Preoperative imaging for endometriosis awareness: an online survey study

Introduction: In 2024, an international consensus statement on non-invasive imaging techniques for the diagnosis of pelvic deep endometriosis was published, recommending transvaginal sonography as the first-line imaging modality because of cost, availability, and low impact on the environment. Despite the increasing body of evidence supporting the use of imaging in the preoperative diagnosis of endometriosis, there is a paucity of data to confirm patient awareness. The aim of this study was to use an online survey or questionnaire from patients to collect quantitative data regarding their awareness, exposure, and experience with preoperative imaging for the diagnosis of endometriosis.

This was a cross-sectional study, based on an online, international survey completed by patients with self-reported endometriosis from multiple online endometriosis groups. The survey went live from November 2025 to March 2026 and consisted of women and gender-diverse individuals with self-reported endometriosis, with a minimum required number of 100 participants.

A total of 180 participants started the survey, of which 142 (78.9%) completed the exercise. The mean age of the participants was 31.6 [standard deviation (SD) 8.7] years, with a median time of endometriosis diagnosis of 2 years (interquartile range 1–5), of whom 99 (69.7%) had at least one surgery, with a mean number of surgeries of 1.8 (SD 1.2). The majority of participants were from Australia (66.2%), followed by Canada (16.9%), New Zealand (11.3%), and the United Kingdom (2.1%), and an equal number were from Brazil, India, the Philippines, and Spain (0.7% each). Overall, 53.5% of participants agreed that endometriosis can be diagnosed without surgery, while only 32.4% agreed that bowel endometriosis can be diagnosed before surgery. Of these, the percentages of participants who agreed that bowel endometriosis can be preoperatively diagnosed with ultrasound, magnetic resonance imaging, computed tomography, and colonoscopy were 32%, 35%, 15%, and 15%, respectively. The participants obtained knowledge about endometriosis investigations and treatments from various sources, including their gynecologists (71.8%), general practitioners (57%), fertility specialists (11.3%), family members (12%), friends (21.8%), social media (68.3%), and other sources (29.6%).

There is a disparity between participant awareness in our study and the evidence in the literature regarding the availability and accuracy of preoperative imaging for the diagnosis of deep endometriosis, possibly due to the misinformation disseminated via social media.

Endometriosis is typically characterized by the deposition of endometrial-like cells outside the uterine cavity, resulting in lesions ranging from peritoneal implants to deep endometriosis (DE). DE is defined as endometrial implants or nodules of ≥5 mm subperitoneal infiltration, which can involve multiple organs in the pelvis, including the bladder, vagina, uterosacral ligaments, bowel, and peritoneum (1,2). A resultant distortion in anatomy can occur, including obliteration of the pouch of Douglas or cul-de-sac. Endometriosis can cause symptoms of chronic pelvic pain, dyspareunia, urinary and/or bowel symptoms, and infertility (3–5). This group of women requires both gynecological and colorectal input at surgery. Preoperative imaging is being increasingly used to predict the level of complexity of laparoscopic surgery for endometriosis. It has the potential to facilitate triaging women with suspected bowel DE to the most appropriate surgical expertise required for laparoscopic intervention for endometriosis. In 2016, the International Deep Endometriosis Analysis (IDEA) Group (6) published a consensus statement to standardize the terms, definitions, and sonographic evaluation of the pelvis and identified five locations for examination, namely, the bladder, the rectovaginal septum, the posterior vaginal fornix, the uterosacral ligaments/torus uterinus, and the rectum/rectosigmoid/sigmoid. Since then, there have been multiple systematic reviews and meta-analyses that have confirmed the diagnostic accuracy of various imaging modalities, with transvaginal ultrasound and magnetic resonance imaging (MRI) being quite comparable (7–12). More recently, in 2024, an international consensus statement on non-invasive imaging techniques for the diagnosis of pelvic DE, involving seven international societies and simultaneously published in five journals, recommended transvaginal ultrasound as the first-line imaging modality because of cost, availability, and low impact on the environment (13–17). Despite the increasing body of evidence supporting the use of imaging in the preoperative diagnosis of endometriosis, there is a paucity of data to confirm patient awareness. The aim of this study was to use an online survey or questionnaire from patients to collect quantitative data (18) regarding their awareness, exposure, and experience with preoperative imaging for the diagnosis of endometriosis. The advantages of an online survey include the ability to target the desired audience, while saving time and cost (19).

