Predictors of Partnership and Sexual Satisfaction and dyadic effects in couples affected by endometriosis and infertility

Predictors of Partnership and Sexual Satisfaction and dyadic effects in couples affected by endometriosis and infertility | 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 Predictors of Partnership and Sexual Satisfaction and dyadic effects in couples affected by endometriosis and infertility Deborah van Eickels, Maren Schick, Ariane Germeyer, Sabine Rösner, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3363425/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 May, 2024 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted 5 You are reading this latest preprint version Abstract Purpose Endometriosis and infertility are associated with impaired partnership and sexuality of the patients, but also of their male partners. The aim of this study was to determine the association of different predictors of partnership and sexual satisfaction in couples with endometriosis and infertility, as well as dyadic effects. Methods A cross-sectional study was conducted with n = 62 women with endometriosis and n = 46 partners, including a total of n = 44 couples, some of whom were affected by infertility. The questionnaire included items on partnership, sexuality, depression, social support, and childbearing. Multiple linear regression and the actor-partner-interdependence-model were used for analysis. Results Depression correlated with lower partnership and sexuality satisfaction and showed in the dyad a significant negative actor effect in men for partnership satisfaction and a negative actor and partner effect in women for sexuality satisfaction (p < .05). For women, social support showed a significant positive actor effect for partnership satisfaction (p < .05), age showed a significant actor and partner effect for sexuality satisfaction (p < .05). Conclusion The results show a significant association of endometriosis and infertility with partnership and sexuality satisfaction in both partners and support the importance of including male partners' perspectives in the treatment of endometriosis. TRIAL REGISTRATION German Clinical Trials Register DRKS00014362 on the 29.03.2018. Endometriosis Infertility APIM Sexuality Partnership Figures Figure 1 Figure 2 INTRODUCTION Endometriosis affects 5–10% of women of childbearing age, with prevalence ranging from 2–11% in asymptomatic women to 5–50% in infertile women and has also been described as a contributing cause of infertility [ 1 – 3 ]. Regarding the German IVF Register, endometriosis was documented in 22,9% of all women undergoing infertility treatment in Germany in 2020, indicating both groups overlapping in large part [ 4 ]. Worldwide 8–12% of all couples suffer from infertility [ 5 ]. Whilst endometriosis can cause physical symptoms such as pain and dyspareunia previous studies also showed a connection of endometriosis with psychological stress in form of depression, anxiety, and stress. All these symptoms lead to an influence on the social and work life of the women as well as on their partnerships and sexual life [ 6 – 9 ]. In addition to the affected women, male partners also experience psychological stress due to the endometriosis affecting the woman as well as the partnership and their sexual life [ 10 ]. Symptoms reported by male partners comprise feeling helpless, frustration, worry, anger and stress [ 11 ]. Social support is reported rarely but is evaluated as positive when received [ 12 ]. Regarding the connection between endometriosis and sexuality, for women symptoms such as dyspareunia, sexual dysfunction and lower sexual satisfaction are consistently described in several studies [ 13 – 16 ]. For male partners, only few studies exist about the influence of endometriosis on sexuality, intimacy and partnership [ 10 , 12 , 17 , 18 ]. Male partners do not seem to suffer consistently from sexual dysfunction but do report an influence on their sexual satisfaction in terms of a lower coital frequency due to the women’s pain while wishing for a higher frequency of sexual intercourse [ 13 ]. Infertility is also often related to psychological burdens such as depression, anxiety, stress and guilt in women but also in men of affected couples [ 19 – 22 ]. Sexual dysfunction and lower sexual satisfaction are reported in both men and women of infertile couples, with women showing a greater impairment [ 19 , 20 , 23 – 26 ]. Relationship satisfaction of infertile couples seems to be connected to the communication and way of coping with the infertility. Whilst some infertile women report that they have been left by their partners [ 27 ], most couples report a high relationship satisfaction despite the infertility [ 19 , 20 , 28 ]. This is linked to a “survival” of those relationships despite the infertility and sometimes even a stronger connection and better communication [ 20 ]. Since studies investigating both women with endometriosis and their male partners are still lacking, and existing studies mostly focus only on endometriosis or only on infertility, the aim of this study was to identify predictors of sexual satisfaction (SS) and partnership satisfaction (PS) in couples with endometriosis and infertility. In addition, we aimed to investigate how these variables are related to each other, while taking into account the infertility factor. MATERIALS AND METHODS Setting and Questionnaires Between September 2016 and August 2018, all women who underwent laparoscopic surgery for infertility or dysmenorrhea at the Department of Gynecological Endocrinology at Heidelberg University Hospital - and in whom endometriosis could be confirmed - were informed about the study. All women and their male partners received further information about the study in writing, an informed consent form, and (if they consented) were each asked to complete a set of questionnaires (see below). The data analysed included the results of the laparoscopic surgery and the patient files from the hospital as well as the handed-out questionnaires, including up to 88 items for female and 72 items for male participants. Partnership satisfaction and social support were surveyed by questions from the Swiss Household Panel [ 29 ]. We used a visual analogue Scale (VAS) with a range from 0 (“not at all”) to 10 (“very much”). Two questions referred to the support and understanding from the social environment like relatives, friends, and colleagues. Both questions were summarized to the variable “social support”. For partnership satisfaction in total 4 questions were used, which addressed support, understanding, intimacy and happiness within the partnership. All 4 questions were summarized to the variable “partnership satisfaction”. Regarding sexuality in total 3 questions were assessed. Sexual satisfaction was measured by using a VAS with a range from 0 (“very unsatisfied”) to 10 (”very satisfied”). Next to that frequency of sexual intercourse and for the women also the frequency of pain during sexual intercourse were asked. All the questions regarding sexuality were taken from the Female Sexual Function Index [ 30 ]. To determine the relative share of painful sexual intercourse we formed a ratio from the frequency of painful sexual intercourse and the frequency of sexual intercourse in total. To assess depression, we used the German version of the “Depression, Anxiety and Stress Scale” [ 31 ]. The scale consists of 21 items regarding depression, anxiety, and stress, using a 4-point Likert-scale from 0 (“never”) to 3 (“almost always”). For each variable 7 items are summarized. Items for depression include questions about listlessness, mood, and joylessness. For depression a Cronbach’s Alpha = .91 was calculated by the authors of the questionnaire, showing a high internal consistency of the scale. Sociodemographic data included age, level of education, current profession, marital status, number of children, duration of wish to conceive, partnership duration, subjective cause of infertility and kind of infertility treatment, as well as status, duration, and treatment of endometriosis. Data Analysis Regarding the status of endometriosis and desire to have children, data from women with endometriosis and their male partners were used and this group was further subdivided according to an actual existing desire for a child (yes/no). Testing was done by using Mann-Whitney-U-Tests and Chi-Square-Tests (depending on the variable’s quality) for between-group comparisons between the men and women with and without infertility. To determine the predictors for sexual and partnership satisfaction as well as the correlation between pain and SS we performed multiple linear regressions with the whole sample. To evaluate how the predictors for sexual and partnership satisfaction interact within a couple and whether they show a mutual effect between men and women we used the Actor-Partner-Interdependence-Model (APIM) by David A. Kenny. This model assumes that one person’s behaviour or a predictor not only shows an effect on him- or herself (actor effect) but also on his/her partner (partner effect). In our APIM, we used the predictors identified in the multiple linear regression as the independent variable and sexual and partnership satisfaction as the dependent variable. The web program APIM_MM (Actor Partner Interdependence Model with Multilevel Modeling) for distinguishable dyads by David A. Kenny ( http://davidakenny.net/DyadR/DyadRweb.htm ) was used to calculate the APIM. This web program also calculates effect sizes (ES) to estimate the clinical relevance of the APIM effects. RESULTS Sociodemographic Data 380 questionnaires were handed out to the patients and their partners; a total of 161 participants completed the questionnaires (response rate: 42,37%). After excluding incomplete data sets and patients without endometriosis, n = 62 women with endometriosis and n = 46 male partners were included in the analysis. In