Quality of life in women with endometriosis in Portugal: a cross-sectional study on the roles of social support and sexual satisfaction

Endometriosis, a  chronic and often painful gynecological condition characterized by the presence of endometrial- like tissue outside the uterine cavity, significantly impacts multiple facets of women’s lives, including their sexual health, psychological well-being, and overall quality of life. The  heterogeneous presentation of symptoms, rang - ing from dysmenorrhea and dyspareunia to infertility, exerts not only a physical toll but also an emotional and social burden. This cross-sectional study explored how so- cial support contributed to the quality of life in Portuguese- speaking women residing in Portugal with endometriosis and how sexual satisfaction could contribute to explaining these associations. participants and procedure A total of 106 women with a self-reported diagnosis of en - dometriosis, with a mean age of 33.54 years (SD = 7.43), par - ticipated in the study. Data were collected online between January and May 2024 using self-report measures of quality of life, sexual satisfaction, and perceived social support.

The results revealed that higher social support is signifi- cantly associated with greater sexual satisfaction (B = .17, SE = .06, t = 2.84, p < .001, 95% CI [.05, .29]) and improved overall quality of life (B = .19, SE = .03, t = 5.44, p < .001, 95%  CI [.12, .26]). Sexual satisfaction significantly medi- ated the relationship between social support and quality of life (indirect effect = .05, SE = .02, 95% CI [.01, .09].

These findings underscore the importance of social con - nections and sexual health in managing endometriosis among Portuguese-speaking women residing in Portugal, offering valuable insights for clinical practice and future re- search on holistic care for women with chronic conditions. key words perceived social support; sexual satisfaction; quality of life; endometriosis Noa Cacete 1 · A,B,E Juliana Pedro id 2,3 · A,D,E Filipa Pimenta id 4 · A,D,E Tânia Brandão id 4 · A,C,D,E Quality of life in women with endometriosis in Portugal: a cross-sectional study on the roles of social support and sexual satisfaction organization – 1: School of Psychology, ISPA – University Institute, Lisboa, Portugal · 2: Center for Reproductive Genetics Prof. Alberto Barros, Porto, Portugal · 3: Center for Psychology at the University of Porto, Porto, Portugal · 4: William James Center for Research, ISPA – University Institute, Lisboa, Portugal authors’ contributions – A: Study design · B: Data collection · C: Statistical analysis · D: Data interpretation · E: Manuscript preparation · F: Literature search · G: Funds collection corresponding author – Prof. Tânia Brandão, William James Center for Research, ISPA – University Institute, Rua Jardim do Tabaco 34, 1149-041 Lisboa, Portugal, e-mail: [email protected] to cite this article – Cacete, N., Pedro, J., Pimenta, F., & Brandão, T. (2026). Quality of life in women with endometriosis in Portugal: a cross-sectional study on the roles of social support and sexual satisfaction. Health Psychology Report. https://doi.org/10.5114/hpr/216284 received 08.07.2025 · reviewed 18.11.2025 · accepted 30.12.2025 · online publication 12.03.2026 This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/) Noa Cacete, Juliana Pedro, Filipa Pimenta, Tânia Brandão 2 health psychology report

Endometriosis is a  chronic gynecological condition characterized by the growth of tissue similar to the endometrium outside the uterus, resulting in inflam‑ mation and scarring (WHO, 2025). Clinically, the con‑ dition is described across four subtypes: superficial peritoneal involvement; deep infiltrating endometrio‑ sis; ovarian cysts (endometriomas); and extra‑pelvic lesions (As‑Sanie et al., 2025). Current evidence suggests that approximately 10% of women of reproductive age worldwide live with endometriosis (WHO, 2025). However, reported rates are not uniform (ranging from 2% to 71.4%), since they reflect variations in geography, clinical setting, symp‑ tom presentation, age distribution, and the methods used to establish the diagnosis (Ghiasi et al., 2020). For instance, in symptomatic women, prevalence varied between 35% and 100% (Nnoaham et al., 2011). In Por‑ tugal, where the present study was conducted, national estimates suggest that approximately 700,000 women may be affected, with the condition most often diag‑ nosed between the ages of 25 and 30 (Adamson et al., 2010; Setúbal, 2023). Despite its prevalence, the etiol‑ ogy of endometriosis remains unclear, with potential causes including hereditary predisposition, immune dysfunction, and