaires. 11 questionnaires have not been analyzed due to incomplete data. The risk factors of sexual dysfunction were assessed by path analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis: \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was performed using the SPSS Software (version 21) and LISREL software (version 8.8). Bivariate correlations and descriptive analysis were used to analyze the degree of correlation between the SF of endometriosis women with sleep quality, anxiety, depression, endometriosis stage, the intensity of pelvic pain and dyspareunia.\u003c/p\u003e\n\u003cp\u003eA path model was used to evaluate the predictive effects of independent variables on SF in women with endometriosis. Path analysis is a kind of multiple regression statistical analysis that is utilized to asses causal models by testing a specific pattern of relationship between some variables. Direct, indirect, and total effects of causal relations between variables were found by path analysis.\u003c/p\u003e\n\u003cp\u003eWe used the lisrel statistical program to fit the path model, which we hypothesized. For evaluation of the model fitness, RMSEA (Root mean square error of approximation), AGFI (adjusted goodness of fit index), CFI (Confirmatory Factor Analytic), and Chi-square/df were used. RMSEA values less than 0.07, Chi-square/df lower than 3, AGFI more than 0.9, and CFI more than 0.95 are indicative of a good fitting model. T-value greater than +2 or less than \u0026ndash; 2 were considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable 1 describes the demographic characteristics of the subjects. The means and standard deviations (SD) of the age and partner age were 32.10(5.44) and 36.63(5.59) years, respectively. Their mean BMI were 27.44 (4.66). Endometriosis was staged as 29.2% minimal (stage I), 22% mild (stage II), 25.4% moderate (stage III) and 23.4% severe (stage IV). Less than half of participants (43.06%) had academic degrees and about 23.4% of them were employed. Their mean BMI was 27.44 (4.66).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 demonstrates the Correlation (bivariate analysis) between all variables submitted to the path model. Results showed that SF was associated with anxiety (r=-0.45, p\u0026lt;0.001), depression (r=-0.39, p\u0026lt;0.001), BMI (r=-0.42, p\u0026lt;0.001), pelvic pain (r= -0.36, p\u0026lt;0.001), dyspareunia (r= -0.36, p\u0026lt;0.001), endometriosis stage (r=-0.28, p\u0026lt;0.001), sleep quality (r=-0.44, p\u0026lt;0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on the conceptual model, the predictors of SF had good fitness indices (P-value=0.09; chi2= 32.03; DF=23; chi2/df=1.39; RMSEA=0.04; CFI=0.98; AGFI=0.93) (Table 3). \u0026nbsp;Findings from the path analysis indicating the direct, indirect and total effects from the predictors on SF are reported in Table 4 and illustrated in Figure 1.\u003c/p\u003e\n\u003cp\u003eWe found that anxiety (\u0026beta; = -0.22), depression (\u0026beta; = -0.20), sleep quality (\u0026beta; = -0.29), BMI (\u0026beta; = -0.22), level of education (\u0026beta; = 0.14), stage of endometriosis (\u0026beta; = -0. 16), and dyspareunia (\u0026beta; = -0.23) have a direct effect on women\u0026rsquo;s SF. In our study, sleep quality, anxiety, pelvic pain, and depression were the four major mediators that the higher scores lead to a decrease in the SF of endometriosis patients. The intensity of pelvic pain with effect on sleep quality (\u0026beta; = 0.13), and dyspareunia (\u0026beta; = 0.46) change women\u0026rsquo;s SF. The lower level of physical activity, and higher BMI with indirect effect thorough anxiety, and sleep quality can worsen SF. Also, a higher level of anxiety leads to poor sleep quality (\u0026beta; = 0.22) and depression (\u0026beta; = 0.24). Anxiety with both direct (\u0026beta; = -0.23) and indirect effect (\u0026beta; = -0.11) impress women\u0026rsquo;s SF. \u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study uses a so-called pathway analysis in which all possible factors are put in to find out that indeed all factors contribute to different functions assessed in the FSFI. Recently, several studies were conducted to explore the factors affecting the SF of women with endometriosis (6, 11, 12, 24). There is controversy regarding the strength of the relationship between physical and psychological variables and women's SF due to uncontrolled interrelationships with various effects of modifiers, mediators or confounding variables on SF of endometriosis women.\u003c/p\u003e\n\u003cp\u003eTo our knowledge, this survey is the first research that simultaneously evaluated the hypothesis that physical and psychological consequences of endometriosis are related to SF of women. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe results of the present study indicated that sleep quality, the intensity of pelvic pain and dyspareunia, physical activity, stage of endometriosis, anxiety, and depression were significant impacting SF in women with endometriosis.\u003c/p\u003e\n\u003cp\u003eIn women with endometriosis, deep dyspareunia is a common symptom. Dyspareunia can be triggered by mechanical pressure on endometriotic lesion during intercourse or by traction of scarred and anelastic endometriotic lesion. Pain during intercourse can increase the risk of another type of sexual dysfunction (such as disorders in desire, lubrication, arousal, and orgasm) (25). In Evangelista et al.\u0026rsquo;s study, endometriosis women had more dyspareunia than healthy women. However, there was no significant relationship between total FSFI score in women with and without endometriosis (26). While in \u003ca href=\"https://onlinelibrary.wiley.com/action/doSearch?ContribAuthorStored=Tripoli%2C+Tatiana+M\"\u003eTripoli\u003c/a\u003e et al study (9), chronic pelvic pain related to endometriosis or other gynecologic disorders led to a reduction in female SF (reduces the frequency of vaginal intercourse, orgasms, and sexual satisfaction) and QOL. Mauro Cozzolino et al. reported that there was no significant difference between mean \u003ca href=\"https://www.sciencedirect.com/topics/medicine-and-dentistry/female-sexual-function-index\"\u003eFSFI\u003c/a\u003e scores of the two groups (with and without pain), only endometriotic lesions at the rectovaginal site, was associated with more impaired sexual activity and SF (27). The result from the \u003ca href=\"https://www.sciencedirect.com/science/article/pii/S2050116118300400#!\"\u003eShum\u003c/a\u003e study demonstrated that worse sexual quality of life was associated with severe deep dyspareunia, severe superficial dyspareunia, increased depression, higher \u003ca href=\"https://www.sciencedirect.com/topics/medicine-and-dentistry/pain-catastrophizing\"\u003epain catastrophizing\u003c/a\u003e, \u003ca href=\"https://www.sciencedirect.com/topics/medicine-and-dentistry/cystalgia\"\u003ebladder pain\u003c/a\u003e syndrome, and \u003ca href=\"https://www.sciencedirect.com/topics/medicine-and-dentistry/heterosexuality\"\u003eheterosexual\u003c/a\u003e orientation (5). In one qualitative study, endometriosis-related dyspareunia had a negative impact on women\u0026rsquo;s lives (such as avoiding sexual activity, reduced self-esteem, and quality of couple relationships) (28).