total there were n = 44 heterosexual couples among the participants. Descriptive statistics for men and women are shown in Tables 1 and 2 . Regarding the presence of infertility there were significant differences between the two groups in several variables. Mean Age and duration of the partnership were significantly higher in infertile women in comparison to women without infertility (p = 0.024 for age and p = 0.032 for duration of partnership), whereas level of depression was significantly lower (p = 0.019). Men without a wish for a child were significantly more likely to be a father already than men with a wish to have children (p = 0.039). Regarding the other variables there were no significant differences. Table 1 Descriptive statistics women Total (n = 62) Endo+/Inf-* (n = 15) Endo+/Inf+** (n = 47) p-value Mean (SD) / N (%) Mean (SD) / N (%) Mean (SD) / N (%) Sociodemographic Age 31,00 (5,30) 27,87 (7,20) 32,00 (4,16) 0,024 a Partnership duration in years 7,15 (4,37) 4,62 (3,81) 7,64 (4,34) 0,032 a Child present already 10 (16,2) 2 (13,4) 8 (16,0) 1,000 c Education 0,118 b No degree - - - Secondary school 37 (59,7) 11 (73,3) 26 (55,3) University 24 (38,7) 3 (20,0) 21 (44,7) Endometriosis New diagnosis 7 (11,3) 1 (6,7) 6 (12,8) 1,000 c Infertility 47 (75,8) Duration of desire for a child (years) 2,81 (2,10) Psychosocial Depression 4,61 (5,24) 6,53 (5,22) 3,98 (5,14) 0,019 a Social support 7,59 (2,41) 7,65 (2,90) 7,57 (2,27) 0,469 a Partnership satisfaction 8,69 (1,92) 8,64 (1,98) 8,70 (1,93) 0,850 a Sexuality Sexual satisfaction 7,22 (3,34) 6,00 (3,64) 7,48 (3,25) 0,204 a Frequence of sex. intercourse (last 4 weeks) 0,090 c Never 9 (14,5) 5 (33,3) 4 (8,5) Once/Month 9 (14,5) 3 (20,0) 6 (12,8) Once/Week 18 (29,0) 2 (13,3) 16 (34,0) Several times/Week 19 (30,6) 4 (26,7) 15 (31,9) * Endo+/Inf- = subgroup with endometriosis, no infertility ** Endo+/Inf + = subgroup with endometriosis und with infertility a Mann-Whitney-U-Test b Pearson’s chi-squared-test c Fisher’s exact test Table 2 Descriptive statistics men Total (n = 46) Endo+/Inf-* (n = 9) Endo+/Inf+** (n = 37) p-value Mean (SD) / N (%) Mean (SD) / N (%) Mean (SD) / N (%) Sociodemographic Age 35,54 (6,26) 33,44 (9,45) 36,05 (5,27) 0,397 a Partnership duration in years 7,16 (4,41) 5,36 (4,03) 7,51 (4,45) 0,193 a Child present already 9 (19,5) 4 (44,4) 5 (13,5) 0,039 c Education 0,243 c No degree - - - Secondary school 23 (50,0) 6 (66,7) 17 (45,9) University 22 (47,8) 2 (22,2) 20 (54,1) Endometriosis New diagnosis 5 (10,9) 1 (11,1) 4 (10,8) 1,000 c Infertility 37 (80,4) Duration of desire for a child (years) 2,62 (1,76) Psychosocial Depression 2,11 (3,15) 4,00 (5,66) 1,70 (2,22) 0,327 a Social support 6,50 (2,69) 6,11 (3,19) 6,59 (2,59) 0,643 a Partnership satisfaction 9,14 (1,18) 7,90 (2,13) 9,44 (0,51) 0,051 a Sexuality Sexual satisfaction 7,64 (2,64) 6,44 (4,02) 7,94 (2,13) 0,492 a Frequence of sexual intercourse (last 4 weeks) 0,433 c Never 8 (17,4) 3 (33,3) 5 (13,5) Once/Month 7 (15,2) 2 (22,2) 5 (13,5) Once/Week 13 (28,3) 1 (11,1) 12 (32,4) Several times/Week 13 (28,3) 3 (33,3) 10 (27,0) * Endo+/Inf- = subgroup with endometriosis, no infertility ** Endo+/Inf + = subgroup with endometriosis und with infertility a Mann-Whitney-U-Test b Pearson’s chi-squared-test c Fisher’s exact test Predictors of Partnership and Sexual Satisfaction: multiple linear regression for individuals In the multiple linear regression for PS for all women with endometriosis and male partners of women with endometriosis with the predictors sex, age, duration of partnership, depression, social support, and wish for a child a variance explanation of 0.12 (corrected R 2 ) was reached. Depression was correlated with lower PS (p = 0.034). The positive correlation between social support and PS was almost significant (p = 0.051) (Table 3 ). Table 3 Multiple linear regression for partnership satisfaction with endometriosis Not standardized coefficients Standardized coefficients T Sig. 95,0% CI for B a Regression Coefficient B Standard Error a Beta Upper Lower (Intercept) 0,118 0,210 0,536 0,593 -0,286 0,485 Gender 0,143 0,099 0,139 1,273 0,207 -0,048 0,341 Age 0,078 0,058 0,135 1,192 0,237 -0,021 0,185 Partnership duration 0,040 0,048 0,078 0,758 0,450 -0,049 0,114 Depression * -0,128 0,088 -0,228 -2,155 0,034 -0,326 -0,001 Social support * 0,105 0,051 0,210 1,976 0,051 0,007 0,224 Infertility -0,111 0,153 -0,078 -0,740 0,461 -0,401 0,199 Model-Test significant (p = 0.01), n = 94 a Bootstrapping result based on 1000 replicates *Significance confirmed in Bootstrapping In the multiple linear regression for SS for all women with endometriosis and male partners of women with endometriosis with the predictors sex, age, duration of partnership, depression, and frequency of sexual intercourse and wish for a child a variance explanation of 0.37 (corrected R 2 ) was reached. Depression was correlated with lower SS (p = 0.004). The frequency of sexual intercourse was correlated with higher SS (p < 0.001) (Table 4 ). In the multiple linear regression for the difference of SS between men and women and the predictor pain during sexual intercourse a variance explanation of 0.13 (corrected R 2 ) was reached. Pain was correlated with a higher difference of SS (p = 0.031). Men showed a higher SS in the descriptive statistics. In the repeated-measures ANCOVA, the partial eta squared was 0.054. Table 4 Multiple linear regression for sexual satisfaction with endometriosis Not standardized coefficients Standardized coefficients T Sig. 95,0% CI for B a Regression Coefficient B Standard Error a Beta Upper Lower (Intercept) -0,312 0,377 -0,792 0,431 -1,031 0,489 Gender -0,035 0,196 -0,016 -0,172 0,864 -0,433 0,293 Age 0,088 0,165 0,064 0,662 0,510 -0,198 0,370 Partnership duration -0,032 0,094 -0,030 -0,323 0,748 -0,230 0,180 Depression * -0,290 0,148 -0,251 -2,679 0,009 -0,577 -0,040 Frequency sexual Intercourse* 0,645 0,138 0,517 5,588 0, 000 0,393 0,900 Infertility 0,192 0,268 0,068 0,720 0,474 -0,327 0,718 Model-Test significant (p < 0.001), n = 83 a Bootstrapping result based on 1000 replicates *Significance confirmed in Bootstrapping Predictors of Partnership and Sexual Satisfaction: dyadic analysis using the APIM The wish to conceive had a significant effect in women with endometriosis and their male partners as a covariate in the APIM analysis of partnership satisfaction. Depression and social support did not show any significant actor or partner effects in the APIM analysis for PS. Using only the data of couples affected by endometriosis and having a wish to conceive, depression showed a significant positive actor effect for male partners with a medium effect size (p = 0.021, r = -0.410). Social support showed a significant positive actor effect for women with a medium effect size (p = 0.046, r = 0.363). The wish to conceive also had a significant effect in women with endometriosis and their male partners as a covariate in the APIM analysis of sexual satisfaction. Depression did not show any significant actor or partner effects in the APIM analysis for SS. Using only the data of couples affected by endometriosis and the wish for a child, depression showed a significant negative actor-effect for women with a medium effect size (p = 0.027, r = -0.378) as well as a significant negative partner-effect (woman ð man) with a medium effect size (p = 0.019, r = -0.322) (Fig. 1). Age showed a significant positive actor-effect for women with a medium effect size (p = 0.044, r = 0.347) as well as a positive partner-effect (woman ðman) with a medium effect size (p = 0.005, r = 0.451) (Fig. 2 ). DISCUSSION The results showed a significant correlation of depression, social support, pain, and childbearing with PZ and SZ in couples affected by endometriosis. Also, the APIM showed significant differences between female and male partners. Depression and Partnership Satisfaction The multiple linear regression showed a negative correlation between depression and PS. This result is in line with results of previous studies about women with endometriosis, which also showed a connection of endometriosis with depression and anxiety [ 6 – 9 ] and also a negative correlation of those two factors with PS [ 14 , 15 , 32 ]. A direct correlation between depression and PS in male partners of women with endometriosis has not been described yet. On the other hand, there are several studies showing an influence of endometriosis on the lifestyle and partnership of the male partners [ 10 – 12 ]. As a negative correlation between depression and partnership is described in both men and women of couples with infertility [ 33 ], a similar correlation for male partners of women with endometriosis is likely. In our APIM-Analysis of the couples with desire to conceive, there was also a negative actor-effect of depression for the male partners. For women, neither an actor- nor a partner-effect could be found. An explanation might be that in our sample women with desire to conceive showed significantly lower values for depression. Social Support and Partnership Satisfaction Furthermore, the results of the multiple linear regression showed a positive correlation between social support and PS. This result is also in line with previous studies on women with endometriosis and their male partners [ 10 , 12 , 34 ], and this is also described for other chronic diseases [ 34 ]. In our APIM-Analysis only women showed a positive actor-effect, in previous studies a positive effect of social support on the PS was also described for male partners [ 12 ]. A similar finding regarding the difference between women and men in terms of social support was described for couples, in which one partner had cancer [ 35 ]. A meta-analysis about gender differences showed that women give (and therefore also receive) significantly more social support then men [ 36 ]. Depression and Sexual Satisfaction The multiple linear regression showed a negative correlation for depression and SS, which is