Reply

We thank Dr Hirsch and his colleagues for their interest in our study1 and their constructive comments. We agree that the development of core outcome sets is a priority in endometriosis research. In our paper, we reported data about the impact of pelvic floor physiotherapy in women with deep infiltrating endometriosis and superficial dyspareunia1. Of the planned outcomes registered in the trial protocol, we reported those related to change in pelvic floor muscle tone, as evaluated by measurement of the levator hiatal area using three/four-dimensional transperineal ultrasound, because we believe these to be of the most relevance to the journal Ultrasound in Obstetrics & Gynecology. As this is the first randomized controlled trial (RCT) evaluating the impact of pelvic floor physiotherapy in women with endometriosis, we chose to give emphasis to the description of the pelvic floor physiotherapy technique, in order to make our outcomes reproducible in future studies, and the use of transperineal ultrasound for the assessment of pelvic floor morphometry. The remaining outcomes, as planned in the study protocol (NCT03572075), will be presented in another paper. However, unpublished data are available subject to approval by our local ethics committee. The core outcome set for endometriosis mentioned by Dr Hirsch and colleagues was reported in the study of Duffy et al.2 which was published after the registration and completion of our RCT. Nonetheless, we evaluated all these core outcomes, except for quality of life and adverse events. In particular, we assessed endometriosis-associated pain symptoms (chronic pelvic pain, dysmenorrhea, dysuria, dyschezia and dyspareunia) with special focus on the most troublesome symptom, superficial dyspareunia, which seems to be widespread in women with endometriosis and, in the majority of cases, is concomitant with deep dyspareunia3. Moreover, the satisfaction of women with the intervention was assessed using a dedicated questionnaire1. We are grateful to Dr Hirsch and colleagues for their efforts to develop a core outcome set for endometriosis2, which we will take into account in future research.