environmental factors such as life ‑ style choices, smoking, and unhealthy dietary habits (Della‑Corte et al., 2020; Wu et al., 2024). Diagnosis is often challenging due to the nonspe‑ cific and sometimes atypical nature of symptoms, re‑ sulting in substantial delays (from 5 to 12 years) (De Corte et al., 2025). Laparoscopy remains the most ac ‑ curate diagnostic method, offering direct visualization of lesions and facilitating treatment planning (Duarte & Righi, 2021; Hsu et al., 2010). Symptoms of endo ‑ metriosis include dysmenorrhea and dyspareunia, chronic pain, and infertility, frequently resulting in significant psychological difficulties, including anxi ‑ ety and depression, impairing women’s mental health and quality of life, social interactions, professional ac‑ tivities, and intimate relationships (Ameratunga et al., 2017; Facchin et al., 2020; Gruber & Mechsner, 2021; Laganà et al., 2017; Missmer et al., 2021; Rossel et al., 2025). Quality of life Quality of life (QoL), as defined by the WHO, rep‑ resents “individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expec‑ tations, standards, and concerns” (WHO, 1997, p. 1). Models developed in pain research show that QoL is shaped by interactions between physical symptoms, emotional functioning, and social resources (e.g., the model of quality of life in a  group of people with chronic low back pain), highlighting the relevance of these dimensions for understanding QoL in other chronic conditions such as endometriosis (Ziętale‑ wicz & Bargiel‑Matusiewicz, 2024). For women with endometriosis, QoL is profound‑ ly impaired by a combination of chronic pain, sexual dysfunction, and professional, social, and psycho‑ logical challenges (Bień et  al., 2020; Hudson et  al., 2013). Research consistently shows that QoL in these women is diminished not only in physical domains but also across psychological and social dimensions; these reductions are primarily attributed to the symptoms of endometriosis rather than the diagnosis itself (Gao et al., 2006; Marinho et al., 2018). Beyond the physical symptoms already men‑ tioned, psychological effects such as depression and anxiety are frequently reported, along with disrup‑ tions in sexual and social relationships (Della‑Corte et al., 2020; Li et al., 2025). The economic burden is another significant factor, as many women experi‑ ence reduced working hours, reduced productivity, job transitions, or even withdrawal from the work‑ force due to debilitating symptoms (Della‑Corte et al., 2020; Fourquet et al., 2010; Moradi et al., 2014). This often leads to financial strain, compounding emotional stress within couples and families. The impact of endometriosis symptoms on inti ‑ mate partner relationships has been shown to signifi‑ cantly affect women’s overall QoL, underlining the importance of addressing relational dynamics (Bień et  al., 2020). Indeed, to improve the QoL of women with endometriosis, there is a growing call to address emotional, social, and sexual issues as integral compo‑ nents of care (Bień et al., 2020). However, a recent re ‑ view has highlighted a lack of research into psychoso‑ cial factors that may further influence women’s QoL, namely in terms of social support (Kalfas et al., 2022). Perceived social su PPort and endometriosis Endometriosis, while primarily affecting women, ex‑ erts a significant impact on their partners and families (Schick et al., 2022). The daily challenges and emotion‑ al burden associated with the disease often strain rela‑ tionships, underscoring the pivotal role of social sup‑ port in mitigating these effects. Despite its recognized importance, research on the influence of perceived so‑ cial support on pain management and QoL in women with endometriosis remains sparse (Kalfas et al., 2022). According to Zimet’s model (Zimet et  al., 1988), perceived social support reflects individuals’ subjec‑ tive appraisal of the support they believe is available from three key sources (including family, friends, and significant others), emphasizing perceived availabil‑ ity rather than the mere presence of people in one’s social network. Perceived social support, particularly Quality of life in women with endometriosis 36 from partners and family, is a  well‑established de‑ terminant of physical and mental well‑being in the context of chronic diseases (Maguire et al., 2021). It enhances self‑efficacy and reduces perceived stress, enabling individuals to better adapt to the challenges posed by chronic conditions (Luo et  al., 2023). Evi‑ dence from other women’s health contexts indicates that social support plays a significant role in protect‑ ing psychological well‑being and quality of