in line with previous studies, showing a negative correlation of depression with SS in women with endometriosis [ 13 – 16 ]. Also, the negative correlation of depression and SS was described for women and men in previous studies and in a meta-analysis [ 37 , 38 ]. Our APIM-analysis with the couples with a desire to conceive showed negative actor- and partner-effects for depression on SS. The actor-effect might be traced back to the direct correlation of depression and SS, while the negative partner-effect might be explained by the interaction with the male partner, which might be affected by pain or depression. Pain during sexual intercourse and sexual satisfaction The positive correlation of pain during sexual intercourse and the difference of SS between men and women confirm the already described different effects of dyspareunia. Dyspareunia is a strong negative predictor for SS in women [ 13 ], affecting women directly and men indirectly. Several studies also described a negative influence of endometriosis on the SS of men, naming their women’s dyspareunia as one of the reasons [ 13 , 18 ]. An explanation for this difference might be that women often do not show or communicate the pain to their male partners [ 18 ]. On the other hand, male partners described in a qualitative study that a reduction of the frequency of sexual intercourse does not influence the SS [ 12 ], which might add to the higher SS of the male partners. Frequency of sexual intercourse and sexual satisfaction The positive correlation of the frequency of sexual intercourse and SS is an expected result. A higher frequency of sexual intercourse is probably connected to a higher satisfaction. Also, women with endometriosis and a high frequency of sexual intercourse might experience less pain symptoms and therefore less dyspareunia. Age and sexual satisfaction The APIM-analysis for SS with the couples with desire to conceive showed a positive actor- and partner-effect for age in women. Previous studies did not describe an explicit effect of age on the SS in women in reproductive age. In one study, a higher age when getting married was described as a protective factor, but a higher age in total also as a risk factor for sexual dysfunction [ 39 ]. In our sample the positive effect of age might have several reasons. As a symptom reduction with higher age was described in patients with endometriosis, this might also have an influence on dyspareunia. Also, older women might have found a suitable therapy for their endometriosis. For example, in one study women described a higher quality of sexuality and a reduction of dyspareunia after a surgical therapy [ 40 ]. A longer partnership duration and better communication within the couple might have a positive effect on the sexual life and SS as well. A factor that always has to be kept in mind when doing surveys about sexuality is the social desirability in the response behavior [ 41 ]. Strengths and Limitations This study shows several strengths but also limitations. One strength is the inclusion of male partners of the women with endometriosis, which enables a further understanding of the influence and effects of endometriosis on the life of male partners. Also, the high number of couples allowed us to do pairwise analysis with the APIM. A further strength of the study is that next to endometriosis we also took the factor infertility into account. Regarding the factor infertility, we also see a limitation of this study. As we did not include couples without endometriosis and infertility or couples with infertility only, we did not have a control group, which would be necessary to have a more precise differentiation between the effects of endometriosis vs. infertility. As endometriosis is often only diagnosed in the process of an infertility treatment, it is probably difficult to find a sample with clearly separated groups. Another limitation is the low number of men and women in the several sub-groups, which did not allow us to perform subgroup analysis with a robust result. Also, we only had heterosexual couples in our study. Especially regarding the factors PS and SS studies with non-heterosexual couples would also be necessary to get a complete picture. Regarding the questionnaires, we only used extracts from the FISFI for the questions about sexuality. This might have reduced the informative value and accuracy of the data [ 41 ]. Further Implications In summary, variables associated with endometriosis, such as depression and pain, were related to sexuality and partnership satisfaction in our study. This effect was particularly evident not only in affected women but also in male partners. In total this finding summarizes also results of previous studies which already described the effect of endometriosis on different parts of life for affected women and male partners. Social support, for example, can be an important resource for affected couples. This means that education and awareness of the topic of endometriosis in the relatives and friends of those affected, but also in society, are important factors in supporting affected couples. In addition, (male) partners should be included in the treatment of endometriosis patients, as they can also be affected and restricted by this disease [ 42 ]. Especially to further differentiate the effects of endometriosis and of an unfulfilled desire to conceive, given the large overlap between the two groups, further studies are important in which both groups and control groups with and without endometriosis or a desire to conceive are included. Overall, studies on both endometriosis and infertility should always consider both factors independently as well as in their interdependence. Declarations AUTHOR CONTRIBUTION DvE: Data analysis, Manuscript writing/editing; MS: Protocol/project development, Data collection, Manuscript writing/editing; AG, SR, TS, TW, BD: Protocol/project development, Manuscript writing/editing. All authors read and approved the final manuscript. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Competing Interests The authors have no relevant financial or non-financial interests to disclose. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. The study was approved by the Ethics Committee of the Medical Faculty of Heidelberg University (S-301/2016). Consent to participate Informed consent was obtained from all individual participants included in the study. 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BMC Womens Health 18(1):92. 10.1186/s12905-018-0584-2 Shindel AW, Nelson CJ, Naughton CK, Ohebshalom M, Mulhall JP (Mar 2008) Sexual function and quality of life in the male partner of infertile couples: prevalence and correlates of dysfunction, (in eng). J Urol 179(3):1056–1059. 10.1016/j.juro.2007.10.069 Millheiser LS, Helmer AE, Quintero RB, Westphal LM, Milki AA, Lathi RB (2010) "Is infertility a risk factor for female sexual dysfunction? A case-control study," (in eng), Fertil Steril , vol. 94, no. 6, pp. 2022-5, Nov 10.1016/j.fertnstert.2010.01.037 Quintero RB, Westphal LM, Lathi RB, Milki AA, Giudice LC, McCallum SW (2005) The Prevalence of Erectile Dysfunction in an Infertile Population. Fertil Steril 83(5):S20. 10.1016/j.fertnstert.2005.01.046 Wirtberg I, Möller A, Hogström L, Tronstad S-E, Lalos A (2006) Life 20 years after unsuccessful infertility treatment. Hum Reprod 22(2):598–604. 10.1093/humrep/del401 Peloquin K, Brassard A, Arpin V, Sabourin S, Wright J (Mar 2018) Whose fault is it? Blame predicting psychological adjustment and couple satisfaction in couples seeking fertility treatment, (in eng). J Psychosom Obstet Gynaecol 39(1):64–72. 10.1080/0167482x.2017.1289369 Tillmann R et al (2022) "The Swiss Household Panel (SHP)," Jahrbücher für Nationalökonomie und Statistik , vol. 242, no. 3, pp. 403–420, doi: 10.1515/jbnst-2021-0039 Rosen R et al (2000) "The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function," (in eng), J Sex Marital Ther , vol. 26, no. 2, pp. 191–208, Apr-Jun 10.1080/009262300278597 Nilges P, Essau C "[Depression, anxiety and stress scales: DASS–A screening procedure not only for pain patients]," (in ger), Schmerz , vol. 29, no. 6, pp. 649 – 57, Dec 2015, doi: 10.1007/s00482-015-0019-z. Die Depressions-Angst-Stress-Skalen: Der DASS–ein Screeningverfahren nicht nur für Schmerzpatienten Facchin F, Buggio L, Vercellini P, Frassineti A, Beltrami S, Saita E (Jul 2021) Quality of intimate relationships, dyadic coping, and psychological health in women with endometriosis: Results from an online survey, (in eng). J Psychosom Res 146:110502. 10.1016/j.jpsychores.2021.110502 Maroufizadeh S, Hosseini M, Rahimi Foroushani A, Omani-Samani R, Amini P The relationship between marital satisfaction and depression in infertile couples: an actor–partner interdependence model approach, BMC Psychiatry, vol. 18, no. 1, p. 310,2018/09/25 2018, 10.1186/s12888-018-1893-6 Tramonti F, Gerini A, Stampacchia G (Feb 2015) Relationship quality and perceived social support in persons with spinal cord injury, (in eng). Spinal Cord 53(2):120–124. 10.1038/sc.2014.229 Chen JJ, Wang QL, Li HP, Zhang T, Zhang SS, Zhou MK (Jun 2021) Family resilience, perceived social support, and individual resilience in cancer couples: Analysis using the actor-partner interdependence mediation model, (in eng). Eur J Oncol Nurs 52:101932. 10.1016/j.ejon.2021.101932 Tifferet S (Apr 2020) Gender Differences in Social Support on Social Network Sites: A Meta-Analysis, (in eng). Cyberpsychol Behav Soc Netw 23(4):199–209. 