Effect of Deep Infiltrative Endometriosis Surgery and Surgical Method on Sexual Function in Females

Effect of Deep Infiltrative Endometriosis Surgery and Surgical Method on Sexual Function in Females | 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 Effect of Deep Infiltrative Endometriosis Surgery and Surgical Method on Sexual Function in Females Ufuk Atlıhan, Onur Yavuz, Can Ata, Huseyin Aytug Avsar, Tevfik Berk Bildaci, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4752096/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Sexual function and quality of life are significantly reduced in Endometriosis, particularly deep infiltrative endometriosis (DIE) patients. The purpose of this study was to compare the effects of endometriosis excision and excision techniques on sexual function among individuals with DIE to those of healthy females in an objective manner. Materials and Methods Our study included 140 individuals who were diagnosed as having DIE and reported dyspareunia in our clinic between January 2018 and 2024, and 70 patients who presented to our family planning clinic. The preoperative and at 6th -month post-surgery scores of the Female Sexual Function Index, Quality of Sexual Experience Scale, and visual analog scale (VAS) values of all patients who described preoperative dyspareunia were examined retrospectively from the patient files. Results In our study, the FSFI score of healthy group was seen to be significantly greater than the pre-surgery and post-surgery groups (p < 0.001 and p < 0.001,irespectively). The QSES scores of the healthy group was found to be significantly higher than the pre-surgery and post surgery groups (p < .001and p < 0.001, respectively). The VAS dyspareunia values of the healthy group were discovered to be significantly lower than the pre-surgery and post surgery groups (p < 0.001 and p < 0.001.irespectively). The FSFI and QSES scores of the post-surgery group were seen to be significantly higher than the pre-surgery group (p < 0.001 and p < 0.001, respectively). The VAS dyspareunia score of the post-surgery group was seen to be significantly lower than that of the pre-surgery group (p < 0.001). The FSFI and QSES scores of patients who underwent laparotomy was discovered to be significantly greater than that of individuals who underwent laparoscopic surgery (p < 0.001 and p = 0.01,irespectively). Conclusion The surgical approach may have a positive effect both on organ dysfunction and sexual function in females affected by DIE, and therefore it is important to incorporate issues regarding females’ sexual health into standard gynecological treatment. sexual function endometriosis deep infiltrative endometriosis surgery INTRODUCTION The gynecologic condition endometriosis is characterized by the persistent inflammation and existence of tissue outside the uterus that resembles endometrial tissue ( 1 ). About 10% of women who are of reproductive age and exhibit pelvic discomfort and infertility are thought to have endometriosis ( 2 , 3 ). A kind of endometriosis that extends more than 5 mm below the peritoneal surface is known as deep infiltrative endometriosis (DIE) ( 4 ). It is well acknowledged that endometriosis, and specifically DIE, significantly lowers quality of life and sexual function ( 5 – 7 ). Changes in sexual function in females with DIE may be caused by a variety of causes, including as tissue fibrosis, discomfort, chronic inflammation, and the presence of neuroactive drugs ( 8 , 9 ). Since endometriosis is a benign condition, pain management and symptom improvement should be the primary objectives of treatment. Conservative approaches, like as medical care, may be risk-free and innocuous, but they frequently don't work, particularly in DIE ( 10 , 11 ). As long as endometriotic foci are completely eliminated, symptomatic endometriosis surgery is usually successful and has a low recurrence rate ( 12 , 13 ). On the other hand, intestinal or urinary neurogenic dysfunction might make DIE laparoscopic treatment more difficult, particularly in cases where nerve-sparing surgery is not an option ( 14 – 16 ). We aimed in this retrospective study to objectively evaluate the effect of endometriosis excision and excision methods on sexual function in individuals having DIE in comparison to healthy females. MATERIALS AND METHODS The present study was designed in a retrospective observational design pursuant to the guidelines of the Helsinki Declaration. Documents of informed consent were taken from all patients. The research obtained approval of our hospital’s Ethics Committee (Date: 26/06/2024, Number: 2024/307). Our study included 140 patients who were diagnosed as having DIE and reported dyspareunia in our clinic between January 2018 and 2024, and 70 patients who presented to our clinic for birth control. Before surgery, all female patients with DIE underwent transvaginal and abdominal ultrasonography as well as gynecologic tests to determine whether they had pelvic endometriosis ( 17 , 18 ). After the patients who underwent surgery due to DIE were retrospectively screened, 70 patients who underwent laparoscopic surgery (L/S) and 70 patients who underwent laparotomy (L/T) were included in the study. The preoperative Female Sexual Function Index (FSFI) ( 19 ), Quality of Sexual Experience Scale (QSES) ( 20 ), and visual analog scale (VAS) ( 21 ) values of all patients who described preoperative dyspareunia were examined retrospectively from the patient files. Females with DIE had complete excision of macroscopic endometriotic lesions in accordance with relevant surgical procedures ( 22 , 23 ). The same surgeon carried out the surgeries, and the surgical team had consistently treated DIE patients with laparoscopic and laparotomic procedures in the past. Histologic analysis was performed on all patients after surgery, and only patients whose diagnosis was confirmed were included in the research. After 6 months, all participants had clinical examinations and transvaginal ultrasonography to make an evaluation on the symptoms and/or anatomic recurrence of endometriotic nodules. Six months after surgery, the FSFI, QSES, and VAS scores of all patients were retrospectively examined from the patient files. On the VAS scale, 0 represents the lack of symptoms and 10 represents the worst conceivable illness. Dyspareunia was scored by participants on a range of 0 to 10. The FSFI assessed six distinct domains: pain/discomfort, satisfaction, orgasm, lubrication, arousal, and desire. The scale ranged from 0 (no sexual activity in the previous four weeks) or 1 (very unhappy) to 5 (very satisfied). A full-scale score ranging from 2.0 (severe dysfunction) to 36.0 (no dysfunction) was used in the study to assess sexual function, with higher FSFI scores thought to be linked to improved symptoms. According to Wiegel et al., there is an ideal cut-off score of 26, which is utilized to identify females who now have sexual dysfunction from those who do not ( 24 ). Greater QSES scores correspond to greater quality; the range of values is 7 to 49 ( 25 ). This questionnaire also examines several facets of sexual life and the influence of pelvic issues on sexual functioning. When responding to the questions, participants were instructed to take into account the preceding four weeks. Exclusion criteria for the study were a history of gynecologic cancer, inflammatory bowel disease, a record of pelvic radiotherapy or systemic chemotherapy, gynecologic infection in based on demographic and clinical characteristics (parity, BMI, age). Statistical analysis was completed with the SPSSi26.0 software package (IBM Inc., Chicago, IL, USA). The distribution normality was evaluated using the Kolmogorov-Smirnov test. Non-normally distributed parameters were analyzed with the Mann-Whitney U test. The Wilcoxon test was employed to determine changes before and after surgery. For the analysis of categorical data, the Chi-square test and Fisher precision test were utilized. Regarding the statistical analysis, categorical variables are reported as percentages, and quantitative variables as median (minimum-maximum). Statistical significance was considered as p < .05 and analyses were within 95% confidence intervals. RESULTS The age average of the participants in our study was 30 years and the BMI average was 24.1kg/m 2 . Fifty-one (24.3%) of the participants in our study had given birth. In this research, the average BMI of patients who underwent endometriosis surgery was 23.9 kg/m 2 , which was significantly lower than that of healthy females (p < 0.001) (Table 1 ). In our study, the FSFI score of the healthy group was significantly greater than the pre-surgery and post-surgery groups (p < 0.001 and p < 0.001,xrespectively). The QSES score of the healthy group was significantly greater than the pre-surgery and post surgery groups (p < 0.001 and p < 0.001, respectively). The VAS dyspareunia score of the healthy group was seen to be significantly lower than the pre-surgery and post surgery groups (p < 0.001 and p < 0.001,xrespectively). The desire score of the healthy group was seen to be significantly higher than the pre-surgery and post surgery groups (p < 0.001 and p < 0.001,irespectively). The arousal score of the healthy group was significantly greater than the pre-surgery group (p < 0.001). The lubrication score of the healthy group was significantly greater than the pre-surgery and postisurgery groups (p < 0.001 and p = 0.03,irespectively). The orgasm score of the healthy groupiwas significantly greater than the pre-surgery group (p < 0.001). The satisfaction score of the healthy group was significantly greater than the pre-surgery group (p < 0.001). The pain score of the healthy group was significantly higher than the pre-surgery group (p < 0.001). In our study, the FSFI score of the post-surgery group was significantly greater than the pre-surgery group (p < 0.001). The QSES score of the post-surgery group was significantly higher than the pre-surgery group (p < 0.001). The VAS dyspareunia score of the post-surgery group was significantly lower than that of the pre-surgery group (p < 0.001). The arousal score of the post-surgery group was significantly greater than the pre-surgery group (p < 0.001). The lubrication score of the post-surgery group was significantly greater than the pre-surgery group (p < 0.001). The orgasm score of the post-surgery group