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Deep Endometriosis: the Involvement of Multiple Pelvic Compartments Is Associated with More Severe Pain Symptoms and Infertility

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Abstract

Endometriosis can be classified into three phenotypes: superficial, ovarian, and deep. Deep endometriosis (DE) has been associated with more severe pain symptoms, although no large-scale studies have evaluated the association between pain intensity and infertility and the different compartments of the pelvis affected by superficial and DE. This retrospective study included 1116 women who underwent laparoscopy for endometriosis treatment at two referral centers between 2009 and 2019. For the evaluation of each symptom, patients were divided according to their visual analog scale score (< 7 and ≥ 7) and fertility status. On multiple logistic regression, severe dysmenorrhea and dyschezia were correlated with DE of the posterior compartment alone (odds ratio (OR) = 1.6, confidence interval (CI) 1.09–2.34, and p = 0.02 and OR = 2.09, CI 1.36–3.23, and p < 0.01, respectively) and in combination with other compartments. DE of the posterior and lateral compartments had the most consistent statistical power (OR = 3.55 for dysmenorrhea and OR = 4.4 for dyschezia). Infertility was associated with DE of the posterior compartment alone (OR = 1.6, CI 1.06–2.54, p = 0.04) and in combination with the anterior compartment (OR = 2.62, CI 1.29–5.29, p < 0.01), with the combination of posterior and anterior compartment having the highest OR value. Severe dyschezia and infertility were also correlated with the presence of multiple localizations of DE (p = 0.04 and p < 0.01). This study confirms the association between DE and severe pain symptoms as well as the influence of the number of DE compartments on the severity of symptoms and the chance of infertility.

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Data Availability

The authors declare that all data and material used in this research are available for consultation.

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Acknowledgements

We would like to thank Cleyton Zanardo for the statistical analysis and Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Endometriosis Section, Faculdade de Medicina, Gynecologic Division. Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Tainá Pezzin Rocha, Marina Paula Andres & Mauricio Simões Abrão

  2. Gynecologic Division, BP - A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, SP, Brazil

    Marina Paula Andres & Mauricio Simões Abrão

  3. Service of Gynecology, ICGON, Hospital Clinic de Barcelona, Barcelona, Spain

    Francisco Carmona

  4. Institut d’Investigations Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain

    Francisco Carmona

  5. Faculty of Medicine, University of Barcelona, Barcelona, Spain

    Francisco Carmona

  6. Faculdade de Medicina, Gynecologic Division. Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Edmund Chada Baracat

Authors
  1. Tainá Pezzin Rocha
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  2. Marina Paula Andres
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  4. Edmund Chada Baracat
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  5. Mauricio Simões Abrão
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Contributions

Conceptualization and methodology: Tainá Pezzin Rocha and Mauricio Simões Abrão. Formal analysis and investigation: Tainá Pezzin Rocha and Marina Paula Andres. Writing-original draft preparation: Tainá Pezzin Rocha. Writing-review and editing: Tainá Pezzin Rocha and Marina Paula Andres. Supervision: Marina Paula Andres, Mauricio Simões Abrão, Francisco Carmona, and Edmund Chada Baracat.

Corresponding author

Correspondence to Mauricio Simões Abrão.

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Ethics Approval

This study was approved by the institutional review board of Hospital das Clinicas—HC-FMUSP (CAPPesq 3.079.709) and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki.

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This study was exempt from the informed consent form by IRB, since the data used were retrieved from medical records and no additional patient intervention was performed.

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The authors declare no competing interests.

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Rocha, T.P., Andres, M.P., Carmona, F. et al. Deep Endometriosis: the Involvement of Multiple Pelvic Compartments Is Associated with More Severe Pain Symptoms and Infertility. Reprod. Sci. 30, 1668–1675 (2023). https://doi.org/10.1007/s43032-022-01104-9

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  • DOI: https://doi.org/10.1007/s43032-022-01104-9

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