life, even under emotionally demanding circumstances (e.g., complicated grief) (Skalski‑Bednarz et al., 2026). Also, women consistently identify support from partners as essential in navigating the condition (Márki et al., 2022). Partners provide emotional and practical assistance, including help with daily tasks, accompanying women to medical appointments, and engaging in treatment decisions (Culley et al., 2017). In a recent study it was found that perceived social support positively influenced partnership satisfac ‑ tion in couples affected by endometriosis and infertil‑ ity (van Eickels et al., 2024). Beyond family support, broader networks – such as friends, online communi‑ ties, and support groups – offer women with endome‑ triosis a sense of belonging, understanding, and hope (Márki et al., 2022). To the best of our knowledge, no studies have spe‑ cifically examined the role of perceived social support in the sexual satisfaction of women with endome ‑ triosis. However, research in other contexts, such as rheumatic diseases, has highlighted the importance of social support in influencing women’s sexual health. For example, dissatisfaction or lack of fulfill ‑ ment in partner relationships has been associated with increased sexual dysfunction (Granero ‑Molina et al., 2018). Furthermore, studies have suggested that social support plays a crucial role in facilitating cop ‑ ing mechanisms for chronic illnesses, which, in turn, can contribute to improved sexual health outcomes (Kengen Traska et  al., 2012; Schulman ‑Green et  al., 2016). A systematic review by Sánchez‑Fuentes et al. (2014) examining factors associated with sexual satis‑ faction identified variables related to social support, such as strong social networks and positive family relationships, as predictors of higher sexual satisfac‑ tion. However, the authors noted the limited research available on these topics. sexual satisfaction and endometriosis According to the WHO, sexual health refers to “a state of physical, emotional, mental and social well ‑being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity” (WHO, 2024, p. 1). Sexual health is recognized as a vital component of women’s quality of life, even in the context of chronic health conditions (Flynn et al., 2016). Sexual satisfac ‑ tion is generally understood as a  multidimensional construct influenced by interpersonal, behavioral, and psychological aspects. Theoretical frameworks describe it as a  subjective appraisal of sexual expe ‑ riences that extends beyond the presence of sexual problems, involving emotional closeness, relational processes, and personal sexual functioning. Models in this field highlight both individual dimensions, such as desire and well ‑being, and relational elements, including communication and perceived responsive‑ ness (Sánchez‑Fuentes et al., 2014). Sexual satisfaction is often diminished in individu‑ als coping with chronic illnesses (Flynn et al., 2016). Research shows that women with endometriosis often experience impaired sexual functioning and reduced levels of sexual satisfaction compared to women without the condition (Kfoury et al., 2023; Montana ‑ ri et al., 2013; Vercellini et al., 2012). Also, a system ‑ atic review and meta ‑analysis revealed that women with endometriosis have an approximately twofold increased risk of experiencing sexual dysfunction compared to women without the condition (OR 2.38) (Pérez‑López et al., 2020). Another systematic review corroborated these findings, reporting a  1.71 ‑fold higher risk of sexual dysfunction in women with en‑ dometriosis (95% CI: 1.21‑2.43). Women with endome‑ triosis consistently scored lower across all domains of sexual functioning, including desire, arousal, lubrica‑ tion, orgasm, satisfaction, and pain, as assessed by the Female Sexual Function Index (FSFI) (Zhu et al., 2023). Among the primary contributors to poor sexual function are symptoms such as dyspareunia and deep pelvic pain, which are hallmark features of this con‑ dition (Shum et al., 2018; Youseflu et al., 2020). How‑ ever, the impact of endometriosis on sexual health extends beyond physical pain. Psychological and emotional factors, including anxiety, depression, low self‑esteem, and infertility‑related challenges, also play a significant role in the development of sexual dysfunction (Norinho et  al., 2020; Shi et  al., 2023; Youseflu et al., 2020). Additionally, poor sleep qual‑ ity – a common issue in women with chronic pain conditions – can further exacerbate sexual difficulties (Youseflu et al., 2020). These findings underscore the pervasive and multifaceted impact of endometriosis on women’s sexual health, highlighting the critical need