10.1089/cyber.2019.0516 Atlantis E, Sullivan T (2012) "Bidirectional association between depression and sexual dysfunction: a systematic review and meta-analysis," (in eng), J Sex Med , vol. 9, no. 6, pp. 1497 – 507, Jun 10.1111/j.1743-6109.2012.02709.x Christensen BS, Grønbaek M, Osler M, Pedersen BV, Graugaard C, Frisch M (2011) "Associations between physical and mental health problems and sexual dysfunctions in sexually active Danes," (in eng), J Sex Med , vol. 8, no. 7, pp. 1890 – 902, Jul 10.1111/j.1743-6109.2010.02145.x McCool-Myers M, Theurich M, Zuelke A, Knuettel H, Apfelbacher C Predictors of female sexual dysfunction: a systematic review and qualitative analysis through gender inequality paradigms, BMC Womens Health, vol. 18, no. 1, p. 108, 2018/06/22 2018, 10.1186/s12905-018-0602-4 Halici BNA, Aktoz F, Kabakci M, Kiran G, Ozcan P Analysis of preoperative and postoperative quality of life, sexual function, and sleep in patients with endometriosis: a prospective cohort study, Arch Gynecol Obstet, vol. 307, no. 1, pp. 113–120, 2023/01/01 2023, 10.1007/s00404-022-06562-9 King BM The Influence of Social Desirability on Sexual Behavior Surveys: A Review, Arch Sex Behav, vol. 51, no. 3, pp. 1495–1501, 2022/04/01 2022, 10.1007/s10508-021-02197-0 Schick M et al (2022) "Partners matter: The psychosocial well-being of couples when dealing with endometriosis," (in eng), Health Qual Life Outcomes , vol. 20, no. 1, p. 86, May 28 10.1186/s12955-022-01991-1 Cite Share Download PDF Status: Published Journal Publication published 06 May, 2024 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted Reviewers agreed at journal 12 Nov, 2023 Editor invited by journal 30 Sep, 2023 Reviewers invited by journal 18 Sep, 2023 Editor assigned by journal 17 Sep, 2023 First submitted to journal 17 Sep, 2023 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. 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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-3363425","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":234381345,"identity":"a736843f-31ab-46cf-bf7e-1e3987ec9c58","order_by":0,"name":"Deborah van Eickels","email":"data:image/png;base64,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","orcid":"https://orcid.org/0009-0001-6809-9049","institution":"Heidelberg University Hospital Psychosocial Medicine Center: Universitatsklinikum Heidelberg Zentrum fur Psychosoziale Medizin","correspondingAuthor":true,"prefix":"","firstName":"Deborah","middleName":"van","lastName":"Eickels","suffix":""},{"id":234381346,"identity":"9a51e93d-6ffd-4ac4-9d6b-98a33f3270bd","order_by":1,"name":"Maren Schick","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Maren","middleName":"","lastName":"Schick","suffix":""},{"id":234381347,"identity":"42d63b58-df56-452a-916f-a4c74c8cfaec","order_by":2,"name":"Ariane Germeyer","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Ariane","middleName":"","lastName":"Germeyer","suffix":""},{"id":234381348,"identity":"5dc4642d-09a7-4049-a193-1d57ded85ca5","order_by":3,"name":"Sabine Rösner","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Sabine","middleName":"","lastName":"Rösner","suffix":""},{"id":234381349,"identity":"898248b3-756c-4775-acc5-35c7d3d48ea7","order_by":4,"name":"Thomas Strowitzki","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Thomas","middleName":"","lastName":"Strowitzki","suffix":""},{"id":234381350,"identity":"372fdb4e-29b8-4d83-b604-7169b9bbb9a8","order_by":5,"name":"Tewes Wischmann","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Tewes","middleName":"","lastName":"Wischmann","suffix":""},{"id":234381351,"identity":"8331151e-974b-4ff9-8a36-e70924453e82","order_by":6,"name":"Beate Ditzen","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Beate","middleName":"","lastName":"Ditzen","suffix":""}],"badges":[],"createdAt":"2023-09-17 14:17:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3363425/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3363425/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00404-024-07516-z","type":"published","date":"2024-05-06T16:56:13+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":43637125,"identity":"b0998e05-a3e7-4dd2-a949-c7ac78cda919","added_by":"auto","created_at":"2023-09-25 14:30:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":106559,"visible":true,"origin":"","legend":"\u003cp\u003eActor- and partner-effects for depression on sexual satisfaction;\u003cbr\u003e\nIndication of effect size r; * = p \u0026lt; 0.05\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3363425/v1/91ee25cd4e9bd0afde93208d.png"},{"id":43637126,"identity":"92bde70c-1a7e-44b9-9ff2-0f32ab2c1e01","added_by":"auto","created_at":"2023-09-25 14:30:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":95588,"visible":true,"origin":"","legend":"\u003cp\u003eActor- and partner-effects for age on sexual satisfaction; \u003cbr\u003e\nIndication of effect size r; * = p \u0026lt; 0.05\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3363425/v1/007fc058cc478ea2585d2b5e.png"},{"id":43637136,"identity":"96ac3055-7ceb-4fa3-8362-9c9904c6fd9e","added_by":"auto","created_at":"2023-09-25 14:30:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":747584,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3363425/v1/f5e27cf6-eb61-46b5-8695-3f84e9345c1f.pdf"}],"financialInterests":"","formattedTitle":"Predictors of Partnership and Sexual Satisfaction and dyadic effects in couples affected by endometriosis and infertility","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEndometriosis affects 5\u0026ndash;10% of women of childbearing age, with prevalence ranging from 2\u0026ndash;11% in asymptomatic women to 5\u0026ndash;50% in infertile women and has also been described as a contributing cause of infertility [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Regarding the German IVF Register, endometriosis was documented in 22,9% of all women undergoing infertility treatment in Germany in 2020, indicating both groups overlapping in large part [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Worldwide 8\u0026ndash;12% of all couples suffer from infertility [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhilst endometriosis can cause physical symptoms such as pain and dyspareunia previous studies also showed a connection of endometriosis with psychological stress in form of depression, anxiety, and stress. All these symptoms lead to an influence on the social and work life of the women as well as on their partnerships and sexual life [\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In addition to the affected women, male partners also experience psychological stress due to the endometriosis affecting the woman as well as the partnership and their sexual life [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Symptoms reported by male partners comprise feeling helpless, frustration, worry, anger and stress [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Social support is reported rarely but is evaluated as positive when received [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Regarding the connection between endometriosis and sexuality, for women symptoms such as dyspareunia, sexual dysfunction and lower sexual satisfaction are consistently described in several studies [\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. For male partners, only few studies exist about the influence of endometriosis on sexuality, intimacy and partnership [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Male partners do not seem to suffer consistently from sexual dysfunction but do report an influence on their sexual satisfaction in terms of a lower coital frequency due to the women\u0026rsquo;s pain while wishing for a higher frequency of sexual intercourse [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInfertility is also often related to psychological burdens such as depression, anxiety, stress and guilt in women but also in men of affected couples [\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Sexual dysfunction and lower sexual satisfaction are reported in both men and women of infertile couples, with women showing a greater impairment [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRelationship satisfaction of infertile couples seems to be connected to the communication and way of coping with the infertility. Whilst some infertile women report that they have been left by their partners [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], most couples report a high relationship satisfaction despite the infertility [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This is linked to a \u0026ldquo;survival\u0026rdquo; of those relationships despite the infertility and sometimes even a stronger connection and better communication [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSince studies investigating both women with endometriosis and their male partners are still lacking, and existing studies mostly focus only on endometriosis or only on infertility, the aim of this study was to identify predictors of sexual satisfaction (SS) and partnership satisfaction (PS) in couples with endometriosis and infertility. In addition, we aimed to investigate how these variables are related to each other, while taking into account the infertility factor.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSetting and Questionnaires\u003c/h2\u003e \u003cp\u003eBetween September 2016 and August 2018, all women who underwent laparoscopic surgery for infertility or dysmenorrhea at the Department of Gynecological Endocrinology at Heidelberg University Hospital - and in whom endometriosis could be confirmed - were informed about the study. All women and their male partners received further information about the study in writing, an informed consent form, and (if they consented) were each asked to complete a set of questionnaires (see below).\u003c/p\u003e \u003cp\u003eThe data analysed included the results of the laparoscopic surgery and the patient files from the hospital as well as the handed-out questionnaires, including up to 88 items for female and 72 items for male participants.