was significantly greater than the pre-surgery group (p < 0.001). The satisfaction score of the post-surgery group was significantly greater than the pre-surgery group (p < 0.001). The pain score of the post-surgery group was significantly higher than that of the pre-surgery group (p < 0.001) (Table 2). In this current research, the FSFI scores of individuals who had L/T were significantly higher than those of patients who underwent L/S (p < 0.001). The QSES scores of patients who underwent L/T were significantly higher than those of patients who underwent L/S (p < 0.001). Arousal scores of individuals who had L/T were significantly higher than those of patients who underwent L/S (p = 0.009). The orgasm scores of patients who underwent L/T were significantly higher than those of patients who underwent L/S (p = 0.01). Satisfaction scores of patients who underwent L/T were significantly higher than those of patients who underwent L/S (p < 0.001). Pain scores of individuals who had L/T were significantly higher than those of patients who underwent L/S (p = 0.01) (Table 3). DISCUSSION In this current research, we hypothesized that surgical treatment of females with DIE may have a positive effect on FSFI and QSES scores and dyspareunia, indicating improvement in overall sexual function. Our goal was to make a comparison of the sexual functioning of female individuals between having DIE and healthy ones. Numerous local environmental, psychological, neurologic, and biological elements that impact one's bodily and mental well-being, as well as one's perception of femininity and interpersonal interactions, are all involved in sexual function ( 26 , 27 ). In addition, depression and infertility, that are very common in females having endometriosis, are also linked with sexual dysfunction ( 28 , 29 ). Recently, there has been increased medical interest in the impact of the presence of endometriosis on sexual function in females. Numerous research in the literature have shown that patients having dyspareunia experience a marked reduction in severity and an improvement in their quality of sexual function following surgical excision of DIE lesions ( 30 , 31 ). Combining L/S with postoperative hormonal treatment is beneficial for females with endometriosis, especially DIE, as it has been demonstrated to enhance sexual function and symptoms ( 32 , 33 ). In line with these studies, our results revealed a notable enhancement in sexual function six months following treatment in patients treated for DIE. There are numerous questionnaire formats for usage in examining sexual activity in in females with endometriosis ( 34 – 36 ). In our study, we used the FSFI survey. We preferred it because of its succinctness, validity proof, and trustworthy subscales (Sexual Desire, Pain/Discomfort, Sexual Arousal, Satisfaction, Orgasm, Lubrication). Furthermore, we evaluated QSES survey data. In our study, in addition to a significant increase in FSFI, QSES, and VAS scores after surgery, we also found a significant improvement in FSFI subcategories. However, despite having no significant difference in FSFI subcategory values among patients in the post-surgery group and the healthy group, FSFI, QSES, and VAS values in the healthy group were still greater than the post-surgery group scores. Sexual desire and satisfaction are deeply influenced by emotions and governed by a range of excitatory and inhibitory impacts. The most important of these obstacles is the presence of dyspareunia. For this reason, the VAS dyspareunia score in the patients in our study was also evaluated using a questionnaire. Because pain is both a potent inhibitor of the sexual response cycle and a potent behavioral modulator, females having dyspareunia are more likely to nurture hypoactive sexual desire disorder (HSDD) or arousing problem ( 37 ). Presumably, because their post-operative pain sensations had decreased and they were more aware that endometriotic lesions had been eliminated, the ladies in the post-surgery group were able to unwind and feel more at ease during sexual activity. It has been demonstrated that the number of DIE nodules detected in certain regions is inversely correlated with the decrease in sexual desire ( 38 ). Of advanced stages, the illness can impact a variety of areas of a woman's life, including her mental health. According to reports, endometriosis-afflicted females have greater rates of psychological disorders such anxiety and sadness ( 39 ). Furthermore, there is a substantial correlation between DIE and persistent pelvic discomfort. Taking into account various studies, there is a substantial correlation between the cumulative size of posterior DIE (less than 1 cm) and both chronic pelvic discomfort and the least severe dyspareunia ( 40 ). involvement of the anterior rectal wall, posterior vaginal fornix, pouch of Douglas, and uterosacral ligaments in two separate investigations by Kor and Vercellini. The degree of Douglas pouch stenosis and the endometriosis stage are associated with the severity of dyspareunia ( 40 , 41 ). Our study's results, which corroborate the findings of the other two studies, show a considerable improvement in VAS dyspareunia ratings following surgery. This finding might be explained by the fact that sexual issues stemming from pelvic issues can be lessened by fully removing all endometriotic lesions and restoring normal pelvic structure. However, we assessed each of the FSFI score subgroups independently and did not restrict the assessment of sexual function to the existence or absence of pelvic discomfort. In particular, we found that the desire scale did not significantly improve following surgical therapy for DIE. Since sexual desire is a multifaceted, complicated process that depends on psychological, anatomical, and physiological components, it is challenging to explain this conclusion ( 42 ). With respect to anatomical variables, it is well recognized that undergoing extensive surgery for endometriosis may result in injury to the autonomic nerve, which might subsequently affect orgasm ( 43 ). In this current research, the higher orgasm score in females with a history of L/T in the post-surgery group than in the L/S group reveals the impression that nerve damage is more limited in the L/T group. We are aware that it is important to take into account the limitations of this research when evaluating the findings. The fact that the research was designed retrospectively, patient data were analyzed only from patient files and data in the database, and the limited number of patients can be cited as limitations of the study. Also, the majority of patients at our tertiary care center for endometriosis therapy were in a severe stage of the illness; as a result, research participants may not be entirely typical of the endometriosis community as a whole. Patients with DIE are more prone than those with less severe illness to experience sexual dysfunction. Because the FSFI and QSES questionnaires inquire about areas of sexual function that many women view as extremely private, there is a considerable danger of response and recall bias even though females complete them independently and without guidance. The psychological elements that characterize human sexuality and the larger cultural background make studies of human sexuality vulnerable to prejudice and confounding variables. Nevertheless, our study has some strengths. Unlike other studies in the literature, our research assessed only the impact of DIE surgery on sexual function, and individuals who had medical treatment in the postoperative period were not included in the study. In this way, it made it possible to assess the impact of DIE surgery alone on sexual function, independent of medical treatment. Furthermore, unlike other studies in the literature, the type of surgical method was also evaluated as a factor in our study. Finally, all surgical patients were diagnosed with histologically confirmed DIE. In conclusion, we found that females affected by DIE generally had significant improvement in their postoperative sexual function compared with the preoperative period. FSFI subparameters and QSES scores improved significantly following surgical treatment. For females affected by DIE, the surgical treatment may improve both organ failure and sexual function; hence, routine gynecologic care should address issues regarding females' sexual health. Abbreviations BMI Body mass index DIE Deep infiltrative endometriosis FSFI FemaleiSexual FunctioniIndex HSDD Hypoactive sexual desire disorder L/S Laparoscopy L/T: Laparatomy QSES Qualityiof Sexual ExperienceiScale VAS Visual analogxscale Declarations Ethical approval: Ethical approval for this study was obtained from the ‘Demokrasi University, Buca Seyfi Demirsoy Training and Research Hospital, Izmir, Turkey’ on June 26, 2024, with the protocol number 2024/307. Consent for publication: Not applicable Consent to participate: All participiants were consented with informed consents approved by local ethical board. Availability of data and materials: The datasets used and/or analyzed in relation to the current study are available from the corresponding author upon reasonable request. Funding: The authors received no financial support for the research, authorship, and/or publication of this article. Acknowledgements: Not applicable Competing interests: The authors declare that they have no competing interests. Authors’ contributions: Ufuk Atlihan contributed to study concept and design, and interpreting the data, composed the statistical dataset, performed the analyses, and wrote and revised the manuscript. Onur Yavuz contributed to data analysis and revision of the paper. Can Ata contributed to study concept and design, interpreting the data and critical revision of the manuscript. Huseyin Aytug Avsar contributed to data analysis and revision of the paper. Tevfik Berk Bildaci contributed to interpreting the data and critical revision of the manuscript. Selcuk Erkilinc contributed to interpreting the data and critical revision of the manuscript. All authors reviewed and approved the final version and no other person made a substantial contribution to the paper. References Zondervan KT, Becker CM, Missmer SA, Endometriosis. N Engl J Med. 2020;382:1244–56. 