for comprehensive management strategies. t he Present study Endometriosis has a  profound impact on women’s QoL, affecting physical, psychological, and social do‑ mains. Chronic pain, sexual dysfunction and dissatis‑ faction, and relational challenges are central contrib‑ utors to reduced QoL in this population (Bień et al., 2020; Hudson et al., 2013). However, the psychosocial mechanisms underlying QoL, particularly the roles of social support and sexual satisfaction, remain un‑ Noa Cacete, Juliana Pedro, Filipa Pimenta, Tânia Brandão 4 health psychology report derexplored. Social support, a critical determinant of health and well‑being in chronic diseases, is associ‑ ated with improved coping strategies, reduced stress, and better overall outcomes (Luo et al., 2023; Maguire et al., 2021). Despite this, little research has examined the specific influence of social support on QoL in women with endometriosis, particularly its indirect effects through sexual satisfaction. Sexual dysfunction and sexual dissatisfaction are prevalent problems in endometriosis (e.g., Pérez ‑ López et  al., 2020; Zhu et  al., 2023). Research from other chronic disease contexts suggests that relational factors and social support are critical for sexual health (Granero‑Molina et  al., 2018; Kengen Traska et  al., 2012; Sánchez‑Fuentes et al., 2014). Dissatisfying re ‑ lationships and lack of partner support have been linked to greater sexual problems, while adequate social support facilitates coping and enhances emo ‑ tional well‑being, potentially improving sexual func‑ tioning (Schulman‑Green et al., 2016). In this study, we tested a  mediational model to investigate the relationships between social support, sexual satisfaction, and QoL in Portuguese‑speaking women residing in Portugal with endometriosis. Specifically, we hypothesized that sexual satisfaction mediates the link between perceived social support and QoL. This model builds on prior evidence sug‑ gesting that social support not only directly enhanc‑ es QoL but also exerts indirect effects by influencing the relational and psychological burdens associated with sexual dissatisfaction. By examining these path‑ ways, our research sought to provide a  more com‑ prehensive understanding of the psychosocial factors influencing QoL in women with endometriosis and to inform the development of holistic interventions, tailored for women with this clinical condition. Partici Pants and Procedure Partici Pants Eligibility required having a formal medical diagnosis of endometriosis. Participants were asked to indicate whether a healthcare professional had diagnosed them with endometriosis, and only those who confirmed a  medically established diagnosis were included. Other inclusion criteria for the study required partici‑ pants to be women of reproductive age and current ‑ ly experiencing at least one symptom related to the disease. Women with asymptomatic endometriosis, pregnant women, and those who were not proficient in Portuguese were excluded from the study. Further‑ more, all participants were required to provide in ‑ formed consent prior to participating in the research. Using G*Power 3.1, we estimated that for a linear multiple regression with two predictors (social sup ‑ port and sexual satisfaction), assuming a medium ef ‑ fect size (f² = .15), α = .05, and desired power of .90, a minimum sample of approximately 88 participants would be required. This cross‑sectional study included 106 women who reported a diagnosis of endometrio ‑ sis, aged between 18 and 52 (M age = 33.54, SD = 7.43). Most of the participants (89.6%) were in a relationship. Regarding the presence of children, 19.8% of the wom‑ en had at least one child. In terms of education, most of the participants had higher education (32.1% with a master’s degree and 25.5% with a bachelor’s degree). In addition, 34% self‑reported a diagnosis of infer ‑ tility associated with endometriosis (see Table 1 for a detailed description of participants’ characteristics). Table 1 Sociodemographic data of the sample Variable M/n SD/% Age 33.54 7.43 Marital status Living together 26 24.5 Married 37 34.9 Single 39 36.8 Divorced 4 3.8 Nationality Portuguese 87 82.1 Brazilian 15 14.2 Other 4 3.8 Education 2nd cycle 2 1.9 3rd cycle or equivalent 4 3.8 High school or equivalent 34 32.1 Bachelor 27 25.5 Postgraduate 4 3.8 Master 34 32.1 Doctorate 1 0.9 Relationship Yes 95 89.6 No 11 10.4 Children Yes 21 19.8 No 85 80.2 Infertility diagnosis Yes 36 34.0 No 70 66.0 Quality of life in women with endometriosis 56 m easures Quality of life . The  Portuguese version of the WHOQOL‑BREF was used to measure women’s QoL (Vaz Serra et al., 2006). It was