\u003c/p\u003e \u003cp\u003ePartnership satisfaction and social support were surveyed by questions from the Swiss Household Panel [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. We used a visual analogue Scale (VAS) with a range from 0 (\u0026ldquo;not at all\u0026rdquo;) to 10 (\u0026ldquo;very much\u0026rdquo;). Two questions referred to the support and understanding from the social environment like relatives, friends, and colleagues. Both questions were summarized to the variable \u0026ldquo;social support\u0026rdquo;. For partnership satisfaction in total 4 questions were used, which addressed support, understanding, intimacy and happiness within the partnership. All 4 questions were summarized to the variable \u0026ldquo;partnership satisfaction\u0026rdquo;.\u003c/p\u003e \u003cp\u003eRegarding sexuality in total 3 questions were assessed. Sexual satisfaction was measured by using a VAS with a range from 0 (\u0026ldquo;very unsatisfied\u0026rdquo;) to 10 (\u0026rdquo;very satisfied\u0026rdquo;). Next to that frequency of sexual intercourse and for the women also the frequency of pain during sexual intercourse were asked. All the questions regarding sexuality were taken from the Female Sexual Function Index [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. To determine the relative share of painful sexual intercourse we formed a ratio from the frequency of painful sexual intercourse and the frequency of sexual intercourse in total.\u003c/p\u003e \u003cp\u003eTo assess depression, we used the German version of the \u0026ldquo;Depression, Anxiety and Stress Scale\u0026rdquo; [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The scale consists of 21 items regarding depression, anxiety, and stress, using a 4-point Likert-scale from 0 (\u0026ldquo;never\u0026rdquo;) to 3 (\u0026ldquo;almost always\u0026rdquo;). For each variable 7 items are summarized. Items for depression include questions about listlessness, mood, and joylessness. For depression a Cronbach\u0026rsquo;s Alpha\u0026thinsp;=\u0026thinsp;.91 was calculated by the authors of the questionnaire, showing a high internal consistency of the scale.\u003c/p\u003e \u003cp\u003eSociodemographic data included age, level of education, current profession, marital status, number of children, duration of wish to conceive, partnership duration, subjective cause of infertility and kind of infertility treatment, as well as status, duration, and treatment of endometriosis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eRegarding the status of endometriosis and desire to have children, data from women with endometriosis and their male partners were used and this group was further subdivided according to an actual existing desire for a child (yes/no).\u003c/p\u003e \u003cp\u003eTesting was done by using Mann-Whitney-U-Tests and Chi-Square-Tests (depending on the variable\u0026rsquo;s quality) for between-group comparisons between the men and women with and without infertility. To determine the predictors for sexual and partnership satisfaction as well as the correlation between pain and SS we performed multiple linear regressions with the whole sample.\u003c/p\u003e \u003cp\u003eTo evaluate how the predictors for sexual and partnership satisfaction interact within a couple and whether they show a mutual effect between men and women we used the Actor-Partner-Interdependence-Model (APIM) by David A. Kenny. This model assumes that one person\u0026rsquo;s behaviour or a predictor not only shows an effect on him- or herself (actor effect) but also on his/her partner (partner effect). In our APIM, we used the predictors identified in the multiple linear regression as the independent variable and sexual and partnership satisfaction as the dependent variable. The web program APIM_MM (Actor Partner Interdependence Model with Multilevel Modeling) for distinguishable dyads by David A. Kenny (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://davidakenny.net/DyadR/DyadRweb.htm\u003c/span\u003e\u003cspan address=\"http://davidakenny.net/DyadR/DyadRweb.htm\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) was used to calculate the APIM. This web program also calculates effect sizes (ES) to estimate the clinical relevance of the APIM effects.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eSociodemographic Data\u003c/h2\u003e\n \u003cp\u003e380 questionnaires were handed out to the patients and their partners; a total of 161 participants completed the questionnaires (response rate: 42,37%). After excluding incomplete data sets and patients without endometriosis, n\u0026thinsp;=\u0026thinsp;62 women with endometriosis and n\u0026thinsp;=\u0026thinsp;46 male partners were included in the analysis. In total there were n\u0026thinsp;=\u0026thinsp;44 heterosexual couples among the participants.\u003c/p\u003e\n \u003cp\u003eDescriptive statistics for men and women are shown in Tables \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003eRegarding the presence of infertility there were significant differences between the two groups in several variables. Mean Age and duration of the partnership were significantly higher in infertile women in comparison to women without infertility (p\u0026thinsp;=\u0026thinsp;0.024 for age and p\u0026thinsp;=\u0026thinsp;0.032 for duration of partnership), whereas level of depression was significantly lower (p\u0026thinsp;=\u0026thinsp;0.019). Men without a wish for a child were significantly more likely to be a father already than men with a wish to have children (p\u0026thinsp;=\u0026thinsp;0.039). Regarding the other variables there were no significant differences.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDescriptive statistics women\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEndo+/Inf-*\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEndo+/Inf+**\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003cp\u003e(SD) / N (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003cp\u003e(SD) / N (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003cp\u003e(SD) / N (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eSociodemographic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31,00 (5,30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27,87 (7,20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32,00 (4,16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,024\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartnership duration in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7,15 (4,37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,62 (3,81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7,64 (4,34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,032\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChild present already\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (16,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (13,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (16,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,000\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e0,118\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (59,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (73,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (55,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (38,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (20,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 (44,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eEndometriosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNew diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (11,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (6,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (12,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,000\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfertility\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47 (75,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of desire for a child\u003c/p\u003e\n \u003cp\u003e(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,81 (2,10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychosocial\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,61 (5,24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6,53 (5,22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,98 (5,14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,019\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7,59 (2,41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7,65 (2,90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7,57 (2,27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,469\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartnership satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8,69 (1,92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8,64 (1,98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8,70 (1,93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,850\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexuality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSexual satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7,22 (3,34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6,00 (3,64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7,48 (3,25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,204\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequence of sex. intercourse\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(last 4 weeks)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003e0,090\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (14,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (33,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (8,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOnce/Month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (14,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (20,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (12,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOnce/Week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (29,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (13,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (34,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSeveral times/Week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (30,6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (26,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (31,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e Endo+/Inf- = subgroup with endometriosis, no infertility\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e Endo+/Inf\u0026thinsp;+\u0026thinsp;=\u0026thinsp;subgroup with endometriosis und with infertility\u003c/p\u003e\n \u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Mann-Whitney-U-Test\u003c/p\u003e\n \u003cp\u003e\u003csup\u003eb\u003c/sup\u003e Pearson\u0026rsquo;s chi-squared-test\u003c/p\u003e\n \u003cp\u003e\u003csup\u003ec\u003c/sup\u003e Fisher\u0026rsquo;s exact test\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDescriptive statistics men\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEndo+/Inf-*\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEndo+/Inf+**\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003cp\u003e(SD) / N (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003cp\u003e(SD) / N (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003cp\u003e(SD) / N (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eSociodemographic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35,54 (6,26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33,44 (9,45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36,05 (5,27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,397\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartnership duration in years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7,16 (4,41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,36 (4,03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7,51 (4,45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,193\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChild present already\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (19,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (44,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (13,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,039\u003c/strong\u003e\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e0,243\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (50,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (66,7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (45,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (47,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (22,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (54,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eEndometriosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNew diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (10,9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (11,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (10,8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,000\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfertility\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (80,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of desire for a child\u003c/p\u003e\n \u003cp\u003e(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,62 (1,76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003ePsychosocial\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,11 (3,15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,00 (5,66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,70 (2,22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,327\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6,50 (2,69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6,11 (3,19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6,59 (2,59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,643\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartnership satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9,14 (1,18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7,90 (2,13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9,44 (0,51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,051\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexuality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSexual satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7,64 (2,64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6,44 (4,02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7,94 (2,13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,492\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequence of sexual intercourse\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(last 4 weeks)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003e0,433\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (17,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (33,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (13,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOnce/Month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (15,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (22,2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (13,5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOnce/Week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (28,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (11,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (32,4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSeveral times/Week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (28,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (33,3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (27,0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e Endo+/Inf- = subgroup with endometriosis, no infertility\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e Endo+/Inf\u0026thinsp;+\u0026thinsp;=\u0026thinsp;subgroup with endometriosis und with infertility\u003c/p\u003e\n \u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Mann-Whitney-U-Test\u003c/p\u003e\n \u003cp\u003e\u003csup\u003eb\u003c/sup\u003e Pearson\u0026rsquo;s chi-squared-test\u003c/p\u003e\n \u003cp\u003e\u003csup\u003ec\u003c/sup\u003e Fisher\u0026rsquo;s exact test\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003ePredictors of Partnership and Sexual Satisfaction: multiple linear regression for individuals\u003c/h2\u003e\n \u003cp\u003eIn the multiple linear regression for PS for all women with endometriosis and male partners of women with endometriosis with the predictors sex, age, duration of partnership, depression, social support, and wish for a child a variance explanation of 0.12 (corrected R\u003csup\u003e2\u003c/sup\u003e) was reached. Depression was correlated with lower PS (p\u0026thinsp;=\u0026thinsp;0.034). The positive correlation between social support and PS was almost significant (p\u0026thinsp;=\u0026thinsp;0.051) (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultiple linear regression for partnership satisfaction with endometriosis\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNot standardized coefficients\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStandardized coefficients\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e95,0% CI for B\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRegression\u003c/p\u003e\n \u003cp\u003eCoefficient B\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStandard Error \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBeta\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(Intercept)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,536\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,099\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,341\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,185\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartnership duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,758\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,450\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,114\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression *\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2,155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,034\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial support *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,976\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,224\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInfertility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,740\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,461\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,199\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"8\"\u003e\n \u003cp\u003eModel-Test significant (p\u0026thinsp;=\u0026thinsp;0.01), n\u0026thinsp;=\u0026thinsp;94\u003c/p\u003e\n \u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Bootstrapping result based on 1000 replicates\u003c/p\u003e\n \u003cp\u003e*Significance confirmed in Bootstrapping\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eIn the multiple linear regression for SS for all women with endometriosis and male partners of women with endometriosis with the predictors sex, age, duration of partnership, depression, and frequency of sexual intercourse and wish for a child a variance explanation of 0.37 (corrected R\u003csup\u003e2\u003c/sup\u003e) was reached. Depression was correlated with lower SS (p\u0026thinsp;=\u0026thinsp;0.004). The frequency of sexual intercourse was correlated with higher SS (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eIn the multiple linear regression for the difference of SS between men and women and the predictor pain during sexual intercourse a variance explanation of 0.13 (corrected R\u003csup\u003e2\u003c/sup\u003e) was reached. Pain was correlated with a higher difference of SS (p\u0026thinsp;=\u0026thinsp;0.031). Men showed a higher SS in the descriptive statistics. In the repeated-measures ANCOVA, the partial eta squared was 0.054.