This was a cross-sectional study, based on an online, international survey completed by members with self-reported endometriosis of various online endometriosis groups, including Endometriosis Australia, Endometriosis New Zealand, Endometriosis Canada, Asociación de Endometriosis España, GAPENDI, and Endometriosis UK. The administrators of these groups were formally approached via email and permission obtained for the survey to be disseminated through their individual channels. The survey was an electronic questionnaire (Supplementary Appendix 1) distributed via the REDCap platform, which went live from November 2025 to March 2026, from which the data were analyzed. Ethics approval was obtained from the local Human Research Ethics Committee of Nepean Blue Mountains Local Health District (HREC 2025/ETH01032). Participants were informed about the essential elements of the research, including the risks and benefits of participation, on the intro page of the survey. Their decision to complete and submit the survey constituted informed consent. Study population The study population consisted of all women and gender-diverse people with self-reported endometriosis who received the questionnaire and volunteered in completing the questionnaire, with a minimum of 100 participants. The inclusion criteria were women and gender-diverse people aged above 18 years old with a self-reported diagnosis of endometriosis, while the exclusion criteria were women and gender-diverse people without a self-reported diagnosis of endometriosis. Statistical analysis Continuous variables were summarized using the mean and standard deviation (SD), the median and the interquartile range (IQR), and minimum (min.) and maximum (max.). Categorical variables were summarized as counts and proportions expressed as percentages. Data descriptions were performed using SAS software, version 9.4.

A total of 180 participants started the survey, of whom 142 (78.9%) completed the exercise. The mean age of the participants was 31.6 (SD 8.7), with a median time of endometriosis diagnosis of 2 years (IQR 1–5), of whom 99 (69.7%) had at least one surgery, with a mean number of surgeries of 1.8 (SD 1.2) (Table 1). The majority of participants were from Australia (66.2%), followed by Canada (16.9%), New Zealand (NZ) (11.3%), the United Kingdom (2.1%), and an equal number from Brazil, India, the Philippines, and Spain (0.7% each). The most common symptoms were pelvic pain (95.1%), period pain (90.8%), bloating (89.4%), bowel symptoms (85.2%), and dyspareunia (72.5%). The diagnosis of endometriosis was based on surgical findings (71.8%), ultrasound (38%), and symptoms (33.1%). A total of 99 (69.7%) participants underwent surgery for endometriosis, of whom 7 (4.9%) had Stage I, 21 (14.8%) had Stage II, 23 (16.2%) had Stage III, 37 (26.1%) had Stage IV endometriosis, and 54 (38%) were unsure or not informed. These and the previous treatments trialed by all participants are detailed in Table 2, while Table 3 outlines the specific awareness of the various imaging modalities of all participants. Supplementary Tables S1 and S2 outline the previous treatments trialed and the awareness of the imaging modalities from participants by country, respectively. Table 1 | Variable | N | Mean (SD) | Median (IQR) | Min. to max. | |---|---|---|---|---| | Age (years) | 141 | 31.6 (8.7) | 30 (25–38) | 17–53 | | How long ago was endometriosis diagnosed? (years) | 142 | 3.9 (5.5) | 2 (1–5) | 0–31 | | Number of procedures | 99 | 1.8 (1.2) | 1 (1–2) | 1–7 | | Endometriosis affecting fertility | 142 | 6.5 (3.3) | 7 (3–9) | 1–10 | General characteristics of the respondents. Table 2 | Variable | N = 142 (%) | |---|---| | Relationship status | | | Single | 47 (33.1) | | Engaged | 13 (9.2) | | Married | 41 (28.9) | | De facto (Two people living together as a couple on a genuine domestic basis without a marriage certificate) | 35 (24.6) | | Separated | 2 (1.4) | | Divorced | 1 (0.7) | | Other | 3 (2.1) | | Country/continent of origin | | | Australia | 94 (66.2) | | Brazil | 1 (0.7) | | Canada | 24 (16.9) | | Spain | 1 (0.7) | | UK | 3 (2.1) | | Europe | 1 (0.7) | | NZ | 16 (11.3) | | Philippines | 1 (0.7) | | India | 1 (0.7) | | Highest level of education | | | High school | 29 (20.4) | | Graduate certificate or diploma | 36 (25.4) | | Bachelor’s degree | 51 (35.9) | | Master’s degree | 22 (15.5) | | PhD | 1 (0.7) | | Other | 3 (2.1) | | Previously diagnosed with endometriosis = yes | 134 (94.4) | | Symptoms (multiple allowed) | | | Period pain | 129 (90.8) | | Pelvic pain | 135 (95.1) | | Pain with intercourse | 103 (72.5) | | Bowel symptoms | 121 (85.2) | | Bladder symptoms | 87 (61.3) | | Bloating | 127 (89.4) | | Infertility | 31 (21.8) | | Other | 38 (26.8) | | Concerned about or have had trouble getting pregnant = yes | 73 (51.4) | | Previous IVF = yes | 10 (7) | | Trying to get pregnant for longer than 6 months = yes | 22 (15.5) | | Diagnosis method (multiple allowed) | | | Based on symptoms | 47 (33.1) | | Surgery | 102 (71.8) | | Ultrasound | 54 (38) | | MRI | 16 (11.3) | | Other | 12 (8.5) | | Treatments tried (multiple allowed) | | | Herbal = natural therapies | 70 (49.3) | | Diet | 99 (69.7) | | NSAIDs | 121 (85.2) | | Oral contraceptive pills | 92 (64.8) | | Progesterone-only pills | 65 (45.8) | | Ryeqo | 8 (5.6) | | Zoladex | 7 (4.9) | | Implanon | 20 (14.1) | | Mirena intrauterine device | 70 (49.3) | | Surgery | 96 (67.6) | | Other | 16 (11.3) | | Have not tried anything | 4 (2.8) | | Surgery for endometriosis = yes | 99 (69.7) | | Diagnosed endometriosis stage | | | Stage 1 | 7 (4.9) | | Stage 2 | 21 (14.8) | | Stage 3 | 23 (16.2) | | Stage 4 | 37 (26.1) | | Unsure = Was not told | 54 (38) | Details of endometriosis history. Percentages are based on N = 142, unless otherwise stated. Participants could select more than one response where indicated. CT, computed tomography; MRI, magnetic resonance imaging; NSAIDs, non-steroidal anti-inflammatory drugs; NZ, New Zealand; UK, United Kingdom. Table 3 | Variable | N = 142 (%) | |---|---| | Preoperative investigations (multiple allowed) | | | Blood tests | 56 (39.4) | | Ultrasound | 131 (92.3) | | MRI | 41 (28.9) | | Deep endometriosis ultrasound | 43 (30.3) | | CT scan | 27 (19) | | Other | 7 (4.9) | | Can endometriosis be diagnosed without surgery = yes | 76 (53.5) | | Can bowel endometriosis be diagnosed before surgery = yes | 46 (32.4) | | Bowel endometriosis diagnosis method (multiple allowed) (N = 46) | | | Ultrasound | 32 (69.6) | | MRI | 35 (76.1) | | CT scan | 15 (32.6) | | Colonoscopy | 15 (32.6) | | Other | 1 (2.2) | | Referred for a deep endometriosis ultrasound = yes | 56 (39.4) | | Underwent a deep endometriosis ultrasound = yes | 53 (94.6) N = 56 | | Reasons for not undergoing a deep endometriosis ultrasound (multiple allowed) (N = 3) | | | Not available near me | 0 (0) | | Too expensive | 2 (66.7) | | Not convinced it was necessary | 0 (0) | | Other | 1 (33.3) | | Obtained knowledge about deep endometriosis ultrasound via (multiple allowed) | | | Gynecologist | 50 (35.2) | | Fertility specialist | 5 (3.5) | | Family | 1 (0.7) | | Friend | 3 (2.1) | | Social media | 10 (7) | | Other | 14 (9.9) | | Did not have any before surgery | 73 (51.4) | | Deep endometriosis ultrasound can diagnose (multiple allowed) | | | Stage I | 38 (26.8) | | Stage II | 40 (28.2) | | Stage III | 55 (38.7) | | Stage IV | 78 (54.9) | | Bowel nodules | 52 (36.6) | | Endometriomas | 90 (63.4) | | Adenomyosis | 56 (39.4) | | Other | 33 (23.2) | | MRI can diagnose (multiple allowed) | | | Stage I | 29 (20.4) | | Stage II | 35 (24.6) | | Stage III | 49 (34.5) | | Stage IV | 65 (45.8) | | Bowel nodules | 58 (40.8) | | Endometriomas | 87 (61.3) | | Adenomyosis | 53 (37.3) | | Other | 35 (24.6) | | CT can diagnose (multiple allowed) | | | Stage I | 18 (12.7) | | Stage II | 15 (10.6) | | Stage III | 17 (12) | | Stage IV | 33 (23.2) | | Bowel nodules | 33 (23.2) | | Endometriomas | 68 (47.9) | | Adenomyosis | 30 (21.1) | | Other | 53 (37.3) | | Sources of knowledge about endometriosis investigations obtained (multiple allowed) | | | GP | 81 (57) | | Gynecologist | 102 (71.8) | | Fertility specialist | 16 (11.3) | | Family | 17 (12) | | Friends | 31 (21.8) | | Social media | 97 (68.3) | | Other | 42 (29.6) | Patient understanding of preoperative imaging for the diagnosis of deep endometriosis. Percentages are based on N = 142, unless otherwise stated. Participants could select more than one response where indicated. CT, computed tomography; GP, general practitioner; MRI, magnetic resonance imaging. Overall, 53.5% of participants agreed that endometriosis can be diagnosed without surgery, while 32.4% agreed that bowel endometriosis can be diagnosed before surgery. Of the latter, the percentages of participants who agreed bowel endometriosis can be preoperatively diagnosed with ultrasound, MRI, computed tomography (CT), and colonoscopy were 32%, 35%, 15%, and 15%, respectively (Figure 1). Only 39.4% were referred for a DE ultrasound, of whom the majority (94.6%) had this performed. Over half of the participants (51.4%) did not have a preoperative DE, while the percentages of participants who obtained knowledge about DE ultrasounds from gynecologists, fertility specialists, family, friends, social media, and others were 50%, 5%, 1%, 3%, 10%, and 14%, respectively, of which “other” included Google and other specialists such as general practitioners, colorectal surgeons, and gastroenterologists. The participants obtained knowledge on endometriosis investigations and treatment from various sources, including their gynecologists (71.8%), general practitioners (57%), fertility specialists (11.3%), family (12%), friends (21.8%), social media (68.3%), and other sources (29.6%), which primarily consisted of their own research from the internet, books, journals, and from online endometriosis societies. Figure 1

Prior to this study, there were no previous publications regarding patient awareness, knowledge, or understanding of preoperative imaging for DE. However, the findings of this study highlight patients’ lack of awareness or adequate education regarding the imaging modalities available for a preoperative diagnosis of endometriosis. Specifically, participants agreed that DE ultrasound, MRI, and CT can detect Stages I and II (namely, superficial endometriosis) in 55%, 45%, and 23.3% of cases, respectively (Figure 1 and Table 3), with the findings being similar when responses were stratified by the country of origin (Supplementary Table S2). This is in stark contrast to the current evidence in the literature, with ultrasound having low sensitivity for the detection of superficial endometriosis, ranging from 4.0% to 43.5% (20) to 65% (95% CI, 27%–100%) (21). The performance of MRI was similarly poor (22). As far as CT was concerned, no studies reviewed its performance, presumably due to its ineffectiveness in diagnosing small (<5 mm), soft-tissue lesions. Participant responses and awareness regarding the use of DE ultrasound (36.6%), MRI (40.5%), and CT (23.2%) for the preoperative detection of bowel nodules also contrasted with those of the current literature. In a systematic review by Gerges et al. (10), the overall pooled sensitivity and specificity for DE ultrasound were 89% (95% CI, 83%–92%) and 97% (95% CI, 95%–98%), for MRI, they were 86% (95% CI, 79%–91%) and 96% (95% CI, 94%–97%), and for CT, they were 93% (95% CI, 84%–97%) and 95% (95% CI, 81%–99%). Similarly, while Stage IV endometriosis can encompass obliteration of the pouch of Douglas and DE nodules in multiple locations, including the rectosigmoid, torus uterinus, uterosacral ligaments, rectovaginal septum, bladder, and ureters, the participant responses revealed limited awareness of the effectiveness of ultrasound, MRI, and CT for preoperative diagnosis, reported at 54.9%, 45.8%, and 40.8%, respectively (Figure 1 and Table 3). These percentages are significantly lower than those reported on the performance of DE ultrasound and MRI, because these locations were based on different meta-analyses (10–12) and the recent international consensus statement on non-invasive imaging techniques for the diagnosis of pelvic DE (13–17). Unsurprisingly, there was limited participant awareness of the role of