selected because it is a theoretically grounded, multidimensional measure of quality of life that aligns with the WHO definition of health and has been widely validated for use in chronic health conditions. It is a 26 ‑item self‑report instrument designed to assess quality of life across four key domains: (1) Physical Domain: encompasses items related to physical health, including mobility, energy, pain, and sleep (item example: “How satis ‑ fied are you with your health?”); (2) Psychological Domain: addresses emotional well‑being, self‑esteem, body image, and mental health (item example: “How often do you have negative feelings such as blue mood, despair, anxiety, or depression?”); (3) Social Relationships Domain: evaluates satisfaction with personal relationships, social support, and sexual life (item example: “How satisfied are you with the sup‑ port you get from your friends?”); and (4) Environ ‑ ment Domain: examines environmental factors such as safety, financial resources, healthcare access, and the physical environment (item example: “How satis‑ fied are you with your transport?”). Items are rated on a  5 ‑point Likert scale, where higher scores indicate better quality of life. In the pres‑ ent study, the WHOQOL ‑BREF instrument demon ‑ strated good internal reliability, with a Cronbach’s α value of .93 and ω coefficient of .92 for the overall ques‑ tionnaire (the environment domain was not included as this study did not focus on environment issues). Perceived social support. Perceived social support was measured using the Portuguese version of the Multidimensional Scale of Perceived Social Support (MSPSS; Carvalho et al., 2011). This instrument was selected because it is grounded in Zimet and col‑ leagues’ theoretical model, which conceptualizes social support as deriving from distinct and mean‑ ingful sources (e.g., family, friends) with a focus on perceived support rather than objective presence of individuals. It has 12 items and assesses three sources of sup ‑ port: family support (4 items; item example: “My family is willing to help me make decisions”), friend support (4 items; item example: “My friends really try to help me”, and support from significant others (4 items; item example: “There is a special person who is around when I am in need”). Items are rated on a  7‑point Likert scale, ranging from 1 ( strongly dis- agree) to 7 ( strongly agree). In the present study, the MSPSS exhibited good psychometric properties, with a global Cronbach’s α of .95 and ω coefficient of .95 for the total score. Sexual satisfaction . Sexual satisfaction was as ‑ sessed using the Portuguese version of the New Sexu‑ al Satisfaction Scale (NSSS; Pechorro et al., 2016). This instrument was selected because it is grounded in contemporary theoretical models of sexual function‑ ing and satisfaction, and captures both personal and relational dimensions of sexual experience. It consists of 20 items, divided into two subscales: Self‑Centeredness (10 items; item example: “The in‑ tensity of my sexual arousal”) and Partner and Sexual Activity‑Centeredness (10 items; item example: “My partner’s emotional opening up during sex”. Items are scored on a  5‑point Likert‑type scale ranging from 1 (not at all satisfied) to 5 (extremely satisfied). In this study, Cronbach’s α was .96 and ω was .96 for the total score of the scale, indicating good internal reliability. Procedure This study was approved by the Ethics Committee of ISPA – University Institute (Reference: I‑134‑12‑23). The  questionnaires were distributed and completed through Google Forms to provide the flexibility to al‑ low participants to complete the instruments at their convenience. Participants were recruited through social networks, including Facebook groups and In‑ stagram pages (e.g., pages dedicated to endometrio‑ sis, pages of (in)fertility clinics, and pages managed by clinicians working in gynecology/reproductive medicine) between January and May 2024. Prior to initiating data collection (on the landing page), all participants were provided with detailed information about the study’s objectives, procedures, inclusion and exclusion criteria, and ethical considerations to ensure transparency and understanding. Informed consent was obtained from each participant before their participation. Data were collected anonymously, with no identi‑ fiable information linked to participants’ responses to protect their confidentiality. Strict security measures were implemented to store and manage data, ensur ‑ ing that they were only accessible to the research team. All data handling followed ethical guidelines and relevant data protection laws. Participants were also informed about