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultiple linear regression for sexual satisfaction with endometriosis\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNot standardized coefficients\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStandardized coefficients\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e95,0% CI for B\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRegression\u003c/p\u003e\n \u003cp\u003eCoefficient B\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStandard Error\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBeta\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(Intercept)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,792\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1,031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,489\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,864\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,293\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,662\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartnership duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,748\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,180\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression *\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,290\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2,679\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,040\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency sexual Intercourse*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,645\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,517\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,\u003cstrong\u003e000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,900\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInfertility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,720\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,474\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,718\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"8\"\u003e\n \u003cp\u003eModel-Test significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), n\u0026thinsp;=\u0026thinsp;83\u003c/p\u003e\n \u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Bootstrapping result based on 1000 replicates\u003c/p\u003e\n \u003cp\u003e*Significance confirmed in Bootstrapping\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003ePredictors of Partnership and Sexual Satisfaction: dyadic analysis using the APIM\u003c/h2\u003e\n \u003cp\u003eThe wish to conceive had a significant effect in women with endometriosis and their male partners as a covariate in the APIM analysis of partnership satisfaction. Depression and social support did not show any significant actor or partner effects in the APIM analysis for PS. Using only the data of couples affected by endometriosis and having a wish to conceive, depression showed a significant positive actor effect for male partners with a medium effect size (p\u0026thinsp;=\u0026thinsp;0.021, r = -0.410). Social support showed a significant positive actor effect for women with a medium effect size (p\u0026thinsp;=\u0026thinsp;0.046, r\u0026thinsp;=\u0026thinsp;0.363).\u003c/p\u003e\n \u003cp\u003eThe wish to conceive also had a significant effect in women with endometriosis and their male partners as a covariate in the APIM analysis of sexual satisfaction. Depression did not show any significant actor or partner effects in the APIM analysis for SS. Using only the data of couples affected by endometriosis and the wish for a child, depression showed a significant negative actor-effect for women with a medium effect size (p\u0026thinsp;=\u0026thinsp;0.027, r = -0.378) as well as a significant negative partner-effect (woman \u0026eth; man) with a medium effect size (p\u0026thinsp;=\u0026thinsp;0.019, r = -0.322) (Fig. 1). Age showed a significant positive actor-effect for women with a medium effect size (p\u0026thinsp;=\u0026thinsp;0.044, r\u0026thinsp;=\u0026thinsp;0.347) as well as a positive partner-effect (woman \u0026eth;man) with a medium effect size (p\u0026thinsp;=\u0026thinsp;0.005, r\u0026thinsp;=\u0026thinsp;0.451) (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe results showed a significant correlation of depression, social support, pain, and childbearing with PZ and SZ in couples affected by endometriosis. Also, the APIM showed significant differences between female and male partners.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDepression and Partnership Satisfaction\u003c/h2\u003e \u003cp\u003eThe multiple linear regression showed a negative correlation between depression and PS. This result is in line with results of previous studies about women with endometriosis, which also showed a connection of endometriosis with depression and anxiety [\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and also a negative correlation of those two factors with PS [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. A direct correlation between depression and PS in male partners of women with endometriosis has not been described yet. On the other hand, there are several studies showing an influence of endometriosis on the lifestyle and partnership of the male partners [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. As a negative correlation between depression and partnership is described in both men and women of couples with infertility [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], a similar correlation for male partners of women with endometriosis is likely. In our APIM-Analysis of the couples with desire to conceive, there was also a negative actor-effect of depression for the male partners. For women, neither an actor- nor a partner-effect could be found. An explanation might be that in our sample women with desire to conceive showed significantly lower values for depression.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSocial Support and Partnership Satisfaction\u003c/h2\u003e \u003cp\u003eFurthermore, the results of the multiple linear regression showed a positive correlation between social support and PS. This result is also in line with previous studies on women with endometriosis and their male partners [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and this is also described for other chronic diseases [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. In our APIM-Analysis only women showed a positive actor-effect, in previous studies a positive effect of social support on the PS was also described for male partners [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A similar finding regarding the difference between women and men in terms of social support was described for couples, in which one partner had cancer [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. A meta-analysis about gender differences showed that women give (and therefore also receive) significantly more social support then men [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDepression and Sexual Satisfaction\u003c/h2\u003e \u003cp\u003eThe multiple linear regression showed a negative correlation for depression and SS, which is in line with previous studies, showing a negative correlation of depression with SS in women with endometriosis [\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Also, the negative correlation of depression and SS was described for women and men in previous studies and in a meta-analysis [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Our APIM-analysis with the couples with a desire to conceive showed negative actor- and partner-effects for depression on SS. The actor-effect might be traced back to the direct correlation of depression and SS, while the negative partner-effect might be explained by the interaction with the male partner, which might be affected by pain or depression.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePain during sexual intercourse and sexual satisfaction\u003c/h2\u003e \u003cp\u003eThe positive correlation of pain during sexual intercourse and the difference of SS between men and women confirm the already described different effects of dyspareunia. Dyspareunia is a strong negative predictor for SS in women [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], affecting women directly and men indirectly. Several studies also described a negative influence of endometriosis on the SS of men, naming their women\u0026rsquo;s dyspareunia as one of the reasons [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. An explanation for this difference might be that women often do not show or communicate the pain to their male partners [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. On the other hand, male partners described in a qualitative study that a reduction of the frequency of sexual intercourse does not influence the SS [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], which might add to the higher SS of the male partners.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eFrequency of sexual intercourse and sexual satisfaction\u003c/h2\u003e \u003cp\u003eThe positive correlation of the frequency of sexual intercourse and SS is an expected result. A higher frequency of sexual intercourse is probably connected to a higher satisfaction. Also, women with endometriosis and a high frequency of sexual intercourse might experience less pain symptoms and therefore less dyspareunia.