{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T03:09:20Z","timestamp":1792465760249,"version":"4.5.0"},"reference-count":60,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T00:00:00Z","timestamp":1619136000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006507","name":"Funda\u00e7\u00e3o Oswaldo Cruz","doi-asserted-by":"publisher","award":["001\/2021 VPEIC \/ Fiocruz"],"award-info":[{"award-number":["001\/2021 VPEIC \/ Fiocruz"]}],"id":[{"id":"10.13039\/501100006507","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Study objective<\/jats:title><jats:p>To assess individual changes of deep dyspareunia (DDyspareunia) six months after laparoscopic nerve-sparing complete excision of endometriosis, with or without robotic assistance.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>This preplanned interdisciplinary observational study with a retrospective analysis of intervention enrolled 126 consecutive women who underwent surgery between January 2018 and September 2019 at a private specialized center. Demographics, medical history and surgery details were recorded systematically. DDyspareunia (primary outcome), dysmenorrhea and acyclic pelvic pain were assessed on self-reported 11-point numeric rating scales both preoperatively and at six-month follow-up. Cases with poor prognosis in relation to dyspareunia were described individually in greater detail.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>Preoperative DDyspareunia showed weak correlation with dysmenorrhea (rho = .240; P = .014) and pelvic pain (rho = .260; P = .004). Although DDyspareunia improved significantly (P &lt; .001) by 3 points or more in 75.8% (95%CI: 64.7\u201386.2) and disappeared totally in 59.7% of cases (95%CI:47.8\u201371.6), individual analysis identified different patterns of response. The probability of a preoperative moderate\/severe DDyspareunia worsening more than 2 points was 4.8% (95%CI: 0.0\u201310.7) and the probability of a woman with no DDyspareunia developing \u201cde novo\u201d moderate or severe DDyspareunia was 7.7% (95%CI: 1.8\u201315.8) and 5.8% (95%CI: 0.0\u201313.0), respectively. In a qualitative analysis, several conditions were hypothesized to impact the post-operative DDyspareunia response; these included adenomyosis, mental health disorders, lack of hormone therapy after surgery, colporrhaphy, nodule excision in ENZIAN B compartment (uterosacral ligament\/parametrium), the rectovaginal septum or the retrocervical region.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>Endometriosis surgery provides significant improvement in DDyspareunia. However, patients should be alerted about the possibility of unsatisfactory results.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0250046","type":"journal-article","created":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T18:03:12Z","timestamp":1619200992000},"page":"e0250046","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Six-month follow-up of minimally invasive nerve-sparing complete excision of endometriosis: What about dyspareunia?"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4371-4754","authenticated-orcid":true,"given":"Claudio Peixoto","family":"Crispi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio Peixoto","family":"Crispi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruna Rafaela Santos","family":"de Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilton","family":"de Nadai Filho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando Maia","family":"Peixoto-Filho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlon de Freitas","family":"Fonseca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,4,23]]},"reference":[{"issue":"5","key":"pone.0250046.ref001","doi-asserted-by":"crossref","first-page":"605","DOI":"10.5468\/ogs.2018.61.5.605","article-title":"Interrelationships among endometriosis-related pain symptoms and their effects on health-related quality of life: a sectional observational study","volume":"61","author":"M de Freitas Fonseca","year":"2018","journal-title":"Obstet Gynecol Sci"},{"issue":"9","key":"pone.0250046.ref002","first-page":"1349","article-title":"Urodynamic observations and lower urinary tract symptoms associated with endometriosis: a prospective cross-sectional observational study assessing women with deep infiltrating disease","volume":"29","author":"JAD de Resende J\u00fanior","year":"2018","journal-title":"IntUrogynecol J"},{"issue":"3","key":"pone.0250046.ref003","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1093\/humupd\/dmv003","article-title":"Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management","volume":"21","author":"MS Abr\u00e3o","year":"2015","journal-title":"Hum Reprod Update"},{"key":"pone.0250046.ref004","first-page":"S1553","article-title":"Surgical Decision Regret in Women Pursuing Surgery for Endometriosis or Chronic Pelvic Pain","author":"M Misal","year":"2020","journal-title":"J Minim Invasive Gynecol"},{"issue":"3","key":"pone.0250046.ref005","first-page":"357","article-title":"Endom\u00e9triose profonde et infertilit\u00e9, RPC Endom\u00e9triose CNGOF-HAS [Deeply infiltrating endometriosis and infertility: CNGOF-HAS Endometriosis Guidelines]","volume":"46","author":"E Mathieu d\u2019Argent","year":"2018","journal-title":"Gynecol Obstet Fertil Senol"},{"issue":"1","key":"pone.0250046.ref006","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1002\/nau.22915","article-title":"Risk of urinary retention after nerve-sparing surgery for deep infiltrating endometriosis: A systematic review and meta-analysis","volume":"36","author":"JA J\u00fanior de Resende","year":"2017","journal-title":"Neurourol Urodyn"},{"key":"pone.0250046.ref007","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.bpobgyn.2015.11.002","article-title":"Bowel complications in endometriosis surgery","volume":"35","author":"MA Oliveira","year":"2016","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"issue":"1","key":"pone.0250046.ref008","doi-asserted-by":"crossref","first-page":"hoaa002","DOI":"10.1093\/hropen\/hoaa002","article-title":"Recommendations for the surgical treatment of endometriosis. 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