how their data would be used, stored, and analyzed, aligning with the principles of ethical research (only for research purposes). Partici‑ pants did not receive any type of incentives. d ata analysis Data were analyzed using SPSS (v. 29). Pearson cor‑ relations were used to analyze correlations among study variables. Mediation analysis was conducted using the PROCESS macro (model 4) (Hayes, 2017). The anal‑ ysis focused on whether sexual satisfaction acts as a  mediator between social support (independent Noa Cacete, Juliana Pedro, Filipa Pimenta, Tânia Brandão 6 health psychology report variables) and QoL (dependent variables) in women with endometriosis. The PROCESS macro is a statis‑ tical tool that allows for the testing of direct, indirect, and total effects in mediation models. Bootstrapping with 5,000 resamples was performed to assess the significance of the indirect effects and provide confi‑ dence intervals, with a 95% confidence level. Direct, total, and indirect effects are reported. A significance level of p < .05 was adopted for all analyses. r esults c orrelational analysis Social support was moderately correlated with sex‑ ual satisfaction and strongly correlated with quality of life. Sexual satisfaction also demonstrated a strong positive correlation with quality of life (see Table 2). m ediational analysis A mediation analysis was conducted to investigate whether sexual satisfaction mediated the relationship between social support and quality of life (see Fig ‑ ure 1), while controlling for participants’ age, marital status, and length of endometriosis diagnosis. Social support was positively associated with sexual satisfac‑ tion (B = .17, SE = .06, t = 2.84, p < .001, 95% CI [.05, .29]). Age was also associated with sexual satisfaction (B = –.03, SE = .01, t  = –2.39, p  .05). Social support had a significant total effect on qual‑ ity of life (B = .19, SE = .03, t = 5.44, p < .001, 95% CI [.12, .26]). In the mediation model, sexual satisfac ‑ tion was significantly associated with quality of life (B = .30, SE = .05, t = 5.88, p < .001, 95% CI [.20, .40]), and social support was also significantly associated with quality of life (B = .14, SE = .03, t = 4.44, p .05). The combined model explained 50.71% of the variance in quality of life ( R 2  =  .51, F(6, 98) = 16.80, p < .001). A significant indirect effect of social support on quality of life through sexual satisfaction was ob ‑ served (indirect effect = .05, SE = .02, 95% CI [.01, .09]). d iscussion This study aimed to investigate the complex interplay between perceived social support, sexual satisfaction, and quality of life in Portuguese‑speaking women re‑ siding in Portugal with endometriosis, focusing on the mediating role of sexual satisfaction. By address‑ ing these variables, the research sought to enhance understanding of the psychosocial factors influenc‑ ing the well‑being of these women living with this chronic condition, providing insights that may guide interventions to improve their overall quality of life. As anticipated, perceived social support was posi‑ tively associated with higher quality of life. This find‑ ing aligns with existing literature, which consistently Table 2 Pearson correlations among study variables (N = 106) Social support Sexual satisfaction Quality of life Social support – Sexual satisfaction .35* – Quality of life .54* .62* – Note. *p < .001. Figure 1 Unstandardized direct, total, and indirect effects of social support and sexual satisfaction on quality of life of women (N = 106), controlling for age, marital status, and length of endometriosis diagnosis Sexual satisfaction Perceived social support Quality of life Direct effect: .14, p < .001 Total effect: .19, p < .001 .30, p < .001.17, p < .001 Quality of life in women with endometriosis 76 emphasizes the vital role of social support in promot‑ ing both physical and mental well‑being, particularly in the context of chronic diseases (e.g., Maguire et al., 2021). Social support serves to enhance individuals’ resources in managing the stress and challenges as‑ sociated with chronic conditions, such as increasing self‑efficacy, reducing perceived stress, and foster‑ ing resilience (Luo et al., 2023). Furthermore, studies have highlighted that support from various sources, particularly from partners, plays a  crucial role in navigating chronic illnesses such as endometriosis. This support helps mitigate feelings of isolation and enhances hope and understanding, ultimately con‑ tributing to improved quality of life (Culley et  al., 2017; Márki et al., 2022; van Eickels et al., 2024). As anticipated, sexual satisfaction was positively associated with improved quality