{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T15:11:21Z","timestamp":1778425881733,"version":"3.51.4"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dyspareunia is a common symptom in women with endometriosis, yet its positional dependency is not routinely assessed in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To investigate the relationship between endometriosis and positional dyspareunia, identifying the most painful sexual positions and correlating them with lesion location.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective monocentric study, women with dyspareunia aged 18 or older undergoing laparoscopic surgery for endometriosis were recruited. Participants completed a preoperative questionnaire assessing dyspareunia and positional dependency. Intraoperative findings were coded according to the Enzian classification. Data were analyzed using descriptive statistics and Fisher\u2019s exact test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>The primary outcomes were the prevalence of positional dyspareunia, identification of the most painful sexual positions, and their correlation with lesion location.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 531 patients screened, 111 met inclusion criteria and 71 completed the study. Endometriosis was histologically confirmed in all participants. 83.1% complained of deep dyspareunia, 7% of superficial dyspareunia, and 9.9% of both. Positional dyspareunia was reported by 68.3% (95%CI, 55.8 to 78.7) of participants, with the doggy style position being the most frequently reported as most painful. Positional dyspareunia was significantly associated with endometriosis cysts on the left ovary (n\u00a0=\u200917\/18; P\u00a0=\u20090.005) and showed a tendency toward association with deep endometriosis of the rectum. No clear link was found between lesion location and avoidance of sexual intercourse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Implications<\/jats:title>\n                    <jats:p>The findings highlight the need for clinicians to address positional dyspareunia during evaluations and suggest exploring alternative sexual positions as a coping strategy. Standardized questionnaires should be updated to include positional aspects of dyspareunia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Strength &amp; Limitations<\/jats:title>\n                    <jats:p>Strengths include prospectively collected data and the study\u2019s conduction in a certified endometriosis center. Limitations include a small sample size, and the exclusion of psychological factors like anxiety and depression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Positional dependency in dyspareunia is highly prevalent among women with endometriosis, highlighting the need for awareness in clinical evaluations, as standardized questionnaires like Female Sexual Function Index and Endometriosis Health Profile-30 do not address this aspect. Further research is needed to explore alternative sexual positions and their effectiveness in mitigating dyspareunia. Avoidance of sexual intercourse may not be solely linked to the extent or location of endometriosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration<\/jats:title>\n                    <jats:p>DRKS - German Clinical Trials Register, ID: DRKS00023833, https:\/\/www.drks.de\/search\/de\/trial\/DRKS00023833<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jsxmed\/qdaf296","type":"journal-article","created":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T11:48:39Z","timestamp":1759578519000},"source":"Crossref","is-referenced-by-count":1,"title":["Painful Sexual poSiTions in endometriosis patients (the PSST! Study): a prospective cohort study"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3487-4561","authenticated-orcid":false,"given":"Simon-Hermann","family":"Enzelsberger","sequence":"first","affiliation":[{"name":"Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz , 4020 Linz ,","place":["Austria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Oppelt","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz , 4020 Linz ,","place":["Austria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nina","family":"Brandstetter","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz , 4020 Linz ,","place":["Austria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaus","family":"Fadinger","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz , 4020 Linz ,","place":["Austria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sorush","family":"Ghannadan","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz , 4020 Linz ,","place":["Austria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip Sebastian","family":"Trautner","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Johannes Kepler University Linz , 4020 Linz ,","place":["Austria"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"issue":"1","key":"2026010506141229200_ref1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.sxmr.2018.12.007","article-title":"Deep dyspareunia: review of pathophysiology and proposed future research priorities","volume":"8","author":"Orr","year":"2020","journal-title":"Sex Med Rev"},{"issue":"3","key":"2026010506141229200_ref2","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1016\/j.esxm.2018.04.006","article-title":"Deep dyspareunia and sexual quality of life in women with endometriosis","volume":"6","author":"Shum","year":"2018","journal-title":"Sex Med"},{"issue":"3","key":"2026010506141229200_ref3","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1016\/j.esxm.2020.06.004","article-title":"Endometriosis and sexual quality of life","volume":"8","author":"van Poll","year":"2020","journal-title":"Sex Med"},{"issue":"3","key":"2026010506141229200_ref4","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1007\/s00404-023-07205-3","article-title":"\"the sound of silence\" giving voice to endometriosis-related positional dyspareunia","volume":"309","author":"Merli","year":"2024","journal-title":"Arch Gynecol Obstet"},{"issue":"7225","key":"2026010506141229200_ref5","doi-asserted-by":"publisher","first-page":"1596","DOI":"10.1136\/bmj.319.7225.1596","article-title":"Magnetic resonance imaging of male and female genitals during coitus and female sexual arousal","volume":"319","author":"Schultz","year":"1999","journal-title":"BMJ."