{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T22:26:55Z","timestamp":1789165615079,"version":"build-2803163510"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,7,19]],"date-time":"2025-07-19T00:00:00Z","timestamp":1752883200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>STUDY QUESTION<\/jats:title>\n                  <jats:p>Is there an association between pre-operative symptoms and intraoperatively described localization and size of endometriosis lesions as assessed by the #ENZIAN classification system?<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>SUMMARY ANSWER<\/jats:title>\n                  <jats:p>Dyschezia is associated with any deep infiltrating endometriosis (DE) lesions; severe dyspareunia is associated with adenomyosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>WHAT IS KNOWN ALREADY<\/jats:title>\n                  <jats:p>Previous attempts to correlate the common symptoms of endometriosis to the size and localization of lesions have been of moderate success.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>STUDY DESIGN, SIZE, DURATION<\/jats:title>\n                  <jats:p>This prospective, multicentre, non-interventional cross-sectional study was conducted between September 2022 and January 2024 at 18 endometriosis centres in Austria, Germany, and Switzerland, enrolling a total of 838 patients with endometriosis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PARTICIPANTS\/MATERIALS, SETTING, METHODS<\/jats:title>\n                  <jats:p>The study included 521 patients with complete information on pre-operative symptoms and intraoperatively diagnosed endometriosis classified by the #ENZIAN classification system. Associations between symptoms and localization of endometriosis lesions were analysed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>MAIN RESULTS AND THE ROLE OF CHANCE<\/jats:title>\n                  <jats:p>Nearly all patients (n\u2009=\u2009513) (98.5%) suffered from dysmenorrhea whereas 294 (56.4%), 208 (39.9%), and 102 (19.6%) patients reported dyspareunia, dyschezia, and dysuria, respectively. Dyspareunia rated as \u22658 on a visual analogue scale was reported 3.5-fold more often in patients with adenomyosis only (OR 3.56 [1.38\u20139.17]) than in those without, while dyschezia was almost twice as likely in those with any form of DE (OR 1.86 [1.3\u20132.65]).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>LIMITATIONS, REASONS FOR CAUTION<\/jats:title>\n                  <jats:p>A larger study population is needed to clinically define relevant sub-groups based on localization of lesions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>WIDER IMPLICATIONS OF THE FINDINGS<\/jats:title>\n                  <jats:p>The findings of the present study identify adenomyosis as a strong driver of pain, especially dyspareunia, making awareness of its high prevalence of utmost importance. Few direct associations between symptoms and lesions were identified. Endometriosis-related symptoms, especially when chronic, are multi-factorial and cannot be readily correlated to specific lesion sites.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>STUDY FUNDING\/COMPETING INTEREST(S)<\/jats:title>\n                  <jats:p>This study received no external funding and all the authors declare they have no conflicts of interest pertaining to this study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>TRIAL REGISTRATION NUMBER<\/jats:title>\n                  <jats:p>Clinical Trials NCT05624567.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/humrep\/deaf120","type":"journal-article","created":{"date-parts":[[2025,7,19]],"date-time":"2025-07-19T06:44:00Z","timestamp":1752907440000},"page":"1643-1650","source":"Crossref","is-referenced-by-count":9,"title":["Evaluation of the association between self-reported pre-operative symptoms with surgically diagnosed endometriosis using the #ENZIAN classification in a multi-centre cohort"],"prefix":"10.1093","volume":"40","author":[{"given":"Elisabeth","family":"Reiser","sequence":"first","affiliation":[{"name":"Department of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Innsbruck , Innsbruck,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"G\u00f6bel","sequence":"additional","affiliation":[{"name":"Institute of Clinical Epidemiology, Public Health, Health Economics, Medical Statistics and Informatics, Medical University of Innsbruck , Innsbruck,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Perricos-Hess","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Medical University of Vienna , Vienna,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olaf","family":"Buchweitz","sequence":"additional","affiliation":[{"name":"Frauenklinik an der Elbe, Center of Surgical Endoscopy and Endometriosis , Hamburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Jaekel","sequence":"additional","affiliation":[{"name":"Frauenklinik an der Elbe, Center of Surgical Endoscopy and Endometriosis , Hamburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Westphal","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Agatharied Hospital , Hausham,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Rimbach","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Agatharied Hospital , Hausham,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Woelfler","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, University Hospital Graz , Graz,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Kraemer","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, University Hospital for Women , Tuebingen,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Kolben","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, LMU University Hospital, LMU Munich , Munich,","place":["Germany"]},{"name":"Gyn-Munich Gynecologic Surgery , Munich,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara Dunja","family":"Pempelfort","sequence":"additional","affiliation":[{"name":"Wiener Gsundheitsverbund, 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