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;In these patients, dyspareunia is not the only determinative factor of sexual health. Many factors such as chronic pelvic pain, advanced endometriosis stage and the presence of psychological and physical comorbidities, personality traits and women\u0026rsquo;s expectations affect women's SF (16). The result of the present study showed that anxiety and depression have more impact on the SF of women with endometriosis; a higher score indicates a more negative effects on women\u0026rsquo;s SF. Our results are inconsistent with the finding of some similar studies conducted in other countries (29-33). Graaff et al.\u0026rsquo;s study demonstrates, dyspareunia and depressive symptoms in women with endometriosis have a negative impact on SF, however, their male partner's SF is not affected by women's disease (34). The results of\u0026nbsp; Finn et al.'s study on the level of sexual satisfaction in men and women with chronic pain demonstrates when psychological variables such as anxiety on sexual satisfaction are considered, variables of physical such as pain accounts for very low additional variance (35).\u003c/p\u003e\n\u003cp\u003eOur findings further showed that physical activity was the variable that significantly affected the SF of women with endometriosis. In women, increased endocrine factors (such as estrogen, oxytocin, testosterone, and cortisol) and alpha-amylase level (as a marker of sympathetic nervous system activity) following exercise can improve physiological sexual arousal (36). In the other hand chronic exercise is related to the improvement of body image and psychological factors that increase sexual well-being (36, 37).\u003c/p\u003e\n\u003cp\u003eTo our knowledge, the influencing factors on sexual dysfunction in Iranian women with endometriosis have not been assessed before. The combination of the evaluated domains (anxiety, sleep, depression, pelvic pain, endometriosis stage) is the major strength of this study as endometriosis is already well known to show interactions with each domain separately. Other strengths of the current study include confirmed diagnosis through laparoscopy, a developed conceptual model (path diagram in Figure 1), and the use of validated questionnaires (eg, FSFI, HADS, VAS scale, PSQI, etc.).\u003c/p\u003e\n\u003cp\u003eDespite the strengths of this study, the results have some limitations. One of the limitations of this study is that we did not consider the impact of other variables which can affect SF (such as hormonal level, love, Intimacy, partner violence, and intrapersonal relationship, etc.). It has been suggested that future studies consider these issues. The selection of patients who are all recruited from an infertility unit is another limitation of this study.\u0026nbsp; Suffer from infertility itself is a risk factor of sexual dysfunction with complex dynamics depending on the duration of infertility, cause of infertility and chosen treatment with the invasiveness of the procedure, financial burden, etc.\u003c/p\u003e\n\u003cp\u003eIn many Asian countries, sexual issues are overlooked, ignored and considered taboo (38, 39). Regarding the religion and culture of Iranian women, talk about sexual behaviors are considered as stigma and embarrassment, thus there might be a social desirability bias among the subjects (40, 41). Also, we did not use a validated tool for the evaluation of physical activity. Our results only apply to married women as we excluded unmarried women.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eRegarding the influence of endometriosis on women\u0026rsquo;s physical and mental health, it is not unlikely that the highest impact of endometriosis on sexual dysfunction is exerted by anxiety, depression, sleep quality, pelvic pain, and dyspareunia. Also, results suggest that despite the potentially impairing impacts of pelvic pain and dyspareunia, other factors such as endometriosis stage, educational status, physical activity, and BMI may affect SF. In the care of women with endometriosis, not only laparoscopy and medical treatment should be performed but also psychotherapeutic and psychosexual help should be offered.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003cp\u003eFSFI: Female Sexual Function Index\u003c/p\u003e\n\u003cp\u003eSF: sexual function\u003c/p\u003e\n\u003cp\u003ePSQI: Pittsburgh Sleep Quality Index\u003c/p\u003e\n\u003cp\u003eHADS: Hospital Anxiety and Depression Scale\u003c/p\u003e\n\u003cp\u003eVAS: Visual Analog Scale\u003c/p\u003e\n\u003cp\u003eQOL: Quality of Life\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Tarbiat Modares University of Medical Sciences (IR.TMU.REC.1396.659). All procedures were in accordance with the ethical standards of the Regional research committee and with the Declaration of Helsinki 1964 and it later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants included in the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributors\u0026rsquo; statements \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSH.J and S.Y contributed to the conception and design of the study; SY and SH.J did the literature search; M.N performed the statistical analysis; SY, SHJ, and M.B wrote\u003cbr /\u003e the first draft of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003econflict and interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor agreement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have seen and approved the final version of the manuscript being submitted. All authors warrant that the article is the authors' original work, has not received the prior publication, and is not under consideration for publication elsewhere.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe data sets used and analyzed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was carried out with the kind collaboration of the participants. We would also like to appreciate the staff of Arash Hospital for their valuable contributions. This study is a part of research work done in Tarbiat Modares University, Tehran, Iran. There were no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFuldeore MJ, Soliman AM. 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Journal of Qualitative Research in Health Sciences. 2013;2(3):221-33.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: Helvetica; color: rgb(0, 0, 0); font-weight: bold;\"\u003e\u003cspan style=\"font-size: 11px; line-height: 200%;\"\u003eTable 1:\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003eDemographic and Anthropometric Characteristics of Women with and without Endometriosis.