# Psychosocial Factors and Disease Localization as Independent Predictors of Sexual Dysfunction in Women with Endometriosis

## TL;DR

This study finds that sexual dysfunction in women with endometriosis is influenced by anatomical disease location and psychosocial factors, not just pain levels.

## Contribution

The study integrates two classification systems to show that anatomical disease localization and psychosocial factors independently predict sexual dysfunction in endometriosis.

## Key findings

- Deep infiltrating endometriosis in specific anatomical regions is linked to sexual dysfunction.
- Sexual dysfunction is not strongly correlated with pain severity or psychosocial variables like anxiety or depression.
- A multidisciplinary approach is recommended to address the multifactorial nature of sexual dysfunction in endometriosis.

## Abstract

Background: This study examines the impact of endometriosis on sexual function, focusing on disease localization, pain severity, and psychosocial factors. It integrates the rASRM and Enzian classification systems to explore anatomical contributions to sexual dysfunction. Methods: In a cross-sectional study, 102 patients with confirmed endometriosis completed an online evaluation. Of these, 77 had surgical and histological confirmation, and 25 had no prior surgery. Thirty-five participants were using hormonal therapy. Validated instruments assessed sexual function, pain intensity (VAS), and psychosocial variables. Analyses included univariate tests and multivariate logistic regression. Results: Deep infiltrating endometriosis involving the sacrouterine ligaments, cardinal ligaments, and pelvic sidewall (Enzian B) was associated with sexual dysfunction, highlighting the anatomical utility of the Enzian system. Surprisingly, those with sexual dysfunction reported lower pain scores (p = 0.024 *). In multivariate analysis (R2 = 0.281), no individual factor, including Enzian B involvement or EHP scores, remained significant. No associations were found between sexual dysfunction and anxiety, depression, stress, or relationship satisfaction, though pain was inversely correlated with anxiety (p = 0.025 *). Conclusions: Sexual dysfunction in endometriosis appears multifactorial, not solely driven by lesion burden or pain. A multidisciplinary approach is recommended, addressing anatomical, psychological, and behavioral dimensions.