10.1056/NEJMra1810764 . De Nardi P, Ferrari S. Deep Pelvic Endometriosis: A Multidisciplinary Approach. Milan, Italy: Springer; 2011. Prescott J, Farland LV, Tobias DK, et al. A prospective cohort study of endometriosis and subsequent risk of infertility. Hum Reprod. 2016;31:1475–82. 10.1093/humrep/dew085 . Philippe R, Koninckx A, Ussia L, Adamyan A, Wattiez J, Donnez. Deep endometriosis: definition, diagnosis, and treatment, Fertility and Sterility, Volume 98, Issue 3, 2012, Pages 564–571. https://doi.org/10.1016/j.fertnstert.2012.07.1061 . Montanari G, Di Donato N, Benfenati A, et al. Women with deep infiltrating endometriosis: sexual satisfaction, desire, orgasm, and pelvic problem interference with sex. J Sex Med. 2013;10:1559–66. Mabrouk M, Montanari G, Di Donato N, et al. What is the impact on sexual function of laparoscopic treatment and subsequent combined oral contraceptive therapy in women with deep infiltrating endometriosis? J Sex Med. 2012;9:770–8. D'Alterio MN, D'Ancona G, Raslan M, Tinelli R, Daniilidis A, Angioni S. Management challenges of deep infiltrating endometriosis. Int J Fertil Steril. 2021;15(2):88–94. 10.22074/IJFS.2020.134689 . Epub 2021 Mar 11. PMID: 33687160; PMCID: PMC8052801. Alcalde AM, Martínez-Zamora MÁ, Gracia M, Ros C, Rius M, Carmona F. Assessment of sexual quality of life and satisfaction in couple relationships among women with deep infiltrating endometriosis and adenomyosis. J Sex Marital Ther. 2021;48(3):263–72. https://doi.org/10.1080/0092623X.2021.1986444 . Norinho P, Martins MM, Ferreira H. A systematic review on the effects of endometriosis on sexuality and couple's relationship. Facts Views Vis Obgyn. 2020;12(3):197–205. PMID: 33123695; PMCID: PMC7580264. Fedele L, Bianchi S, Zanconato G, et al. Long-term follow-up after conservative surgery for rectovaginal endometriosis. Am J Obstet Gynecol. 2004;190:1020–4. Donnez O. Conservative management of rectovaginal deep endometriosis: Shaving should be considered as the primary surgical approach in a high majority of cases. J Clin Med. 2021;10(21):5183. https://doi.org/10.3390/jcm10215183 . De Cicco C, Corona R, Schonman R, et al. Bowel resection for deep endometriosis: a systematic review. BJOG. 2011;118:285–91. Yela DA, Vitale SG, Vizotto MP, Benetti-Pinto CL. Risk factors for recurrence of deep infiltrating endometriosis after surgical treatment. J Obstet Gynecol Res. 2021;47(8):2713–9. Rubod C. Pre and postoperative lower urinary tract dysfunction associated with deep infiltrating endometriosis: A prospective observational study. EC Gynecol. 2020;9:40–8. Rosati A, Pavone M, Campolo F, Nardone ADC, Raimondo D, Seracchioli R, Ianieri MM. Surgical and functional impact of nerve-sparing radical hysterectomy for parametrial deep endometriosis: a single centre experience. Volume 14. Facts, Views & Vision in Obgyn; 2022. p. 121. 2. Atlıhan U, et al. Vitamin D evaluation in adenomyosis: A retrospective cross-sectional study. Turk J Obstet Gynecol. 2024;21(2):98–103. Seracchioli R, Poggioli G, Pierangeli F, et al. Surgical outcome and long-term follow up after laparoscopic rectosigmoid resection in women with deep infiltrating endometriosis. BJOG. 2007;114:889–95. Seracchioli R, Mabrouk M, Montanari G, et al. Conservative laparoscopic management of urinary tract endometriosis (UTE): surgical outcome and long-term follow-up. Fertil Steril. 2010;94:856–61. Sonbahar AE, Culha MG, Jannini E. The validity and reliability of the Turkish version of the 6-item female sexual function index (FSFI-6) and the relationship between climacturia and female sexual dysfunction. Int J Impot Res. 2022;34(6):610–3. 10.1038/s41443-021-00463-2 . Epub 20210802. Sanders SA, Herbenick D, Reece M, Schick V, Mullinax M, Dodge B, Fortenberry JD. The development and validation of a brief Quality of Sexual Experience (QSE) scale: results from a nationally representative sample of men and women in the United States. J Sex Med. 2013;10(10):2409-17. 10.1111/jsm.12198 . Epub 2013 May 16. PMID: 23679190. Inal FY, Gul K, Yilmaz Camgoz Y, Daskaya H, Kocoglu H. Validation of the Turkish version of the Pain Sensitivity Questionnaire in patients with chronic pain. J Int Med Res. 2021;49(12):3000605211060158. : 10.1177/03000605211060158. PubMed PMID: 34855531; PubMed Central PMCID: PMC8646826. Villa G, Mabrouk M, Guerrini M, et al. Relationship between site and size of bladder endometriotic nodules and severity of dysuria. J Minim Invasive Gynecol. 2007;14:628–32. Seracchioli R, Mabrouk M, Manuzzi L, et al. Importance of retroperitoneal ureteric evaluation in cases of deep infiltrating endometriosis. J Minim Invasive Gynecol. 2008;15:435–9. Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31(1):1–20. doi: 10.1080/00926230590475206. PubMed PMID: 15841702. Yassa M, Sargin MA, Dereli N, Özdemir YÖ, Akca G, Günay T, Tuğ N. The validity and reliability of the Turkish version of the Quality of Sexual Experience Scale. Anatol J Psychiatry. 2020;21:48–55. De Ugarte C, Marin L, Berman, Berman J. Female sexual dysfunction—From diagnosis to treatment. Sexuality. Reprod Menopause. 2004;2(3):139–45. Dubuisson J, Pont M, Roy P, et al. Female sexuality after surgical treatment of symptomatic deep pelvic endometriosis. Gynecol Obstet Fertil. 2013;41:38–44. Leroy A, et al. Psychology and sexology are essential, from diagnosis to comprehensive care of endometriosis. Gynecologie. Obstetrique Fertil. 2016;44(6):363–7. Guillemot C, Klinkenberg J, Sordes F. Psychological experience of sexuality in painful endometriosis patients. Psychologie Française. 2023;68(3):345–58. Van den Broeck U, et al. Effect of laparoscopic surgery for moderate and severe endometriosis on depression, relationship satisfaction and sexual functioning: comparison of patients with and without bowel resection. Hum Reprod. 2013;28(9):2389–97. Deguara CS, Pepas L, Davis C. August. Does minimally invasive surgery for endometriosis improve pelvic symptoms and quality of life? Current Opinion in Obstetrics and Gynecology 24(4):p 241–244, 2012. | 10.1097/GCO.0b013e328355626f . Vercellini P, Somigliana E, Consonni D, et al. Surgical versus medical treatment for endometriosis-associated severe deep dyspareunia: I. Effect on pain during intercourse and patient satisfaction. Hum Reprod. 2012;27:3450–9. Ferrero S, Abbamonte LH, Giordano M, et al. Deep dyspareunia and sex life after laparoscopic excision of endometriosis. Hum Reprod. 2006;22:1142–8. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D'Agostino R Jr.. The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000 Apr-Jun;26(2):191–208. doi: 10.1080/009262300278597. PMID: 10782451. De Rogatis L, et al. Validation of the female sexual distress scale-revised for assessing distress in women with hypoactive sexual desire disorder. J Sex Med. 2008;5(2):357–64. Diem SJ, Elisheva R, Danan. GSM and quality of life measures. Clin Obstet Gynecol. 2024;67(1):58–67. Ronghe V, Pannase K, Gomase KP, Mahakalkar MG, UndeRSTANDING, HYPOACTIVE SEXUAL DESIRE DISORDER (HSDD). in Women: Etiology, diagnosis, and treatment. Cureus. 2023;15(11):e49690. 10.7759/cureus.49690 . PMID: 38161863; PMCID: PMC10757759. Cozzolino M, et al. Evaluation of sexual function in women with deep infiltrating endometriosis. Sex reproductive Healthc. 2018;16:6–9. La Rosa V, Lucia, et al. An overview on the relationship between endometriosis and infertility: the impact on sexuality and psychological well-being. J Psychosom Obstet Gynecol. 2020;41(2):93–7. Kor E, et al. Relationship between the severity of endometriosis symptoms (dyspareunia, dysmenorrhea and chronic pelvic pain) and the spread of the disease on ultrasound. BMC Res Notes. 2020;13:1–8. Vercellini P, Fedele L, Aimi G, Pietropaolo G, Consonni D, Crosignani PG. Association between endometriosis stage, lesion type, patient characteristics and severity of pelvic pain symptoms: a multivariate analysis of over 1000 patients. Hum Reprod (Oxford England). 2007;22(1):266–71. Rossi V, Galizia R, Tripodi F, Simonelli C, Porpora MG, Nimbi FM. Endometriosis and sexual functioning: How much do cognitive and psycho-emotional factors matter? Int J Environ Res Public Health. 2022;19:5319. https://doi.org/10.3390/ijerph19095319 . Oppenheimer A, Boitrelle F, Nicolas-Boluda A, Fauconnier A. Measurement properties of sexual function assessment questionnaires in women with endometriosis: A systematic review following COSMIN guidelines. Acta Obstet Gynecol Scand. 2024;103(5):799–823. 10.1111/aogs.14768 . Epub 2024 Jan 16. PMID: 38226426; PMCID: PMC11019533. Tables Table1. Comparison of demographic characteristics of main groups Variables All Patients n=210 (100%) Healthy Females n=70 (33.3%) Surgery (+) n=140 (66.7%) p* Age (years) 30 (20-38) 30 (20-38) 30 (20-38) 0.5 BMI (kg/m 2 ) 24.1 (18.2-28.5) 24.5 (19.2-28.5) 23.9 (18.2-28.5) <0.001 Birth history 51 (24.3%) 22 (31.4%) (29) (20.7%) 0.08 * pivalue: Mann-WhitneyiU test, BMI: Bodyimass index Table i 2. Comparisoniof scores of healthy females and females with a history of surgery Variables Healthy Females n=70 (33.3%) Pre-surgery n=140 (66.7%) Post-surgery n=140 (66.7%) p* p** p*** FSFI 29 (23-36) 26 (21-32) 28 (25-34) <0.001 <0.001 <0.001 QSES 43 (36-46) 40 (32-45) 41 (33-46) <0.001 <0.001 <0.001 VAS (dyspareunia) 2 (0-7) 4 (2-10) 3 (1-5) <0.001 <0.001 <0.001 Desire 5 (4-6) 4 (4-5) 4 (4-6) <0.001 <0.001 0.08 Arousal 5 (4-6) 4 (3-5) 5 (4-6) <0.001 0.2 <0.001 Lubrication 5 (4-6) 4 (3-5) 4 (3-6) <0.001 0.03 <0.001 Orgasm 5 (3-6) 4 (3-6) 5 (4-6) <0.001 0.3 <0.001 Satisfaction 5 (4-6) 4 (3-6) 5 (4-6) <0.001 0.06 <0.001 Pain 5 (4-6) 4 (3-6) 5 (4-6) <0.001 0.1 <0.001 P value*: Healthy vs.iPre-surgery (Mann-WhitneyUitest), p value**: Healthy vs.iPost-surgery (Mann-WhitneyUitest), p value***: Pre-surgeryivs. Post-Surgery (Wilcoxon test), FSFI: Femaleisexual functioniindex, QSES: Qualityiof SexualiExperienceiScale, VAS: Visualianalog scale Table i 3 . Comparisoniof score changes in individuals who underwent laparoscopy and laparotomy Variables Laparoscopy n=70 (50%) Laparotomy n=70 (50%) p* Pre-FSFI Post-FSFI p** 25 (21-31) 28 (25-32) <0.001 26 (21-31) 29 (25-34) <0.001 0.4 <0.001 Pre-QSES Post-QSES p** 40 (32-45) 41 (33-45) <0.001 40 (33-45) 41 (34-46) <0.001 0.3 0.01 Pre-VAS (dyspareunia) Post-VAS (dyspareunia) p** 4 (2-10) 3 (2-5) <0.001 4.5 (2-10) 3 (1-5) <0.001 0.8 0.2 Pre-Desire Post-Desire p** 4 (4-5) 4 (4-6) 0.2 4 (4-5) 5 (4-6) 0.1 0.6 0.4 Pre-Arousal Post-Arousal p** 4 (3-5) 5 (4-5) 0.02 4 (3-5) 5 (4-6) <0.01 0.2 0.009 Pre-Lubrication Post-Lubrication p** 4 (3-5) 5 (4-6) <0.001 4 (3-5) 5 (4-6) <0.001 