of life. This aligns with the understanding that sexual health, and sexu‑ al satisfaction specifically, plays a significant role in women’s overall well‑being and quality of life (Flynn et  al., 2016). A fulfilling sexual life may contribute to reducing symptoms such as anxiety, stress, and low self‑esteem, which can have a profound impact on mental and emotional health (Fritzer et al., 2013; Gewirtz‑Meydan et al., 2019; La Rosa et al., 2020). Finally, as expected, social support was positively associated with quality of life through sexual satisfac‑ tion. This finding aligns with existing research across different contexts, which highlights the critical role of social and relational factors in sexual health (Gra‑ nero‑Molina et al., 2018; Kengen Traska et al., 2012; Sánchez‑Fuentes et al., 2014). Poor or unsupportive relationships have been linked to increased sexual difficulties, while sufficient social support serves to facilitate coping mechanisms and boost emotional well‑being, ultimately enhancing sexual function and satisfaction (Schulman‑Green et al., 2016). Also, open and secure communication between partners is cru‑ cial to building satisfying relationships and enhanc‑ ing various aspects, including sexuality and overall quality of life (Hudson et al., 2013; Law et al., 2025; Norinho et  al., 2020). Overall, this study highlights the importance of social support and sexual satisfac‑ tion in improving the overall quality of life for wom‑ en with endometriosis, offering valuable insights for promoting emotional and relational well‑being.

and future research This study has several limitations. First, the sample was relatively small, comprising Portuguese‑speaking women residing in Portugal, which may limit the gen‑ eralizability of the findings. Additionally, the use of self‑reported data could introduce biases, such as so‑ cial desirability or recall bias. Another limitation is the cross‑sectional design, which limits the ability to draw causal inferences regarding the relationships between social support, sexual satisfaction, and quality of life. Another limitation is the reliance on self‑reported dia‑ gnoses of endometriosis and infertility, which may be subject to misclassification or reporting bias. Also, be‑ cause recruitment occurred through social networks without the ability to monitor reach or link access, we could not track how many individuals viewed the study announcement, accessed the survey, or were screened for eligibility. Only the final number of par‑ ticipants who met the inclusion criteria is available. Future research should address these limitations by including larger, more diverse samples and em‑ ploying longitudinal designs to better understand the causal relationships. Additionally, exploring the im‑ pact of specific types of social support (e.g., partner support versus family support) and examining other potential mediators and moderators of these relation‑ ships could provide deeper insights into how to im‑ prove quality of life for women with endometriosis. Further investigation into the role of psychological and emotional factors in shaping sexual satisfaction and quality of life is also warranted. Practical im Plications The findings of this study highlight several practical implications for healthcare professionals working with Portuguese‑speaking women residing in Portu‑ gal with endometriosis. Firstly, fostering strong social support networks – whether through family, friends, partners, or healthcare providers – can significantly contribute to improving quality of life. Healthcare practitioners should emphasize the importance of emotional and relational support in managing chron‑ ic conditions such as endometriosis. Additionally, addressing sexual health is crucial, as it plays a significant role in overall well‑being. In‑ terventions aimed at enhancing sexual satisfaction and managing sexual dysfunction could be integrat‑ ed into treatment plans to support holistic care for women with endometriosis. Lastly, promoting psychological counseling and support groups may help mitigate feelings of isola‑ tion and improve coping mechanisms, which are es‑ sential for managing both the physical and emotional challenges associated with the disease. By focusing on these areas, healthcare providers can offer more comprehensive and effective care. Disclosures This research received no external funding. The study was approved by the Ethics Committee of the ISPA – University Institute (Approval No. I-134- 12-23). The authors declare no conflict of interest. Noa Cacete, Juliana Pedro, Filipa Pimenta, Tânia Brandão 8 health psychology report

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