preoperative imaging, particularly DE ultrasound and MRI, for the detection of ovarian endometriomas, with the responses being 63.4% and 61.3%, respectively (Figure 1 and Table 3). Once again, these figures contrast with those in the literature, with the sensitivity and specificity of ultrasound for the detection of endometriomas being 93%–95% and 96%–100% (20), respectively. However, the sensitivity and specificity of MRI were 95% (95% CI: 95%–100%) and 91% (95% CI: 86%–97%) (21, 22), respectively. Although the majority of participants were from Australia (66.2%), followed by Canada (16.9%) and NZ (11.3%), there were more participants from Australia who were referred for a DE scan (48.9% vs. 25% vs. 12.5%, respectively), although the majority of those referred in all three countries proceeded to have the DE scan. It is difficult to ascertain the reasons for the higher referral rates in Australia, although they may be attributed to the mix of both private and public care and possibly to the fact that the procedure is referred to and performed in the private sector. However, it is impossible to determine this from this online survey, as this was not a question that was previously considered. There are certainly differences between countries with regard to reimbursement, accessibility, and education, which would undoubtedly impact the generalizability of the findings of this study. The disparity between participant awareness in our study and the evidence in the literature is possibly due to misinformation from social media, given that 68.3% (Table 3) of participants identified social media as a source of knowledge. This is consistent with the findings of a study by Adler et al. (23), who analyzed evidence-based content on endometriosis posted on Instagram to find that only 36.8% of claims regarding diagnosis were evidence-based. They postulated that people did not consider other forms of diagnosis for endometriosis to be possible or accurate, given the common claim that “endo[metriosis] can only officially be diagnosed through invasive and expensive laparoscopic surgery or biopsy” (23). Furthermore, it was possible that patients were misinformed that they did not have endometriosis in the context of a “negative” scan, as would be the case with superficial endometriosis, only to be diagnosed at surgery. This further propagates that surgery is the only way to diagnose endometriosis. These findings serve to remind and encourage clinicians and researchers to publish evidence-based educational content on social media platforms, enriching public health communication, thereby strengthening the value of clinical translation. Although this study is, to our knowledge, the first to assess patient awareness of preoperative imaging for the diagnosis of endometriosis, it is not without limitations. The main limitation pertains to the nature of an online survey, during which there is little control over factors such as the accuracy and validity of participants' understanding of the survey questions and their answers. Specifically, there is the issue of potential selection bias (24), as participants who join online endometriosis support groups are not representative of the broader patient population, as they are typically more engaged, symptomatic, and possibly have different levels of knowledge. This is further impacted by non-response bias (25), low-quality data (26, 27), and validation challenges (28). Diagnostic accuracy can be impacted because of the potential for self-reported diagnosis bias, with 38% of participants being unclear of their disease stage. Although the participants had to actively agree to proceed with the survey, there were no measures to prevent or detect fraudulent responses (e.g., CAPTCHAs and attention checks), which increases this risk (27). Also, for reasons that we are unable to explain, the response rates were significantly lower than we expected, possibly due to the survey potentially being perceived as irrelevant or not exciting enough for participants to warrant involvement. The results were heavily skewed, with the majority of the participants hailing from Australia and with minimal to no participants from Southeast Asia. This geographic bias significantly limits the generalizability of our findings, as the availability, cost, and clinician referral patterns for advanced imaging can vary dramatically by country. These limitations may be reduced in future studies with the incorporation of multilingual, multicenter prospective surveys while verifying clinical diagnosis through medical records to offset the cross-sectional self-report bias.