\u0026nbsp;\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;\"\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" dir=\"rtl\" style=\"width:374.85pt;border-collapse:collapse;border:none;\" width=\"500\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.65pt;border-color: windowtext white;border-style: solid;border-width: 1pt;padding: 0in 5.4pt;height: 10.6pt;vertical-align: top;\" valign=\"top\" width=\"30.8%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;margin-right:-21.3pt;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.6in;border-top: 1pt solid windowtext;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 10.6pt;vertical-align: top;\" valign=\"top\" width=\"69.2%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.65pt;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;height: 15.6pt;vertical-align: top;\" valign=\"top\" width=\"30.8%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e32.10±5.44\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.6in;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 15.6pt;vertical-align: top;\" valign=\"top\" width=\"69.2%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eAge (years)\u003csup\u003e*\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.65pt;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;height: 15.6pt;vertical-align: top;\" valign=\"top\" width=\"30.8%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e36.63±5.59\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.6in;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 15.6pt;vertical-align: top;\" valign=\"top\" width=\"69.2%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003ePartner age\u003csup\u003e*\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.65pt;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;height: 19.45pt;vertical-align: top;\" valign=\"top\" width=\"30.8%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e27.44±4.66\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.6in;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 19.45pt;vertical-align: top;\" valign=\"top\" width=\"69.2%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eBMI\u003csup\u003e*\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.65pt;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;height: 19.45pt;vertical-align: top;\" valign=\"top\" width=\"30.8%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e61(29.2)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e46(22)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e53(25.4)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e49(23.4)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.6in;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 19.45pt;vertical-align: top;\" valign=\"top\" width=\"69.2%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eStage of endometriosis\u003csup\u003e**\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Stage1\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Stage2\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Stage3\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Stage4\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.65pt;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;height: 40.3pt;vertical-align: top;\" valign=\"top\" width=\"30.8%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e119(56.93)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e90(43.06)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.6in;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 40.3pt;vertical-align: top;\" valign=\"top\" width=\"69.2%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eEducation\u003csup\u003e**\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp; \u0026nbsp;Lower than university\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp; \u0026nbsp;University\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 115.65pt;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;height: 34.35pt;vertical-align: top;\" valign=\"top\" width=\"30.8%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e160(76.55)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e49(23.44)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.6in;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;height: 34.35pt;vertical-align: top;\" valign=\"top\" width=\"69.2%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eOccupation\u003csup\u003e2\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp; \u0026nbsp;Housewife\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:11px;line-height:200%;\"\u003e\u0026nbsp; \u0026nbsp;Employed\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan dir=\"RTL\" style=\"font-size:15px;line-height:200%;\"\u003e*\u003c/span\u003e\u003cspan style=\"font-size:15px;line-height:200%;\"\u003eValues are given as mean ± SD, \u003cspan dir=\"RTL\"\u003e**\u003c/span\u003eValues are given as number (%), BMI; Body Mass Index.\u003c/span\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size:15px;line-height:200%;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cstrong\u003e\u003cspan style=\"font-size: 16px; line-height: 200%;\"\u003e\n \u003cbr\u003e\u0026nbsp;\n \u003c/span\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin:0in;margin-bottom:8.0pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eTable 2. Correlations between sleep quality, anxiety, depression, pelvic pain, dyspareunia, BMI, endometriosis stage and sexual function.\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border-collapse:collapse;border:none;\" width=\"636\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117pt;border-color: windowtext white;border-style: solid;border-width: 1pt;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"24.528301886792452%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e1\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e2\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e3\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e4\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e5\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e6\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: 1pt solid windowtext;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e7\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117pt;border-right: 1pt solid white;border-bottom: 1pt solid white;border-left: 1pt solid white;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"24.528301886792452%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e1. \u0026nbsp;Poor Sleep quality\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117pt;border-right: 1pt solid white;border-bottom: 1pt solid white;border-left: 1pt solid white;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"24.528301886792452%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e2. \u0026nbsp;Anxiety\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.32\u003csup\u003e***\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117pt;border-right: 