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eAge and sexual satisfaction\u003c/h2\u003e \u003cp\u003eThe APIM-analysis for SS with the couples with desire to conceive showed a positive actor- and partner-effect for age in women. Previous studies did not describe an explicit effect of age on the SS in women in reproductive age. In one study, a higher age when getting married was described as a protective factor, but a higher age in total also as a risk factor for sexual dysfunction [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In our sample the positive effect of age might have several reasons. As a symptom reduction with higher age was described in patients with endometriosis, this might also have an influence on dyspareunia. Also, older women might have found a suitable therapy for their endometriosis. For example, in one study women described a higher quality of sexuality and a reduction of dyspareunia after a surgical therapy [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. A longer partnership duration and better communication within the couple might have a positive effect on the sexual life and SS as well. A factor that always has to be kept in mind when doing surveys about sexuality is the social desirability in the response behavior [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThis study shows several strengths but also limitations. One strength is the inclusion of male partners of the women with endometriosis, which enables a further understanding of the influence and effects of endometriosis on the life of male partners. Also, the high number of couples allowed us to do pairwise analysis with the APIM. A further strength of the study is that next to endometriosis we also took the factor infertility into account.\u003c/p\u003e \u003cp\u003eRegarding the factor infertility, we also see a limitation of this study. As we did not include couples without endometriosis and infertility or couples with infertility only, we did not have a control group, which would be necessary to have a more precise differentiation between the effects of endometriosis vs. infertility. As endometriosis is often only diagnosed in the process of an infertility treatment, it is probably difficult to find a sample with clearly separated groups. Another limitation is the low number of men and women in the several sub-groups, which did not allow us to perform subgroup analysis with a robust result. Also, we only had heterosexual couples in our study. Especially regarding the factors PS and SS studies with non-heterosexual couples would also be necessary to get a complete picture. Regarding the questionnaires, we only used extracts from the FISFI for the questions about sexuality. This might have reduced the informative value and accuracy of the data [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eFurther Implications\u003c/h2\u003e \u003cp\u003eIn summary, variables associated with endometriosis, such as depression and pain, were related to sexuality and partnership satisfaction in our study. This effect was particularly evident not only in affected women but also in male partners. In total this finding summarizes also results of previous studies which already described the effect of endometriosis on different parts of life for affected women and male partners.\u003c/p\u003e \u003cp\u003eSocial support, for example, can be an important resource for affected couples. This means that education and awareness of the topic of endometriosis in the relatives and friends of those affected, but also in society, are important factors in supporting affected couples. In addition, (male) partners should be included in the treatment of endometriosis patients, as they can also be affected and restricted by this disease [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEspecially to further differentiate the effects of endometriosis and of an unfulfilled desire to conceive, given the large overlap between the two groups, further studies are important in which both groups and control groups with and without endometriosis or a desire to conceive are included. Overall, studies on both endometriosis and infertility should always consider both factors independently as well as in their interdependence.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDvE: Data analysis, Manuscript writing/editing; MS: Protocol/project development, Data collection, Manuscript writing/editing; AG, SR, TS, TW, BD: Protocol/project development, Manuscript writing/editing. All\u003c/em\u003e \u003cem\u003eauthors read and approved the final manuscript.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. The study was approved by the Ethics Committee of the Medical Faculty of Heidelberg University (S-301/2016).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSimoens S et al (May 2012) The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum Reprod 27(5):1292\u0026ndash;1299. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/humrep/des073\u003c/span\u003e\u003cspan address=\"10.1093/humrep/des073\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZondervan KT, Becker CM, Koga K, Missmer SA, Taylor RN, Vigano P (Jul 19 2018) Endometriosis. 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902, Jul \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1743-6109.2010.02145.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1743-6109.2010.02145.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcCool-Myers M, Theurich M, Zuelke A, Knuettel H, Apfelbacher C Predictors of female sexual dysfunction: a systematic review and qualitative analysis through gender inequality paradigms, BMC Womens Health, vol. 18, no. 1, p. 108, 2018/06/22 2018, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12905-018-0602-4\u003c/span\u003e\u003cspan address=\"10.1186/s12905-018-0602-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHalici BNA, Aktoz F, Kabakci M, Kiran G, Ozcan P Analysis of preoperative and postoperative quality of life, sexual function, and sleep in patients with endometriosis: a prospective cohort study, Arch Gynecol Obstet, vol. 307, no. 1, pp. 113\u0026ndash;120, 2023/01/01 2023, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00404-022-06562-9\u003c/span\u003e\u003cspan address=\"10.1007/s00404-022-06562-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKing BM The Influence of Social Desirability on Sexual Behavior Surveys: A Review, Arch Sex Behav, vol. 51, no. 3, pp. 1495\u0026ndash;1501, 2022/04/01 2022, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10508-021-02197-0\u003c/span\u003e\u003cspan address=\"10.1007/s10508-021-02197-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchick M et al (2022) \"Partners matter: The psychosocial well-being of couples when dealing with endometriosis,\" (in eng), \u003cem\u003eHealth Qual Life Outcomes\u003c/em\u003e, vol.\u0026nbsp;20, no. 1, p.\u0026nbsp;86, May 28 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12955-022-01991-1\u003c/span\u003e\u003cspan address=\"10.1186/s12955-022-01991-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Endometriosis, Infertility, APIM, Sexuality, Partnership","lastPublishedDoi":"10.21203/rs.3.rs-3363425/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3363425/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eEndometriosis and infertility are associated with impaired partnership and sexuality of the patients, but also of their male partners. The aim of this study was to determine the association of different predictors of partnership and sexual satisfaction in couples with endometriosis and infertility, as well as dyadic effects.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted with n\u0026thinsp;=\u0026thinsp;62 women with endometriosis and n\u0026thinsp;=\u0026thinsp;46 partners, including a total of n\u0026thinsp;=\u0026thinsp;44 couples, some of whom were affected by infertility. The questionnaire included items on partnership, sexuality, depression, social support, and childbearing. Multiple linear regression and the actor-partner-interdependence-model were used for analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eDepression correlated with lower partnership and sexuality satisfaction and showed in the dyad a significant negative actor effect in men for partnership satisfaction and a negative actor and partner effect in women for sexuality satisfaction (p\u0026thinsp;\u0026lt;\u0026thinsp;.05). For women, social support showed a significant positive actor effect for partnership satisfaction (p\u0026thinsp;\u0026lt;\u0026thinsp;.05), age showed a significant actor and partner effect for sexuality satisfaction (p\u0026thinsp;\u0026lt;\u0026thinsp;.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe results show a significant association of endometriosis and infertility with partnership and sexuality satisfaction in both partners and support the importance of including male partners' perspectives in the treatment of endometriosis.\u003c/p\u003e\u003ch2\u003eTRIAL REGISTRATION\u003c/h2\u003e \u003cp\u003eGerman Clinical Trials Register DRKS00014362 on the 29.03.2018.\u003c/p\u003e","manuscriptTitle":"Predictors of Partnership and Sexual Satisfaction and dyadic effects in couples affected by endometriosis and infertility","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-09-25 14:30:49","doi":"10.21203/rs.3.rs-3363425/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2023-11-12T17:54:50+00:00","index":0,"fulltext":""},{"type":"editorInvited","content":"Archives of Gynecology and Obstetrics","date":"2023-09-30T14:54:06+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-09-18T10:56:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-09-17T14:26:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Gynecology and Obstetrics","date":"2023-09-17T10:17:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"373d51e4-bc2d-4113-91cf-15e3bddc1d4f","owner":[],"postedDate":"September 25th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-05-09T16:56:13+00:00","versionOfRecord":{"articleIdentity":"rs-3363425","link":"https://doi.org/10.1007/s00404-024-07516-z","journal":{"identity":"archives-of-gynecology-and-obstetrics","isVorOnly":false,"title":"Archives of Gynecology and Obstetrics"},"publishedOn":"2024-05-06 16:56:13","publishedOnDateReadable":"May 6th, 2024"},"versionCreatedAt":"2023-09-25 14:30:49","video":"","vorDoi":"10.1007/s00404-024-07516-z","vorDoiUrl":"https://doi.org/10.1007/s00404-024-07516-z","workflowStages":[]},"version":"v1","identity":"rs-3363425","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3363425","identity":"rs-3363425","version":["v1"]},"buildId":"M1DPXKE8UapkOyQliHcFZ","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}