0.07 0.2 Pre-Orgasm Post-Orgasm p** 4 (3-5) 5 (4-5) <0.001 4 (3-6) 5 (4-6) <0.001 0.7 0.01 Pre-Satisfaction Post-Satisfaction p** 4 (4-6) 4 (3-6) <0.001 4 (3-6) 5 (4-6) <0.001 0.5 <0.001 Pre-Pain Post-Pain p** 4 (3-5) 5 (4-5) <0.001 4 (3-6) 5 (4-6) <0.001 0.02 0.01 P value*: Mann-Whitneyitest, p value**: Wilcoxonitest, FSFI: Femaleisexual functioniindex, QSES: Qualityiof SexualiExperience Scale, VAS: Visualianalog scale Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-4752096","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":328765258,"identity":"ba89a71f-6707-4737-95b5-6c9836b6faf0","order_by":0,"name":"Ufuk Atlıhan","email":"","orcid":"","institution":"Private Karataş Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ufuk","middleName":"","lastName":"Atlıhan","suffix":""},{"id":328765264,"identity":"b23d06b0-a2a7-4b14-b334-29c40d004df6","order_by":1,"name":"Onur Yavuz","email":"","orcid":"","institution":"Dokuz Eylul University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Onur","middleName":"","lastName":"Yavuz","suffix":""},{"id":328765268,"identity":"95dbf3a0-bbf8-4c43-95b7-c75bcfa7ee9f","order_by":2,"name":"Can Ata","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYDCCA1Can4GBjSQtBgySDSRrMThArBa+24cffi6o+SNvfCP52YMPFQzy/GIH8GuRPJdmLD3jmIHhthtp5oYzzjAYzpydgF+LwRkeBmkeNgPGbTcSzKR52xgSDG4T1sL8m+efgf3mGenfiNbCBlRpkLhBIodIWyTPsJlZ8/YZJ88486ZMcsYZCcJ+4TvD/Pg2zzc52/729G0SHyps5PmlCWhBAAGwSglilYMA/wFSVI+CUTAKRsFIAgAgkT+4O35KXAAAAABJRU5ErkJggg==","orcid":"","institution":"Izmir Demokrasi University","correspondingAuthor":true,"prefix":"","firstName":"Can","middleName":"","lastName":"Ata","suffix":""},{"id":328765272,"identity":"d52c6d68-7b68-4c89-91f6-2062f08aecc7","order_by":3,"name":"Huseyin Aytug Avsar","email":"","orcid":"","institution":"Izmir Demokrasi University","correspondingAuthor":false,"prefix":"","firstName":"Huseyin","middleName":"Aytug","lastName":"Avsar","suffix":""},{"id":328765280,"identity":"cd82eec0-5681-4f29-8585-6bb1eeea254c","order_by":4,"name":"Tevfik Berk Bildaci","email":"","orcid":"","institution":"Izmir Demokrasi University","correspondingAuthor":false,"prefix":"","firstName":"Tevfik","middleName":"Berk","lastName":"Bildaci","suffix":""},{"id":328765281,"identity":"8de213e0-e7c8-477d-a17f-74dfc891c1e7","order_by":5,"name":"Selcuk Erkılınc","email":"","orcid":"","institution":"Izmir Demokrasi University","correspondingAuthor":false,"prefix":"","firstName":"Selcuk","middleName":"","lastName":"Erkılınc","suffix":""}],"badges":[],"createdAt":"2024-07-16 19:32:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4752096/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4752096/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":65051203,"identity":"dac3a534-85aa-47fc-a449-42bcc4421bd4","added_by":"auto","created_at":"2024-09-23 06:05:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":549966,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4752096/v1/7d860fc9-b71d-4821-8c73-cc3cc4305346.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of Deep Infiltrative Endometriosis Surgery and Surgical Method on Sexual Function in Females","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe gynecologic condition endometriosis is characterized by the persistent inflammation and existence of tissue outside the uterus that resembles endometrial tissue (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). About 10% of women who are of reproductive age and exhibit pelvic discomfort and infertility are thought to have endometriosis (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). A kind of endometriosis that extends more than 5 mm below the peritoneal surface is known as deep infiltrative endometriosis (DIE) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). It is well acknowledged that endometriosis, and specifically DIE, significantly lowers quality of life and sexual function (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Changes in sexual function in females with DIE may be caused by a variety of causes, including as tissue fibrosis, discomfort, chronic inflammation, and the presence of neuroactive drugs (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Since endometriosis is a benign condition, pain management and symptom improvement should be the primary objectives of treatment. Conservative approaches, like as medical care, may be risk-free and innocuous, but they frequently don't work, particularly in DIE (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs long as endometriotic foci are completely eliminated, symptomatic endometriosis surgery is usually successful and has a low recurrence rate (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). On the other hand, intestinal or urinary neurogenic dysfunction might make DIE laparoscopic treatment more difficult, particularly in cases where nerve-sparing surgery is not an option (\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). We aimed in this retrospective study to objectively evaluate the effect of endometriosis excision and excision methods on sexual function in individuals having DIE in comparison to healthy females.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e The present study was designed in a retrospective observational design pursuant to the guidelines of the Helsinki Declaration. Documents of informed consent were taken from all patients. The research obtained approval of our hospital\u0026rsquo;s Ethics Committee (Date: 26/06/2024, Number: 2024/307). Our study included 140 patients who were diagnosed as having DIE and reported dyspareunia in our clinic between January 2018 and 2024, and 70 patients who presented to our clinic for birth control. Before surgery, all female patients with DIE underwent transvaginal and abdominal ultrasonography as well as gynecologic tests to determine whether they had pelvic endometriosis (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). After the patients who underwent surgery due to DIE were retrospectively screened, 70 patients who underwent laparoscopic surgery (L/S) and 70 patients who underwent laparotomy (L/T) were included in the study.\u003c/p\u003e \u003cp\u003eThe preoperative Female Sexual Function Index (FSFI) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), Quality of Sexual Experience Scale (QSES) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), and visual analog scale (VAS) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) values of all patients who described preoperative dyspareunia were examined retrospectively from the patient files. Females with DIE had complete excision of macroscopic endometriotic lesions in accordance with relevant surgical procedures (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The same surgeon carried out the surgeries, and the surgical team had consistently treated DIE patients with laparoscopic and laparotomic procedures in the past. Histologic analysis was performed on all patients after surgery, and only patients whose diagnosis was confirmed were included in the research. After 6 months, all participants had clinical examinations and transvaginal ultrasonography to make an evaluation on the symptoms and/or anatomic recurrence of endometriotic nodules. Six months after surgery, the FSFI, QSES, and VAS scores of all patients were retrospectively examined from the patient files. On the VAS scale, 0 represents the lack of symptoms and 10 represents the worst conceivable illness. Dyspareunia was scored by participants on a range of 0 to 10.\u003c/p\u003e \u003cp\u003eThe FSFI assessed six distinct domains: pain/discomfort, satisfaction, orgasm, lubrication, arousal, and desire. The scale ranged from 0 (no sexual activity in the previous four weeks) or 1 (very unhappy) to 5 (very satisfied). A full-scale score ranging from 2.0 (severe dysfunction) to 36.0 (no dysfunction) was used in the study to assess sexual function, with higher FSFI scores thought to be linked to improved symptoms. According to Wiegel et al., there is an ideal cut-off score of 26, which is utilized to identify females who now have sexual dysfunction from those who do not (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGreater QSES scores correspond to greater quality; the range of values is 7 to 49 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This questionnaire also examines several facets of sexual life and the influence of pelvic issues on sexual functioning. When responding to the questions, participants were instructed to take into account the preceding four weeks.\u003c/p\u003e \u003cp\u003eExclusion criteria for the study were a history of gynecologic cancer, inflammatory bowel disease, a record of pelvic radiotherapy or systemic chemotherapy, gynecologic infection in based on demographic and clinical characteristics (parity, BMI, age).\u003c/p\u003e \u003cp\u003eStatistical analysis was completed with the SPSSi26.0 software package (IBM Inc., Chicago, IL, USA). The distribution normality was evaluated using the Kolmogorov-Smirnov test. Non-normally distributed parameters were analyzed with the Mann-Whitney U test. The Wilcoxon test was employed to determine changes before and after surgery. For the analysis of categorical data, the Chi-square test and Fisher precision test were utilized. Regarding the statistical analysis, categorical variables are reported as percentages, and quantitative variables as median (minimum-maximum). Statistical significance was considered as p\u0026thinsp;\u0026lt;\u0026thinsp;.05 and analyses were within 95% confidence intervals.