(097) Endometriosis and Female Sexual Function: Insights from a Portuguese Case –Control Study

Abstract Introduction Endometriosis is a chronic estrogen-dependent inflammatory condition affecting approximately 10% of women of reproductive age worldwide. Beyond pelvic pain and infertility, it often compromises sexual function and quality of life (QoL). Deep dyspareunia is a recognized symptom, but psychosocial contributors to sexual dysfunction remain insufficiently addressed in clinical settings. Understanding the interaction between pain, emotional well-being, and social support is essential for comprehensive sexual medicine care. This study explores how endometriosis affects sexual function and QoL, aiming to identify modifiable factors that may improve holistic treatment strategies. Objective To compare sexual function and quality of life between women with and without endometriosis and to identify clinical and psychosocial predictors of sexual dysfunction among affected women. Methods A case–control study was conducted including 205 sexually active women aged 18–54 years, of whom 87 had a confirmed diagnosis of endometriosis and 118 served as controls. Participants completed validated self-report questionnaires assessing sociodemographic and clinical characteristics, sexual function using the Female Sexual Function Index (FSFI), and quality of life using the Endometriosis Health Profile-30 (EHP-30). Descriptive and inferential analyses were performed using non-parametric tests and logistic regression to determine predictors of sexual dysfunction, defined as a total FSFI score ≤ 26.55. Ethical approval was obtained from the appropriate health and academic ethics committees, and informed consent was secured from all participants. Results Women with endometriosis reported significantly poorer sexual function across all FSFI domains, with a median total FSFI score of 21.5 compared with 28.9 among controls (p < .001). Sexual dysfunction was present in 67% of cases versus 28% of controls. Dyspareunia was an independent predictor, increasing the odds of sexual dysfunction more than threefold (odds ratio [OR] = 3.16; 95% confidence interval [CI] = 1.07–9.33; p = .037). Lower perceived social support, assessed by the EHP-30, also independently predicted dysfunction (OR = 1.035; 95% CI = 1.014–1.057; p = .001). QoL was markedly impaired among women with endometriosis, particularly in the “Social support” and “Emotional well-being” dimensions. Longer diagnostic delay correlated with worse pain-related QoL (ρ = 0.247; p = .024), while longer time since diagnosis correlated with lower sexual dysfunction rates (ρ = –0.306; p = .004), suggesting gradual adaptation over time. No significant QoL differences were found between surgical and medical treatment groups. Conclusions Endometriosis significantly affects both sexual function and quality of life, reinforcing its dual physical and psychosocial burden. Dyspareunia and low social support were identified as modifiable predictors of sexual dysfunction and should be routinely assessed in sexual medicine practice. These findings highlight the need for early diagnosis and multidisciplinary management that integrates sexual, psychological, and relational care. Addressing psychosocial determinants alongside symptom control is vital to preserving intimacy, relational satisfaction, and overall well-being in women affected by endometriosis. This study provides novel population-based evidence supporting a biopsychosocial approach to sexual health in chronic gynecological conditions. Disclosure No