1pt solid white;border-bottom: 1pt solid white;border-left: 1pt solid white;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"24.528301886792452%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e3. \u0026nbsp;Depression\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.16\u003csup\u003e*\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.21\u003csup\u003e**\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117pt;border-right: 1pt solid white;border-bottom: 1pt solid white;border-left: 1pt solid white;border-image: initial;border-top: none;padding: 0in 5.4pt;height: 31pt;vertical-align: top;\" valign=\"top\" width=\"24.528301886792452%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e4. \u0026nbsp;Pelvic pain\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;height: 31pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.21\u003csup\u003e**\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;height: 31pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.24\u003csup\u003e***\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;height: 31pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.23\u003csup\u003e***\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;height: 31pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;height: 31pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;height: 31pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;height: 31pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117pt;border-right: 1pt solid white;border-bottom: 1pt solid white;border-left: 1pt solid white;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"24.528301886792452%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e5. \u0026nbsp;Dyspareunia\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.06\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.15*\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.18\u003csup\u003e*\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.45\u003csup\u003e***\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117pt;border-right: 1pt solid white;border-bottom: 1pt solid white;border-left: 1pt solid white;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"24.528301886792452%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e6. \u0026nbsp;BMI\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.30\u003csup\u003e***\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.25\u003csup\u003e***\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.11\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.14*\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.06\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117pt;border-right: 1pt solid white;border-bottom: 1pt solid white;border-left: 1pt solid white;border-image: initial;border-top: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"24.528301886792452%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e7. \u0026nbsp;Stage\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.10\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.05\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.06\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.22\u003csup\u003e*\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.10\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.13\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid white;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 117pt;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"24.528301886792452%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e8. \u0026nbsp;Sexual function\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.44\u003csup\u003e***\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.45\u003csup\u003e***\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.39\u003csup\u003e***\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.36***\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 0.75in;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.320754716981131%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.36\u003csup\u003e***\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.42\u003csup\u003e***\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 49.5pt;border-top: none;border-left: none;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.377358490566039%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.28\u003csup\u003e***\u003c/sup\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eValues are given as Pearson coefficient (P-value) using Pearson correlation test.\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e*\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05; ** \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.01; *** \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 16px;\"\u003e\n \u003cbr\u003e\u0026nbsp;\n \u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eTable 3. The goodness of Fit Indices for the Models.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"left\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;\"\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" dir=\"rtl\" style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 57.65pt;border-color: windowtext white;border-style: solid;border-width: 1pt;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.34020618556701%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eP-value\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102.65pt;border-top: 1pt solid windowtext;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"20.176730486008836%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eChi-square/df\u003cspan dir=\"RTL\"\u003e٭٭٭٭\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.3pt;border-top: 1pt solid windowtext;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"6.774668630338733%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003edf\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.2pt;border-top: 1pt solid windowtext;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"13.402061855670103%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eChi-square\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border-top: 1pt solid windowtext;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"13.991163475699558%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eRMSEA\u003cspan dir=\"RTL\"\u003e٭٭٭\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.75pt;border-top: 1pt solid windowtext;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.1620029455081%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eAGFI\u003cspan dir=\"RTL\"\u003e٭٭\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.9pt;border-top: 1pt solid windowtext;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.014727540500736%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eCFI*\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: 1pt solid windowtext;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"14.138438880706921%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 