Table 3. Possible confounders in assessing pain response to surgery and the changes in self-reported endometriosis-related symptoms assessed prior to surgery and at follow-up in the 22 women who were not considered responders for deep dyspareunia.
| Case | Dysp | Dysm | PPain | Length of | Pelvic surgery | Mental | Indication | Follow-up | Hormones | Hormones at | Goserelin |
|---|---|---|---|---|---|---|---|---|---|---|---|
| (NRS) | (NRS) | (NRS) | NM PPain | in the past | disorder | of surgery | (months) | prior to surgery | follow-up | implant | |
| Nonresponder | |||||||||||
| 1 | 9 → 9 | Ø → Ø | 9 → 2 | 36 | P | 6.2 | OP | No | 0 | ||
| 2 | 9 → 7 | 7 → 7 | 5 → 6 | 24 | P | 6.9 | OP+COC | cCOC | 0 | ||
| 3 | 9 → 7 | 9 → Ø | 8 → 5 | 12 | mood+sleep | P+I | 7.1 | OP | OP | 0 | |
| 4 | 8 → 9 | 0 → Ø | 10 → 8 | 3 | P | 5.3 | VR | VR | 0 | ||
| 5 | 8 → 7 | 8 → Ø | 8 → 4 | 72 | not assessed | P+I | 6.4 | No | OP | 2 | |
| 6 | 8 → 7 | 10 → Ø | 5 → 2 | 30 | anxiety | P | 6.1 | OP | No | 0 | |
| 7 | 7 → 5 | 7 → 0 | 5 → 2 | 24 | mood+anxiety | P | 6.6 | No | No | 2 | |
| 8 | 6 → 4 | 10 → 3 | 4 → 4 | 6 | sleep | P+I | 6.4 | No | No | 0 | |
| 9 | 5 → 7 | 7 → 5 | 8 → 0 | 24 | I | 7.0 | No | No | 0 | ||
| 10 | 5 → 5 | 10 → 8 | 4 → 4 | 24 | relational | P+I | 6.1 | OP | No | 0 | |
| 11 | 4 → 4 | 1 → 3 | 0 → 0 | 0 | I | 6.3 | No | No | 0 | ||
| 12 | 4 → 4 | Ø → Ø | 0 → 0 | 0 | mood | P | 6.1 | OP+COC+IUD | IUD | 0 | |
| Paradoxical | |||||||||||
| 13 | 6 → 10 | 9 → Ø | 5 → 3 | 6 | VagHTM | anxiety+panic | P | 6.0 | COC | No | 0 |
| 14 | 5 → 8 | 9 → Ø | 8 → 0 | 3 | mood | P | 6.0 | No | No | 0 | |
| 15 | 4 → 9 | 8 → 5 | 5 → 5 | 3 | I | 6.0 | No | No | 0 | ||
| “de novo” | |||||||||||
| 16 | 0 → 8 | 7 → Ø | 8 → 0 | 20 | P | 8.5 | No | No | 1 | ||
| 17 | 0 → 8 | 10 → 5 | 4 → 0 | 72 | mood | P+I | 6.1 | No | No | 0 | |
| 18 | 0 → 7 | 8 → Ø | 0 → 0 | 0 | Opt+End | P | 5.9 | COC | cCOC | 0 | |
| 19 | 0 → 6 | Ø → Ø | 10 → 3 | 3 | SubHTM+End | pain (fibromyalgia) | P | 6.4 | No | No | 0 |
| 20 | 0 → 5 | 8 → Ø | 0 → 5 | 0 | P | 7.1 | No | No | 0 | ||
| 21 | 0 → 4 | 8 → 2 | 6 → 6 | 2 | eating+sleep | P+I | 6.9 | No | No | 0 | |
| 22 | 0 → 4 | 3 → Ø | 9 → 0 | 144 | Opt+Otm+End+A | anxiety+mood | P+I | 6.3 | OP | cCOC | 0 |
NRS: self-reported 11 points (0–10) numeric rating scale prior to surgery (during the preoperative evaluation period) and at six-months follow-up.
Nonresponders: NRS changed by less than 3 points. Paradoxical response: NRS ↑ by 3 points or more. “de novo” dyspareunia: NRS prior to surgery = 0 and NRS ↑ by 3 points or more. Dysp: deep dyspareunia. Dysm: dysmenorrhea (Ø means not assessed—hormone blockade). PPain: nonmenstrual pelvic pain. NM: nonmenstrual (acyclic). Length of nonmenstrual pelvic pain (in months). Pelvic surgery in the past includes VagHTM: vaginal hysterectomy, Opt: oophoroplasty, Otm: oophorectomy, SubHTM: subtotal hysterectomy, End: endometriosis, A: Arthrodesis (spinal fusion)].
Mental disorders according the International Classification of Diseases published by the World Health Organization; diagnosis was established by a psychologist and/or a psychiatrist. Case 5 was not assessed by a psychologist. The pain disorder of the case 19 includes fibromyalgia. Case 21’s eating disorder is binge eating. Indications of surgery inlcudes P: pain, I: infertility issues. Hormone use (those used in the last 3 months) includes COC: combined estrogen-progestin oral contraceptives (cCOC: continuous). VR: combined estrogen-progestin vaginal ring. IUD: progestin intrauterine device. Goserelin: 10.8 mg goserelin acetate implant (number of injections after surgery). Cases 12 and 22 were the only who underwent long-term postoperative physical therapy as a complementary treatment (the positive outcomes subsequent to the six-month follow-up were not included in this study). No patient required bladder catheterization for more than 2 weeks.