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe age average of the participants in our study was 30 years and the BMI average was 24.1kg/m\u003csup\u003e2\u003c/sup\u003e. Fifty-one (24.3%) of the participants in our study had given birth. In this research, the average BMI of patients who underwent endometriosis surgery was 23.9 kg/m\u003csup\u003e2\u003c/sup\u003e, which was significantly lower than that of healthy females (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eIn our study, the FSFI score of the healthy group was significantly greater than the pre-surgery and post-surgery groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.001,xrespectively). The QSES score of the healthy group was significantly greater than the pre-surgery and post surgery groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively). The VAS dyspareunia score of the healthy group was seen to be significantly lower than the pre-surgery and post surgery groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.001,xrespectively). The desire score of the healthy group was seen to be significantly higher than the pre-surgery and post surgery groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.001,irespectively). The arousal score of the healthy group was significantly greater than the pre-surgery group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The lubrication score of the healthy group was significantly greater than the pre-surgery and postisurgery groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and p\u0026thinsp;=\u0026thinsp;0.03,irespectively). The orgasm score of the healthy groupiwas significantly greater than the pre-surgery group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The satisfaction score of the healthy group was significantly greater than the pre-surgery group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The pain score of the healthy group was significantly higher than the pre-surgery group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In our study, the FSFI score of the post-surgery group was significantly greater than the pre-surgery group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The QSES score of the post-surgery group was significantly higher than the pre-surgery group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The VAS dyspareunia score of the post-surgery group was significantly lower than that of the pre-surgery group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The arousal score of the post-surgery group was significantly greater than the pre-surgery group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The lubrication score of the post-surgery group was significantly greater than the pre-surgery group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The orgasm score of the post-surgery group was significantly greater than the pre-surgery group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The satisfaction score of the post-surgery group was significantly greater than the pre-surgery group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The pain score of the post-surgery group was significantly higher than that of the pre-surgery group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table 2).\u003c/p\u003e\n\u003cp\u003eIn this current research, the FSFI scores of individuals who had L/T were significantly higher than those of patients who underwent L/S (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The QSES scores of patients who underwent L/T were significantly higher than those of patients who underwent L/S (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Arousal scores of individuals who had L/T were significantly higher than those of patients who underwent L/S (p\u0026thinsp;=\u0026thinsp;0.009). The orgasm scores of patients who underwent L/T were significantly higher than those of patients who underwent L/S (p\u0026thinsp;=\u0026thinsp;0.01). Satisfaction scores of patients who underwent L/T were significantly higher than those of patients who underwent L/S (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Pain scores of individuals who had L/T were significantly higher than those of patients who underwent L/S (p\u0026thinsp;=\u0026thinsp;0.01) (Table\u0026nbsp;3).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this current research, we hypothesized that surgical treatment of females with DIE may have a positive effect on FSFI and QSES scores and dyspareunia, indicating improvement in overall sexual function. Our goal was to make a comparison of the sexual functioning of female individuals between having DIE and healthy ones. Numerous local environmental, psychological, neurologic, and biological elements that impact one's bodily and mental well-being, as well as one's perception of femininity and interpersonal interactions, are all involved in sexual function (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In addition, depression and infertility, that are very common in females having endometriosis, are also linked with sexual dysfunction (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Recently, there has been increased medical interest in the impact of the presence of endometriosis on sexual function in females. Numerous research in the literature have shown that patients having dyspareunia experience a marked reduction in severity and an improvement in their quality of sexual function following surgical excision of DIE lesions (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCombining L/S with postoperative hormonal treatment is beneficial for females with endometriosis, especially DIE, as it has been demonstrated to enhance sexual function and symptoms (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). In line with these studies, our results revealed a notable enhancement in sexual function six months following treatment in patients treated for DIE. There are numerous questionnaire formats for usage in examining sexual activity in in females with endometriosis (\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). In our study, we used the FSFI survey. We preferred it because of its succinctness, validity proof, and trustworthy subscales (Sexual Desire, Pain/Discomfort, Sexual Arousal, Satisfaction, Orgasm, Lubrication). Furthermore, we evaluated QSES survey data. In our study, in addition to a significant increase in FSFI, QSES, and VAS scores after surgery, we also found a significant improvement in FSFI subcategories. However, despite having no significant difference in FSFI subcategory values among patients in the post-surgery group and the healthy group, FSFI, QSES, and VAS values in the healthy group were still greater than the post-surgery group scores.\u003c/p\u003e \u003cp\u003eSexual desire and satisfaction are deeply influenced by emotions and governed by a range of excitatory and inhibitory impacts. The most important of these obstacles is the presence of dyspareunia. For this reason, the VAS dyspareunia score in the patients in our study was also evaluated using a questionnaire. Because pain is both a potent inhibitor of the sexual response cycle and a potent behavioral modulator, females having dyspareunia are more likely to nurture hypoactive sexual desire disorder (HSDD) or arousing problem (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Presumably, because their post-operative pain sensations had decreased and they were more aware that endometriotic lesions had been eliminated, the ladies in the post-surgery group were able to unwind and feel more at ease during sexual activity. It has been demonstrated that the number of DIE nodules detected in certain regions is inversely correlated with the decrease in sexual desire (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOf advanced stages, the illness can impact a variety of areas of a woman's life, including her mental health. According to reports, endometriosis-afflicted females have greater rates of psychological disorders such anxiety and sadness (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Furthermore, there is a substantial correlation between DIE and persistent pelvic discomfort. Taking into account various studies, there is a substantial correlation between the cumulative size of posterior DIE (less than 1 cm) and both chronic pelvic discomfort and the least severe dyspareunia (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). involvement of the anterior rectal wall, posterior vaginal fornix, pouch of Douglas, and uterosacral ligaments in two separate investigations by Kor and Vercellini. The degree of Douglas pouch stenosis and the endometriosis stage are associated with the severity of dyspareunia (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Our study's results, which corroborate the findings of the other two studies, show a considerable improvement in VAS dyspareunia ratings following surgery. This finding might be explained by the fact that sexual issues stemming from pelvic issues can be lessened by fully removing all endometriotic lesions and restoring normal pelvic structure. However, we assessed each of the FSFI score subgroups independently and did not restrict the assessment of sexual function to the existence or absence of pelvic discomfort. In particular, we found that the desire scale did not significantly improve following surgical therapy for DIE. Since sexual desire is a multifaceted, complicated process that depends on psychological, anatomical, and physiological components, it is challenging to explain this conclusion (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). With respect to anatomical variables, it is well recognized that undergoing extensive surgery for endometriosis may result in injury to the autonomic nerve, which might subsequently affect orgasm (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). In this current research, the higher orgasm score in females with a history of L/T in the post-surgery group than in the L/S group reveals the impression that nerve damage is more limited in the L/T group. We are aware that it is important to take into account the limitations of this research when evaluating the findings. The fact that the research was designed retrospectively, patient data were analyzed only from patient files and data in the database, and the limited number of patients can be cited as limitations of the study. Also, the majority of patients at our tertiary care center for endometriosis therapy were in a severe stage of the illness; as a result, research participants may not be entirely typical of the endometriosis community as a whole. Patients with DIE are more prone than those with less severe illness to experience sexual dysfunction. Because the FSFI and QSES questionnaires inquire about areas of sexual function that many women view as extremely private, there is a considerable danger of response and recall bias even though females complete them independently and without guidance. The psychological elements that characterize human sexuality and the larger cultural background make studies of human sexuality vulnerable to prejudice and confounding variables. Nevertheless, our study has some strengths. Unlike other studies in the literature, our research assessed only the impact of DIE surgery on sexual function, and individuals who had medical treatment in the postoperative period were not included in the study. In this way, it made it possible to assess the impact of DIE surgery alone on sexual function, independent of medical treatment. Furthermore, unlike other studies in the literature, the type of surgical method was also evaluated as a factor in our study. Finally, all surgical patients were diagnosed with histologically confirmed DIE.