57.65pt;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: 1pt solid white;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"11.34020618556701%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.09\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102.65pt;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"20.176730486008836%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e1.39\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 34.3pt;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"6.774668630338733%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e23\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68.2pt;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"13.402061855670103%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e32.03\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71.1pt;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"13.991163475699558%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.04\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 51.75pt;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.1620029455081%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.93\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50.9pt;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"10.014727540500736%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp; \u0026nbsp;0.98\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1in;border-top: none;border-left: 1pt solid white;border-bottom: 1pt solid windowtext;border-right: none;padding: 0in 5.4pt;vertical-align: top;\" valign=\"top\" width=\"14.138438880706921%\"\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003ePath\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"LTR\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eN=209\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e*CFI: comparative fit index, \u003cspan dir=\"RTL\"\u003e٭٭\u003c/span\u003eAGFI: Adjusted goodness fit index, \u003cspan dir=\"RTL\"\u003e٭٭٭\u003c/span\u003eRMSEA: root mean square error of approximation, \u003cspan dir=\"RTL\"\u003e٭٭٭٭\u003c/span\u003eChi-square/df: chi-square to the degree of freedom index.\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan style=\"font-size: 16px; line-height: 200%;\"\u003e\n \u003cbr\u003e\u0026nbsp;\n \u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:justify;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eTable 4. Path coefficients for, anxiety, depression, physical activity, BMI, sleep quality, stage of endometriosis, the intensity of pelvic pain, dyspareunia and sexual function of women with endometriosis.\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;\"\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border-collapse:collapse;border:none;\" width=\"687\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:70.85pt;border-top:windowtext;border-left:white;border-bottom:windowtext;border-right:white;border-style:solid;border-width: 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.0pt;\" width=\"13.70262390670554%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003ePredictors\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:1.5in;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.0pt;\" width=\"20.99125364431487%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:83.15pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.0pt;\" width=\"16.18075801749271%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eDirect effect\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.0pt;\" width=\"15.743440233236152%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eIndirect effect\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:100.0pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.0pt;\" width=\"19.387755102040817%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eTotal effect\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:solid windowtext 1.0pt;border-left: none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.0pt;\" width=\"13.994169096209912%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eT-value\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"9\" style=\"width:70.85pt;border-top:none;border-left:solid white 1.0pt;border-bottom:solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.0pt;\" width=\"13.70262390670554%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eFSFI\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:1.5in;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.0pt;\" width=\"20.99125364431487%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eBMI\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:83.15pt;border-top:none;border-left: none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.0pt;\" width=\"16.18075801749271%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.22\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.0pt;\" width=\"15.743440233236152%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.10\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:100.0pt;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.0pt;\" width=\"19.387755102040817%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.32\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:16.0pt;\" width=\"13.994169096209912%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-6.36\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width:1.5in;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.8pt;\" width=\"24.324324324324323%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eDepression\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:83.15pt;border-top:none;border-left: none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.8pt;\" width=\"18.75%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.20\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.8pt;\" width=\"18.243243243243242%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:100.0pt;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.8pt;\" width=\"22.466216216216218%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.20\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.8pt;\" width=\"16.216216216216218%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-3.96\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width:1.5in;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"24.324324324324323%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003ePhysical activity\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:83.15pt;border-top:none;border-left: none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"18.75%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"18.243243243243242%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.31\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:100.0pt;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"22.466216216216218%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.31\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"16.216216216216218%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e3.14\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width:1.5in;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"24.324324324324323%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eDyspareunia\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:83.15pt;border-top:none;border-left: none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"18.75%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.23\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"18.243243243243242%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:100.0pt;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"22.466216216216218%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan dir=\"RTL\"\u003e-\u003c/span\u003e0.23\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"16.216216216216218%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-4.84\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width:1.5in;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"24.324324324324323%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003ePelvic pain\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:83.15pt;border-top:none;border-left: none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"18.75%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"18.243243243243242%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.19\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:100.0pt;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"22.466216216216218%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003cspan dir=\"RTL\"\u003e0.\u003c/span\u003e19\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"16.216216216216218%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e\u003cspan dir=\"RTL\"\u003e-\u003c/span\u003e4.44\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width:1.5in;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"24.324324324324323%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eanxiety\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:83.15pt;border-top:none;border-left: none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"18.75%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.23\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"18.243243243243242%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.11\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:100.0pt;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"22.466216216216218%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.34\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"16.216216216216218%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-6.16\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width:1.5in;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"24.324324324324323%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003ePoor sleep quality\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:83.15pt;border-top:none;border-left: none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"18.75%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.29\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"18.243243243243242%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:100.0pt;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"22.466216216216218%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.29\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"16.216216216216218%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-5.62\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width:1.5in;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"24.324324324324323%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eStage\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:83.15pt;border-top:none;border-left: none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"18.75%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.16\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"18.243243243243242%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.10\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:100.0pt;border-top:none;border-left:none;border-bottom:solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"22.466216216216218%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.26\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid white 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"16.216216216216218%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-3.86\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width:1.5in;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"24.324324324324323%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eEducation\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:83.15pt;border-top:none;border-left: none;border-bottom:solid black 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"18.75%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.14\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"18.243243243243242%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:100.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"22.466216216216218%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.14\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid black 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"16.216216216216218%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e2.89\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width:71.45pt;border-top:none;border-left:solid white 1.0pt;border-bottom:solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"13.848396501457726%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eAnxiety\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:1.5in;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"20.99125364431487%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eBMI\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003ePhysical activity\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width:82.55pt;border-top:none;border-left: none;border-bottom:solid black 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"16.034985422740526%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.24\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.15\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"15.743440233236152%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:100.0pt;border-top:none;border-left:none;border-bottom:solid black 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"19.387755102040817%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.24\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.15\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid black 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"13.994169096209912%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e3.61\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-2.21\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width:76.1pt;border-top:none;border-left:solid white 1.0pt;border-bottom:solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"14.723032069970845%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eDepression\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:107.9pt;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"20.99125364431487%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eExercise\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eBMI\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eAnxiety\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"15.160349854227405%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.24\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"15.743440233236152%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.18\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.04\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:100.