},{"issue":"5","key":"2026010506141229200_ref6","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1080\/713846807","article-title":"Magnetic resonance imaging of sexual intercourse: initial experience","volume":"27","author":"Faix","year":"2001","journal-title":"J Sex Marital Ther"},{"issue":"Suppl 1","key":"2026010506141229200_ref7","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1080\/00926230252851203","article-title":"Magnetic resonance imaging (MRI) of sexual intercourse: second experience in missionary position and initial experience in posterior position","volume":"28","author":"Faix","year":"2002","journal-title":"J Sex Marital Ther"},{"issue":"1","key":"2026010506141229200_ref8","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1002\/uog.24786","article-title":"Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure","volume":"60","author":"","year":"2022","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"9596","key":"2026010506141229200_ref9","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet."},{"key":"2026010506141229200_ref10","first-page":"100224","article-title":"Endometriosis and dyspareunia: solving the enigma","volume":"19","author":"Jimenez","year":"2023","journal-title":"Eur J Obstet Gynecol Reprod Biol X"},{"issue":"3","key":"2026010506141229200_ref11","doi-asserted-by":"publisher","first-page":"1397","DOI":"10.1007\/s10508-021-02246-8","article-title":"What are the physical demands of sexual intercourse? A systematic review of the literature","volume":"51","author":"Oliva-Lozano","year":"2022","journal-title":"Arch Sex Behav"},{"issue":"6","key":"2026010506141229200_ref12","doi-asserted-by":"publisher","first-page":"509","DOI":"10.18502\/ijrm.v21i6.13638","article-title":"Effects of sensate focus technique and position changing on sexual function of women with deep-infiltrating endometriosis after surgery: a clinical trial study","volume":"21","author":"Tajik","year":"2023","journal-title":"Int J Reprod Biomed"},{"issue":"6","key":"2026010506141229200_ref13","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1016\/j.jsxm.2018.03.087","article-title":"Does endometriosis affect sexual activity and satisfaction of the man partner? A comparison of partners from women diagnosed with endometriosis and controls","volume":"15","author":"Hammerli","year":"2018","journal-title":"J Sex Med"},{"issue":"9","key":"2026010506141229200_ref14","doi-asserted-by":"publisher","first-page":"1764","DOI":"10.1111\/aogs.14921","article-title":"Lesion size and location in deep infiltrating bowel endometriosis: correlation with gastrointestinal dysfunction and pain","volume":"103","author":"Pashkunova","year":"2024","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2026010506141229200_ref15","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.srhc.2017.12.005","article-title":"Evaluation of sexual function in women with deep infiltrating endometriosis","volume":"16","author":"Cozzolino","year":"2018","journal-title":"Sex Reprod Healthc"},{"issue":"4","key":"2026010506141229200_ref16","doi-asserted-by":"publisher","first-page":"2091","DOI":"10.1007\/s00404-024-07643-7","article-title":"Painful sexual intercourse, quality of life and sexual function in patients with endometriosis: not just deep dyspareunia","volume":"310","author":"Del Forno","year":"2024","journal-title":"Arch Gynecol Obstet"},{"issue":"4","key":"2026010506141229200_ref17","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1093\/sxmrev\/qead033","article-title":"Neuroproliferative dyspareunia in endometriosis and vestibulodynia","volume":"11","author":"Mwaura","year":"2023","journal-title":"Sex Med Rev"},{"issue":"10","key":"2026010506141229200_ref18","doi-asserted-by":"publisher","first-page":"2677","DOI":"10.1093\/humrep\/det284","article-title":"The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional survey","volume":"28","author":"De Graaff","year":"2013","journal-title":"Hum Reprod"},{"key":"2026010506141229200_ref19","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1002\/uog.29150","article-title":"Impact of deep or ovarian endometriosis on pelvic pain and quality of life: prospective cross-sectional ultrasound study","volume":"65","author":"Chaggar","year":"2025","journal-title":"Ultrasound Obst Gyn"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jsm\/advance-article-pdf\/doi\/10.1093\/jsxmed\/qdaf296\/65044276\/qdaf296.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/advance-article-pdf\/doi\/10.1093\/jsxmed\/qdaf296\/65044276\/qdaf296.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T11:14:16Z","timestamp":1767611656000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/doi\/10.1093\/jsxmed\/qdaf296\/8307081"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,5]]}},"URL":"https:\/\/doi.org\/10.1093\/jsxmed\/qdaf296","relation":{},"ISSN":["1743-6095","1743-6109"],"issn-type":[{"value":"1743-6095","type":"print"},{"value":"1743-6109","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1]]},"published":{"date-parts":[[2025,10,31]]},"article-number":"qdaf296"}}