\u003c/p\u003e \u003cp\u003eIn conclusion, we found that females affected by DIE generally had significant improvement in their postoperative sexual function compared with the preoperative period. FSFI subparameters and QSES scores improved significantly following surgical treatment. For females affected by DIE, the surgical treatment may improve both organ failure and sexual function; hence, routine gynecologic care should address issues regarding females' sexual health.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Body mass index\u003c/p\u003e\n\u003cp\u003eDIE\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Deep infiltrative endometriosis\u003c/p\u003e\n\u003cp\u003eFSFI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;FemaleiSexual FunctioniIndex\u003c/p\u003e\n\u003cp\u003eHSDD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Hypoactive sexual desire disorder\u003c/p\u003e\n\u003cp\u003eL/S\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Laparoscopy\u003c/p\u003e\n\u003cp\u003eL/T: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Laparatomy\u003c/p\u003e\n\u003cp\u003eQSES\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Qualityiof Sexual ExperienceiScale\u003c/p\u003e\n\u003cp\u003eVAS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Visual analogxscale\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval:\u003c/strong\u003e Ethical approval for this study was obtained from the \u0026lsquo;Demokrasi University,\u0026nbsp;Buca Seyfi Demirsoy Training and Research Hospital, Izmir, Turkey\u0026rsquo; on June 26, 2024, with the protocol number 2024/307.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eAll participiants were consented with informed consents approved by local ethical board. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analyzed in relation to the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThe authors received no financial support for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUfuk Atlihan contributed to \u0026nbsp;study concept and design, and interpreting the data, composed the statistical dataset, performed the analyses, and wrote and revised the manuscript.\u003c/p\u003e\n\u003cp\u003eOnur Yavuz contributed to data analysis and revision of the paper.\u003c/p\u003e\n\u003cp\u003eCan Ata contributed to study concept and design, interpreting the data and critical revision of the manuscript.\u003c/p\u003e\n\u003cp\u003eHuseyin Aytug Avsar contributed to data analysis and revision of the paper.\u003c/p\u003e\n\u003cp\u003eTevfik Berk Bildaci contributed to interpreting the data and critical revision of the manuscript.\u003c/p\u003e\n\u003cp\u003eSelcuk Erkilinc contributed to interpreting the data and critical revision of the manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors reviewed and approved the final version and no other person made a substantial contribution to the paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZondervan KT, Becker CM, Missmer SA, Endometriosis. N Engl J Med. 2020;382:1244\u0026ndash;56. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1056/NEJMra1810764\u003c/span\u003e\u003cspan address=\"10.1056/NEJMra1810764\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Nardi P, Ferrari S. Deep Pelvic Endometriosis: A Multidisciplinary Approach. Milan, Italy: Springer; 2011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrescott J, Farland LV, Tobias DK, et al. A prospective cohort study of endometriosis and subsequent risk of infertility. Hum Reprod. 2016;31:1475\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/humrep/dew085\u003c/span\u003e\u003cspan address=\"10.1093/humrep/dew085\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhilippe R, Koninckx A, Ussia L, Adamyan A, Wattiez J, Donnez. Deep endometriosis: definition, diagnosis, and treatment, Fertility and Sterility, Volume 98, Issue 3, 2012, Pages 564\u0026ndash;571. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.fertnstert.2012.07.1061\u003c/span\u003e\u003cspan address=\"10.1016/j.fertnstert.2012.07.1061\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMontanari G, Di Donato N, Benfenati A, et al. Women with deep infiltrating endometriosis: sexual satisfaction, desire, orgasm, and pelvic problem interference with sex. J Sex Med. 2013;10:1559\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMabrouk M, Montanari G, Di Donato N, et al. What is the impact on sexual function of laparoscopic treatment and subsequent combined oral contraceptive therapy in women with deep infiltrating endometriosis? J Sex Med. 2012;9:770\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD'Alterio MN, D'Ancona G, Raslan M, Tinelli R, Daniilidis A, Angioni S. Management challenges of deep infiltrating endometriosis. Int J Fertil Steril. 2021;15(2):88\u0026ndash;94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.22074/IJFS.2020.134689\u003c/span\u003e\u003cspan address=\"10.22074/IJFS.2020.134689\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2021 Mar 11. PMID: 33687160; PMCID: PMC8052801.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlcalde AM, Mart\u0026iacute;nez-Zamora M\u0026Aacute;, Gracia M, Ros C, Rius M, Carmona F. Assessment of sexual quality of life and satisfaction in couple relationships among women with deep infiltrating endometriosis and adenomyosis. J Sex Marital Ther. 2021;48(3):263\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/0092623X.2021.1986444\u003c/span\u003e\u003cspan address=\"10.1080/0092623X.2021.1986444\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNorinho P, Martins MM, Ferreira H. A systematic review on the effects of endometriosis on sexuality and couple's relationship. Facts Views Vis Obgyn. 2020;12(3):197\u0026ndash;205. PMID: 33123695; PMCID: PMC7580264.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFedele L, Bianchi S, Zanconato G, et al. Long-term follow-up after conservative surgery for rectovaginal endometriosis. Am J Obstet Gynecol. 2004;190:1020\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDonnez O. Conservative management of rectovaginal deep endometriosis: Shaving should be considered as the primary surgical approach in a high majority of cases. J Clin Med. 2021;10(21):5183. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/jcm10215183\u003c/span\u003e\u003cspan address=\"10.3390/jcm10215183\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Cicco C, Corona R, Schonman R, et al. Bowel resection for deep endometriosis: a systematic review. BJOG. 2011;118:285\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYela DA, Vitale SG, Vizotto MP, Benetti-Pinto CL. Risk factors for recurrence of deep infiltrating endometriosis after surgical treatment. J Obstet Gynecol Res. 2021;47(8):2713\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRubod C. Pre and postoperative lower urinary tract dysfunction associated with deep infiltrating endometriosis: A prospective observational study. EC Gynecol. 2020;9:40\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosati A, Pavone M, Campolo F, Nardone ADC, Raimondo D, Seracchioli R, Ianieri MM. Surgical and functional impact of nerve-sparing radical hysterectomy for parametrial deep endometriosis: a single centre experience. Volume 14. Facts, Views \u0026amp; Vision in Obgyn; 2022. p. 121. 2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAtlıhan U, et al. Vitamin D evaluation in adenomyosis: A retrospective cross-sectional study. Turk J Obstet Gynecol. 2024;21(2):98\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeracchioli R, Poggioli G, Pierangeli F, et al. Surgical outcome and long-term follow up after laparoscopic rectosigmoid resection in women with deep infiltrating endometriosis. BJOG. 2007;114:889\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeracchioli R, Mabrouk M, Montanari G, et al. Conservative laparoscopic management of urinary tract endometriosis (UTE): surgical outcome and long-term follow-up. Fertil Steril. 2010;94:856\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSonbahar AE, Culha MG, Jannini E. The validity and reliability of the Turkish version of the 6-item female sexual function index (FSFI-6) and the relationship between climacturia and female sexual dysfunction. Int J Impot Res. 2022;34(6):610\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41443-021-00463-2\u003c/span\u003e\u003cspan address=\"10.1038/s41443-021-00463-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 20210802.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSanders SA, Herbenick D, Reece M, Schick V, Mullinax M, Dodge B, Fortenberry JD. The development and validation of a brief Quality of Sexual Experience (QSE) scale: results from a nationally representative sample of men and women in the United States. J Sex Med. 2013;10(10):2409-17. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jsm.12198\u003c/span\u003e\u003cspan address=\"10.1111/jsm.12198\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2013 May 16. PMID: 23679190.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInal FY, Gul K, Yilmaz Camgoz Y, Daskaya H, Kocoglu H. Validation of the Turkish version of the Pain Sensitivity Questionnaire in patients with chronic pain. J Int Med Res. 2021;49(12):3000605211060158. : 10.1177/03000605211060158. PubMed PMID: 34855531; PubMed Central PMCID: PMC8646826.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVilla G, Mabrouk M, Guerrini M, et al. Relationship between site and size of bladder endometriotic nodules and severity of dysuria. J Minim Invasive Gynecol. 2007;14:628\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeracchioli R, Mabrouk M, Manuzzi L, et al. Importance of retroperitoneal ureteric evaluation in cases of deep infiltrating endometriosis. J Minim Invasive Gynecol. 2008;15:435\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31(1):1\u0026ndash;20. doi: 10.1080/00926230590475206. PubMed PMID: 15841702.