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"19.387755102040817%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.18\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.04\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.24\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"13.994169096209912%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-1.88\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e2.54\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e3.58\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width:76.1pt;border-top:none;border-left:solid white 1.0pt;border-bottom:solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"14.723032069970845%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003ePoor sleep quality\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:107.9pt;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"20.99125364431487%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eExercise\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eBMI\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eStage\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003ePelvic pain\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eAnxiety\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"15.160349854227405%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.17\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.19\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.13\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.22\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"15.743440233236152%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.14\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.04\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.09\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:100.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"19.387755102040817%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-0.31\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.23\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.09\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.13\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.22\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"13.994169096209912%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-3.06\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e3.72\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e1.70\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e2.04\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e3.29\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width:76.1pt;border-top:none;border-left:solid white 1.0pt;border-bottom:solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"14.723032069970845%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003ePelvic pain\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:107.9pt;border-top:none;border-left: none;border-bottom:solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"20.99125364431487%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003eStage\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:78.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"15.160349854227405%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.21\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:81.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"15.743440233236152%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e-\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:100.0pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"19.387755102040817%\"\u003e\n \u003cp style=\"margin:0in;margin-bottom:.0001pt;font-size:16px;font-family:\u0026quot;Times New Roman\u0026quot;,serif;text-align:center;line-height:200%;\"\u003e\u003cspan style=\"font-family: \n Helvetica;\"\u003e\u003cspan style=\"color: rgb(0, 0, 0);\"\u003e0.21\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:1.0in;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid white 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.3pt;\" width=\"13.994169096209912%\"\u003e\n 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[BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Endometriosis, sexual function, path model, sleep quality, HADS, pain intensity ","lastPublishedDoi":"10.21203/rs.2.21328/v3","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.2.21328/v3","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Background: Endometriosis have a negative influence on women’s sexual life. The aim of the current study was to test a conceptual model considering the interrelated role of anxiety, depression, sleep quality, physical activity, BMI, stage of endometriosis, the intensity of dyspareunia and pelvic pain on sexual function (SF) in infertile women with endometriosis. Also test the mediating role of sleep quality, anxiety, and depression.\nMethod: In the present cross-sectional study, 220 infertile women with a laparoscopically confirmed endometriosis were recruited. Data were collected using a socio-demographic checklist, Female Sexual Function Index (FSFI), Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Visual Analog Scale (VAS).\nResults: We found that anxiety, depression, sleep quality, BMI, level of education, stage of endometriosis, and dyspareunia have a direct effect on women’s SF. In our study, sleep quality, anxiety, pelvic pain, and depression were the four major mediators that the higher scores lead to a decrease in the SF of endometriosis patients. The intensity of pelvic pain with an effect on sleep quality and dyspareunia change women’s SF. The lower level of physical activity, and higher BMI with indirect effect thorough anxiety, and sleep quality can worsen SF. Also, a higher level of anxiety leads to poor sleep quality and depression. Anxiety with both direct and indirect effect impress women’s SF.