This study highlights the lack of awareness and misinformation of patients with endometriosis regarding the availability and accuracy of preoperative imaging for the diagnosis of DE. This is a disappointing revelation for us as health professionals and experts in the field and stresses the importance of ensuring that accurate and understandable information is properly disseminated. The findings of this study also emphasize the need for the implementation of clinical education strategies to enhance practical value, which could include patient-friendly, standardized imaging brochures for gynecology clinics, formalized physician education protocols, and regulation of unsubstantiated medical content, while also using verified healthcare social media platforms for evidence-based dissemination. Furthermore, in the context of the recent international consensus statement on preoperative imaging and diagnosis (14), further studies are needed to assess the awareness of clinicians regarding this statement and how to bridge any gaps in this regard. Key message The evidence for preoperative imaging for the diagnosis of deep endometriosis is well established; however, little is known about patient awareness regarding this evidence. This study highlighted that there continues to be a lack of patient awareness with regard to the availability and accuracy of preoperative imaging, specifically deep endometriosis ultrasound and magnetic resonance imaging, for the diagnosis of deep endometriosis. There is an increasing urgency for clinicians to address these knowledge gaps. Statements Data availability statement The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. Ethics statement The studies involving humans were approved by the Human Research Ethics Committee of the Nepean Blue Mountains Local Health District (HREC 2025/ETH01032). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Author contributions BG: Conceptualization, Data curation, Investigation, Methodology, Writing – original draft, Writing – review & editing. AE: Formal analysis, Writing – review & editing. GC: Supervision, Writing – review & editing. Funding The author(s) declared that financial support was not received for this work and/or its publication. Acknowledgments We would like to sincerely thank the endometriosis society groups, specifically Endometriosis Australia, Endometriosis New Zealand, Endometriosis Canada, Asociación de Endometriosis España, GAPENDI, and Endometriosis UK, for their willingness and assistance in publishing this online survey on their respective pages. Conflict of interest BG has served on an advisory board for Gedeon Richter and is also a director/owner/inventor of a patent relating to a laparoscopic device. GC has received honoraria as a key opinion leader from GE, Samsung, and SonoScape. The remaining author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Generative AI statement The author(s) declared that generative AI was not used in the creation of this manuscript. Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence, and reasonable efforts have been made to ensure accuracy, including review by the authors, wherever possible. If you identify any issues, please contact us. Publisher’s note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Supplementary material The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/frph.2026.1917458/full#supplementary-material Abbreviations CT, computed tomography; DE, deep endometriosis; GP, general practitioner; IQR, interquartile range; MRI, magnetic resonance imaging; SD, standard deviation.