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYassa M, Sargin MA, Dereli N, \u0026Ouml;zdemir Y\u0026Ouml;, Akca G, G\u0026uuml;nay T, Tuğ N. The validity and reliability of the Turkish version of the Quality of Sexual Experience Scale. Anatol J Psychiatry. 2020;21:48\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Ugarte C, Marin L, Berman, Berman J. Female sexual dysfunction\u0026mdash;From diagnosis to treatment. Sexuality. Reprod Menopause. 2004;2(3):139\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDubuisson J, Pont M, Roy P, et al. Female sexuality after surgical treatment of symptomatic deep pelvic endometriosis. Gynecol Obstet Fertil. 2013;41:38\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeroy A, et al. Psychology and sexology are essential, from diagnosis to comprehensive care of endometriosis. Gynecologie. Obstetrique Fertil. 2016;44(6):363\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuillemot C, Klinkenberg J, Sordes F. Psychological experience of sexuality in painful endometriosis patients. Psychologie Fran\u0026ccedil;aise. 2023;68(3):345\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan den Broeck U, et al. Effect of laparoscopic surgery for moderate and severe endometriosis on depression, relationship satisfaction and sexual functioning: comparison of patients with and without bowel resection. Hum Reprod. 2013;28(9):2389\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeguara CS, Pepas L, Davis C. August. Does minimally invasive surgery for endometriosis improve pelvic symptoms and quality of life? Current Opinion in Obstetrics and Gynecology 24(4):p 241\u0026ndash;244, 2012. | \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/GCO.0b013e328355626f\u003c/span\u003e\u003cspan address=\"10.1097/GCO.0b013e328355626f\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVercellini P, Somigliana E, Consonni D, et al. Surgical versus medical treatment for endometriosis-associated severe deep dyspareunia: I. Effect on pain during intercourse and patient satisfaction. Hum Reprod. 2012;27:3450\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerrero S, Abbamonte LH, Giordano M, et al. Deep dyspareunia and sex life after laparoscopic excision of endometriosis. Hum Reprod. 2006;22:1142\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D'Agostino R Jr.. The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000 Apr-Jun;26(2):191\u0026ndash;208. doi: 10.1080/009262300278597. PMID: 10782451.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Rogatis L, et al. Validation of the female sexual distress scale-revised for assessing distress in women with hypoactive sexual desire disorder. J Sex Med. 2008;5(2):357\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiem SJ, Elisheva R, Danan. GSM and quality of life measures. Clin Obstet Gynecol. 2024;67(1):58\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRonghe V, Pannase K, Gomase KP, Mahakalkar MG, UndeRSTANDING, HYPOACTIVE SEXUAL DESIRE DISORDER (HSDD). in Women: Etiology, diagnosis, and treatment. Cureus. 2023;15(11):e49690. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.49690\u003c/span\u003e\u003cspan address=\"10.7759/cureus.49690\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 38161863; PMCID: PMC10757759.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCozzolino M, et al. Evaluation of sexual function in women with deep infiltrating endometriosis. Sex reproductive Healthc. 2018;16:6\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLa Rosa V, Lucia, et al. An overview on the relationship between endometriosis and infertility: the impact on sexuality and psychological well-being. J Psychosom Obstet Gynecol. 2020;41(2):93\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKor E, et al. Relationship between the severity of endometriosis symptoms (dyspareunia, dysmenorrhea and chronic pelvic pain) and the spread of the disease on ultrasound. BMC Res Notes. 2020;13:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVercellini P, Fedele L, Aimi G, Pietropaolo G, Consonni D, Crosignani PG. Association between endometriosis stage, lesion type, patient characteristics and severity of pelvic pain symptoms: a multivariate analysis of over 1000 patients. Hum Reprod (Oxford England). 2007;22(1):266\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRossi V, Galizia R, Tripodi F, Simonelli C, Porpora MG, Nimbi FM. Endometriosis and sexual functioning: How much do cognitive and psycho-emotional factors matter? Int J Environ Res Public Health. 2022;19:5319. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph19095319\u003c/span\u003e\u003cspan address=\"10.3390/ijerph19095319\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOppenheimer A, Boitrelle F, Nicolas-Boluda A, Fauconnier A. Measurement properties of sexual function assessment questionnaires in women with endometriosis: A systematic review following COSMIN guidelines. Acta Obstet Gynecol Scand. 2024;103(5):799\u0026ndash;823. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/aogs.14768\u003c/span\u003e\u003cspan address=\"10.1111/aogs.14768\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2024 Jan 16. PMID: 38226426; PMCID: PMC11019533.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable1.\u0026nbsp;\u003c/strong\u003eComparison of demographic characteristics of main groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.636363636363637%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll Patients\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en=210 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.983471074380166%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthy Females\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;n=70 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.818181818181817%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery (+)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en=140 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.561983471074381%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.636363636363637%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e30 (20-38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.983471074380166%\" valign=\"top\"\u003e\n \u003cp\u003e30 (20-38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.818181818181817%\" valign=\"top\"\u003e\n \u003cp\u003e30 (20-38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.561983471074381%\" valign=\"top\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.636363636363637%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e24.1 (18.2-28.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.983471074380166%\" valign=\"top\"\u003e\n \u003cp\u003e24.5 (19.2-28.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.818181818181817%\" valign=\"top\"\u003e\n \u003cp\u003e23.9 (18.2-28.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.561983471074381%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.636363636363637%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBirth history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e51 (24.3%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.983471074380166%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;22 (31.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.818181818181817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;(29) (20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.561983471074381%\" valign=\"top\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e*\u003c/strong\u003epivalue: Mann-WhitneyiU test, BMI: Bodyimass index\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u003c/strong\u003ei\u003cstrong\u003e2.\u0026nbsp;\u003c/strong\u003eComparisoniof scores of healthy females and females with a history of surgery\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.85430463576159%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.728476821192054%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealthy Females\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en=70 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.562913907284768%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-surgery\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en=140 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.072847682119205%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-surgery\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en=140 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep***\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.85430463576159%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFSFI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.728476821192054%\" valign=\"top\"\u003e\n \u003cp\u003e29 (23-36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.562913907284768%\" valign=\"top\"\u003e\n \u003cp\u003e26 (21-32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.072847682119205%\" valign=\"top\"\u003e\n \u003cp\u003e28 (25-34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.85430463576159%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eQSES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.728476821192054%\" valign=\"top\"\u003e\n \u003cp\u003e43 (36-46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.562913907284768%\" valign=\"top\"\u003e\n \u003cp\u003e40 (32-45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.072847682119205%\" valign=\"top\"\u003e\n \u003cp\u003e41 (33-46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.85430463576159%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVAS (dyspareunia)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.728476821192054%\" valign=\"top\"\u003e\n \u003cp\u003e2 (0-7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.562913907284768%\" valign=\"top\"\u003e\n \u003cp\u003e4 (2-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.072847682119205%\" valign=\"top\"\u003e\n \u003cp\u003e3 (1-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.85430463576159%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDesire\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.728476821192054%\" valign=\"top\"\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.562913907284768%\" valign=\"top\"\u003e\n \u003cp\u003e4 (4-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.072847682119205%\" valign=\"top\"\u003e\n \u003cp\u003e4 (4-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.85430463576159%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eArousal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.728476821192054%\" valign=\"top\"\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.562913907284768%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.072847682119205%\" valign=\"top\"\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.85430463576159%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLubrication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.728476821192054%\" valign=\"top\"\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.562913907284768%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.072847682119205%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.85430463576159%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOrgasm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.728476821192054%\" valign=\"top\"\u003e\n \u003cp\u003e5 (3-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.562913907284768%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.072847682119205%\" valign=\"top\"\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.85430463576159%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSatisfaction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.728476821192054%\" valign=\"top\"\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.562913907284768%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.072847682119205%\" valign=\"top\"\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.85430463576159%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.728476821192054%\" valign=\"top\"\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.562913907284768%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.072847682119205%\" valign=\"top\"\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.927152317880795%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eP value*: Healthy vs.iPre-surgery (Mann-WhitneyUitest), p value**: Healthy vs.iPost-surgery (Mann-WhitneyUitest), p value***: Pre-surgeryivs. Post-Surgery (Wilcoxon test), FSFI: Femaleisexual functioniindex, QSES: Qualityiof SexualiExperienceiScale, VAS: Visualianalog scale\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u003c/strong\u003ei\u003cstrong\u003e3\u003c/strong\u003e. Comparisoniof score changes in individuals who underwent laparoscopy and laparotomy\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72727272727273%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparoscopy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=70 (50%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaparotomy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=70 (50%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.049586776859504%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72727272727273%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-FSFI\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePost-FSFI\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e25 (21-31)\u003c/p\u003e\n \u003cp\u003e28 (25-32)\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e26 (21-31)\u003c/p\u003e\n \u003cp\u003e29 (25-34)\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.049586776859504%\" valign=\"top\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72727272727273%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-QSES\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePost-QSES\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e40 (32-45)\u003c/p\u003e\n \u003cp\u003e41 (33-45)\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e40 (33-45)\u003c/p\u003e\n \u003cp\u003e41 (34-46)\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.049586776859504%\" valign=\"top\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72727272727273%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-VAS (dyspareunia)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePost-VAS (dyspareunia)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e4 (2-10)\u003c/p\u003e\n \u003cp\u003e3 (2-5)\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e4.5 (2-10)\u003c/p\u003e\n \u003cp\u003e3 (1-5)\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.049586776859504%\" valign=\"top\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72727272727273%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-Desire\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePost-Desire\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e4 (4-5)\u003c/p\u003e\n \u003cp\u003e4 (4-6)\u003c/p\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e4 (4-5)\u003c/p\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.049586776859504%\" valign=\"top\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72727272727273%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-Arousal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePost-Arousal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003cp\u003e5 (4-5)\u003c/p\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.049586776859504%\" valign=\"top\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72727272727273%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-Lubrication\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePost-Lubrication\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.049586776859504%\" valign=\"top\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72727272727273%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-Orgasm\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePost-Orgasm\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003cp\u003e5 (4-5)\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3-6)\u003c/p\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.049586776859504%\" valign=\"top\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72727272727273%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-Satisfaction\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePost-Satisfaction\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e4 (4-6)\u003c/p\u003e\n \u003cp\u003e4 (3-6)\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3-6)\u003c/p\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.049586776859504%\" valign=\"top\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.72727272727273%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-Pain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePost-Pain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3-5)\u003c/p\u003e\n \u003cp\u003e5 (4-5)\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.611570247933884%\" valign=\"top\"\u003e\n \u003cp\u003e4 (3-6)\u003c/p\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.049586776859504%\" valign=\"top\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003cp\u003e0.01\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\u003eP value*: Mann-Whitneyitest, p value**: Wilcoxonitest, FSFI: Femaleisexual functioniindex, QSES: Qualityiof SexualiExperience Scale, VAS: Visualianalog scale\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"sexual function, endometriosis, deep infiltrative endometriosis, surgery","lastPublishedDoi":"10.21203/rs.3.rs-4752096/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4752096/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eSexual function and quality of life are significantly reduced in Endometriosis, particularly deep infiltrative endometriosis (DIE) patients. The purpose of this study was to compare the effects of endometriosis excision and excision techniques on sexual function among individuals with DIE to those of healthy females in an objective manner.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eOur study included 140 individuals who were diagnosed as having DIE and reported dyspareunia in our clinic between January 2018 and 2024, and 70 patients who presented to our family planning clinic. The preoperative and at 6th -month post-surgery scores of the Female Sexual Function Index, Quality of Sexual Experience Scale, and visual analog scale (VAS) values of all patients who described preoperative dyspareunia were examined retrospectively from the patient files.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn our study, the FSFI score of healthy group was seen to be significantly greater than the pre-surgery and post-surgery groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.001,irespectively). The QSES scores of the healthy group was found to be significantly higher than the pre-surgery and post surgery groups (p\u0026thinsp;\u0026lt;\u0026thinsp;.001and p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively). The VAS dyspareunia values of the healthy group were discovered to be significantly lower than the pre-surgery and post surgery groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.001.irespectively). The FSFI and QSES scores of the post-surgery group were seen to be significantly higher than the pre-surgery group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively). The VAS dyspareunia score of the post-surgery group was seen to be significantly lower than that of the pre-surgery group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The FSFI and QSES scores of patients who underwent laparotomy was discovered to be significantly greater than that of individuals who underwent laparoscopic surgery (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and p\u0026thinsp;=\u0026thinsp;0.01,irespectively).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe surgical approach may have a positive effect both on organ dysfunction and sexual function in females affected by DIE, and therefore it is important to incorporate issues regarding females\u0026rsquo; sexual health into standard gynecological treatment.\u003c/p\u003e","manuscriptTitle":"Effect of Deep Infiltrative Endometriosis Surgery and Surgical Method on Sexual Function in Females","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-12 10:55:57","doi":"10.21203/rs.3.rs-4752096/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fb8e0895-d752-4326-a955-059a4cd3c167","owner":[],"postedDate":"August 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-23T05:57:16+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-12 10:55:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4752096","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4752096","identity":"rs-4752096","version":["v1"]},"buildId":"B-jG_2CBjPDmsCi4Wdhf-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}