\nConclusion: It seems that the main risk factors for sexual dysfunction in women with endometriosis are higher rates of anxiety, depression, poor sleep quality, pelvic pain, and dyspareunia. In the care of women with endometriosis, not only laparoscopy and medical treatment should be performed but also psychotherapeutic and psychosexual help should be offered.","manuscriptTitle":"Influential Factors on Sexual Function in Infertile Women with Endometriosis: A Path Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":3,"date":"2020-04-09 17:16:23","doi":"10.21203/rs.2.21328/v3","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accept","date":"2020-04-04T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-04-02T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-04-01T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-04-01T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":2,"date":"2020-02-25 18:48:57","doi":"10.21203/rs.2.21328/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2020-04-01T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-03-11T12:00:00+00:00","index":2,"fulltext":"Recommendation: Accept without revision\nForm responses:\n---\n\nComments to Author:\n---\nI've read well about the comments you answered. Thank you* Are the methods appropriate and well described?: **Yes**\n* Does the work include the necessary controls?: **Yes**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I am able to assess the statistics**\n* Quality of written English: **Acceptable**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* I agree to the open peer review policy of the journal. I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: ** I agree to the open peer review policy of the journal**\n"},{"type":"editorInvitedReview","content":"","date":"2020-03-09T12:00:00+00:00","index":1,"fulltext":"Recommendation: Accept without revision\nForm responses:\n---\n\nComments to Author:\n---\n* Are the methods appropriate and well described?: **Yes**\n* Does the work include the necessary controls?: **Yes**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I am able to assess the statistics**\n* Quality of written English: **Acceptable**\n* Declaration of competing interests: **'I declare that I have no competing interests'**\n* I agree to the open peer review policy of the journal. I understand that my name will be included on my report to the authors and, if the manuscript is accepted for publication, my named report including any attachments I upload will be posted on the website along with the authors' responses. I agree for my report to be made available under an Open Access Creative Commons CC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any comments which I do not wish to be included in my named report can be included as confidential comments to the editors, which will not be published.: ** I agree to the open peer review policy of the journal**\n"},{"type":"reviewerAgreed","content":"","date":"2020-03-08T12:00:00+00:00","index":2,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-03-07T12:00:00+00:00","index":1,"fulltext":""},{"type":"editorAssigned","content":"","date":"2020-03-06T12:00:00+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-03-06T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-03-05T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-02-25T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2020-01-20 19:49:42","doi":"10.21203/rs.2.21328/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2020-02-18T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2020-02-17T12:00:00+00:00","index":1,"fulltext":"Recommendation: Accept after minor essential revisions\nForm responses:\n---\n* Are the methods appropriate and well described?: **Yes**\n* Does the work include the necessary controls?: **Yes**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I recommend additional statistical review**\n* Quality of written English: **Acceptable**\n* Declaration of competing interests: **'I declare that I have no competing interests'**\n\nComments to Author:\n---\nIn this paper, I think that there are 4 factors (sleep quality, anxiety, pelvic pain, and depression) that most influence sexual function.\nBy the way, I don't know the interpretation of the table, so I think BMI is 3rd higher in the factors that affect sexual function in Table 2.\nIn the discussion on page 11, the two most influential ones in the current study are called anxiety and depression, and I think that the larger the number, the greater the effect.\nAnd for tables 3 and 4, I don't know how to interpret it. Especially in the case of table 4, if the total effect number of each item is larger, the relationship is greater and education is bigger.\nWhat does T-value mean?\nSo at the end of page 11, my research indicates that physical activity and sexual function are obviously affected, but it seems difficult to understand at my level.\nThe path analysis used in this paper is an area that we are not familiar with, so I think that more expert evaluation is needed."},{"type":"editorInvitedReview","content":"","date":"2020-02-13T12:00:00+00:00","index":2,"fulltext":"Recommendation: Accept without revision\nForm responses:\n---\n* Are the methods appropriate and well described?: **Yes**\n* Does the work include the necessary controls?: **Unable to assess**\n* Are the conclusions drawn adequately supported by the data shown?: **Yes**\n* Are you able to assess any statistics in the manuscript or would you recommend an additional statistical review?: **I am able to assess the statistics**\n* Quality of written English: **Acceptable**\n* Declaration of competing interests: **'I declare that I have no competing interests'**\n\nComments to Author:\n---\n"},{"type":"reviewerAgreed","content":"","date":"2020-02-08T12:00:00+00:00","index":2,"fulltext":""},{"type":"reviewerAgreed","content":"","date":"2020-02-02T12:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2020-01-28T12:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2020-01-16T12:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2020-01-16T12:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2020-01-15T12:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2020-01-09T12:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2ec5be5f-499e-4b1a-8b3d-5fe2a041150a","owner":[],"postedDate":"February 25th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":51366,"name":"Preventive Medicine"},{"id":51367,"name":"Internal Medicine"}],"tags":[],"updatedAt":"2021-09-27T18:29:18+00:00","versionOfRecord":{"articleIdentity":"rs-11923","link":"https://doi.org/10.1186/s12905-020-00941-7","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2020-05-05 18:24:24","publishedOnDateReadable":"May 5th, 2020"},"versionCreatedAt":"2020-02-25 18:48:57","video":"","vorDoi":"10.1186/s12905-020-00941-7","vorDoiUrl":"https://doi.org/10.1186/s12905-020-00941-7","workflowStages":[]},"version":"v2","identity":"rs-11923","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"identity":"rs-11923","version":["v2"]},"buildId":"B-jG_2CBjPDmsCi4Wdhf-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}