1. GiudiceLC. Clinical practice. Endometriosis. N Engl J Med. (2010) 362:2389–98. 10.1056/NEJMcp1000274 2. JohnsonNPHummelshojLAbraoMSAdamsonGDAllaireCAmelungVet al. Consensus on current management of endometriosis. Hum Reprod. (2013) 28:1552–68. 10.1093/humrep/det050 3. Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril. (2012) 98:591–8. 10.1016/j.fertnstert.2012.05.031 4. BerubeSMarcouxSLangevinMMaheuxR. Fecundity of infertile women with minimal or mild endometriosis and women with unexplained infertility. The Canadian Collaborative Group on Endometriosis. Fertil Steril. (1998) 69:1034–41. 10.1016/S0015-0282(98)00081-8 5. GuptaSGoldbergJMAzizNGoldbergEKrajcirNAgarwalA. Pathogenic mechanisms in endometriosis-associated infertility. Fertil Steril. (2008) 90:247–57. 10.1016/j.fertnstert.2008.02.093 6. GuerrieroSCondousGVan Den BoschTValentinLLeoneFPGVan SchoubroeckDet al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. (2016) 48:318–32. 10.1002/uog.15955 7. NoventaMSaccardiCLittaPVitaglianoAD'AntonaDAbdulrahimBet al. Ultrasound techniques in the diagnosis of deep pelvic endometriosis: algorithm based on a systematic review and meta-analysis. Fertil Steril. (2015) 104:366-83 e362. 10.1016/j.fertnstert.2015.05.002 8. HudelistGEnglishJThomasAETinelliASingerCFKecksteinJ. Diagnostic accuracy of transvaginal ultrasound for non-invasive diagnosis of bowel endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol. (2011) 37:257–63. 10.1002/uog.8858 9. PereiraAMGBrizonVSCCarvas JuniorNDe CarvalhoMSRCuveroEMBuehlerAMet al. Can enhanced techniques improve the diagnostic accuracy of transvaginal sonography and magnetic resonance imaging for rectosigmoid endometriosis? A systematic review and meta-analysis. J Obstet Gynaecol Can. (2020) 42:488–99.e484. 10.1016/j.jogc.2019.07.016 10. GergesBLiWLeonardiMMolBWCondousG. Optimal imaging modality for detection of rectosigmoid deep endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol. (2021) 58:190–200. 10.1002/uog.23148 11. GergesBLiWLeonardiMMolBWCondousG. Meta-analysis and systematic review to determine the optimal imaging modality for the detection of uterosacral ligaments/torus uterinus, rectovaginal septum and vaginal deep endometriosis. Hum Reprod Open. (2021) 2021:hoab041. 10.1093/hropen/hoab041 12. GergesBLiWLeonardiMMolBWCondousG. Meta-analysis and systematic review to determine the optimal imaging modality for the detection of bladder deep endometriosis. Eur J Obstet Gynecol Reprod Biol. (2021) 261:124–33. 10.1016/j.ejogrb.2021.04.030 13. CondousGGergesBThomassin-NaggaraIBeckerCTomassettiCKrentelHet al. Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an International Consensus Statement. Eur J Radiol. (2024) 176:111450. 10.1016/j.ejrad.2024.111450 14. CondousGGergesBThomassin-NaggaraIBeckerCTomassettiCKrentelHet al. Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an International Consensus Statement. Ultrasound Obstet Gynecol. (2024) 64:129–44. 10.1002/uog.27560 15. CondousGGergesBThomassin-NaggaraIBeckerCMTomassettiCKrentelHet al. Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an International Consensus Statement. J Minim Invasive Gynecol. (2024) 31:557–73. 10.1016/j.jmig.2024.04.006 16. CondousGGergesBThomassin-NaggaraIBeckerCTomassettiCKrentelHet al. Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an International Consensus Statement. Hum Reprod Open. (2024) 2024:hoae029. 10.1093/hropen/hoae029 17. CondousGGergesBThomassin-NaggaraIBeckerCTomassettiCKrentelHet al. Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an International Consensus Statement. Facts Views Vis Obgyn. (2024) 16:127–44. 10.52054/FVVO.16.2.012 18. BoyntonPMGreenhalghT. Selecting, designing, and developing your questionnaire. Br Med J. (2004) 328:1312–5. 10.1136/bmj.328.7451.1312 19. WrightKB. Researching internet-based populations: advantages and disadvantages of online survey research, online questionnaire authoring software packages, and web survey services. J Comput Mediat Commun. (2017) 10(3). 10.1111/j.1083-6101.2005.tb00259.x 20. MickIFregerSMMarienMGholiofMLeonardiM. Diagnostic accuracy of transvaginal ultrasonography for endometriosis according to the International Deep Endometriosis Analysis consensus. O G Open. (2025) 2:e061. 10.1097/og9.0000000000000061 21. NisenblatVBossuytPMFarquharCJohnsonNHullML. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. (2016) 2:CD009591. 10.1002/14651858.CD009591.pub2 22. AveryJCKnoxSDeslandesALeonardiMLoGWangHet al. Noninvasive diagnostic imaging for endometriosis part 2: a systematic review of recent developments in magnetic resonance imaging, nuclear medicine and computed tomography. Fertil Steril. (2024) 121:189–211. 10.1016/j.fertnstert.2023.12.017 23. AdlerHLewisMNgCHMBrooksCLeonardiMMikocka-WalusAet al. Social media, endometriosis, and evidence-based information: an analysis of Instagram content. Healthcare (Basel). (2024) 12(1):121. 10.3390/healthcare12010121 24. De ManJCampbellLTabanaHWoutersE. The pandemic of online research in times of COVID-19. BMJ Open. (2021) 11:e043866. 10.1136/bmjopen-2020-043866 25. HeiervangEGoodmanR. Advantages and limitations of web-based surveys: evidence from a child mental health survey. Soc Psychiatry Psychiatr Epidemiol. (2011) 46:69–76. 10.1007/s00127-009-0171-9 26. PozzarRHammerMJUnderhill-BlazeyMWrightAATulskyJAHongFet al. Threats of bots and other bad actors to data quality following research participant recruitment through social media: cross-sectional questionnaire. J Med Internet Res. (2020) 22:e23021. 10.2196/23021 27. NgWZErdembilegSLiuJCJTuckerJDTanRKJ. Increasing rigor in online health surveys through the reduction of fraudulent data. J Med Internet Res. (2025) 27:e68092. 10.2196/68092 28. GouesbetSDu CheyronJAmazouzHBretonZPaneIToko-KamgaLet al. Reliability of self-reported endometriosis and adenomyosis data in online surveys: results from the ComPaRe-Endometriosis e-cohort. Hum Reprod. (2025) 40:2181–8. 10.1093/humrep/deaf160 Summary

awareness, computed tomography, endometriosis, preoperative imaging, magnetic resonance imaging, preoperative diagnosis, ultrasound Citation Gerges B, Eathorne A and Condous G (2026) Preoperative imaging for endometriosis awareness: an online survey study. Front. Reprod. Health 8:1917458. doi: 10.3389/frph.2026.1917458 Received 23 June 2026 Revised 15 July 2026 Accepted 20 July 2026 Published 03 September 2026 Volume 8 - 2026 Edited by Francesco Giuseppe Martire, University of Rome Tor Vergata, Italy Reviewed by Jing Chen, Shanghai University of Traditional Chinese Medicine, China Mohammed Abdel-Wahab, Alazhar University, Egypt Updates Copyright © 2026 Gerges, Eathorne and Condous. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. *Correspondence: Bassem Gerges [email protected] ORCID Bassem Gerges orcid.org/0000-0001-8559-7050 Allie Eathorne orcid.org/0000-0002-0706-044X Disclaimer All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.