{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:41:51Z","timestamp":1787506911972,"version":"build-2736575974"},"reference-count":83,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T00:00:00Z","timestamp":1745884800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CAPES-PROAP","award":["001\/2021 VPEIC"],"award-info":[{"award-number":["001\/2021 VPEIC"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec027\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endometriosis-related pain duration and burden are associated with poorer psychological well-being and health-related quality of life (HQoLife). This study aimed to compare the relative burdens of 4 different non-menstrual pelvic symptoms on HQoLife: Deep dyspareunia (DDyspareunia), non-menstrual pelvic pain (NMPelvicPain), non-menstrual dyschezia (NMDyschezia) and non-menstrual dysuria (NMDysuria).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec028\">\n                    <jats:title>Subjects and Methods<\/jats:title>\n                    <jats:p>This is a pre-planned cross-sectional interdisciplinary retrospective observational study. The sample consists of 369 consecutive patients referred for minimally invasive surgery at a private institution. DDyspareunia, NMPelvicPain, NMDyschezia and NMDysuria were assessed with a self-reported 11-point (0\u201310) numeric rating scale (NRS). The Short Form 36 (SF36) and Endometriosis Health Profile 30 (EHP30) full questionnaires were applied to assess HQoLife. Multiple linear regression models were used to compare the 4 explanatory variables (correlates), which were tested for 19 different HQoLife domains.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec029\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Multivariate exploratory analyses indicated that NMPelvicPain and NMDyschezia may be the non-menstrual pelvic symptoms that most impact the HQoLife of women with endometriosis, an association that was observed in practically all domains of both the SF36 and the EHP30 questionnaires. DDyspareunia was the most important symptom for the sexual intercourse EHP30 domain. Despite the biological plausibility and statistical significance found in virtually all models, their low explanatory power suggests the existence of additional major covariates (not contemplated in this study). Moreover, the presence of significant positive intercepts (P&lt;0.001) implies that some HQoLife impairment is expected for any hypothetical woman with endometriosis, even if all 4 correlates\u2019 scores are equal to zero. Our findings support the hypothesis that the importance of bowel symptoms has been underestimated in endometriosis assessment whereas the burden of other potential covariates should not be neglected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec030\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>DDyspareunia was the most important non-menstrual pelvic symptoms for the EHP30Sex domain, but NMPelvic Pain and NMDyschezia were the most important for overall HQoLife.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0321922","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T13:43:31Z","timestamp":1745934211000},"page":"e0321922","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Non-menstrual pelvic symptoms and women\u2019s quality of life: a cross-sectional observational study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8568-324X","authenticated-orcid":true,"given":"Marlon de Freitas","family":"Fonseca","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7805-9374","authenticated-orcid":true,"given":"Felipe Ventura","family":"Sessa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio Peixoto","family":"Crispi Jr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilton de Nadai","family":"Filho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3000-7070","authenticated-orcid":true,"given":"Bruna Rafaela Santos","family":"de Oliveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael Ferreira","family":"Garcia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio Peixoto","family":"Crispi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,4,29]]},"reference":[{"issue":"13","key":"pone.0321922.ref001","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1056\/NEJMra1810764","article-title":"Endometriosis","volume":"382","author":"KT Zondervan","year":"2020","journal-title":"N Engl J Med"},{"issue":"6","key":"pone.0321922.ref002","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1016\/S0015-0282(16)53570-5","article-title":"Deeply infiltrating pelvic endometriosis: histology and clinical significance","volume":"53","author":"FJ Cornillie","year":"1990","journal-title":"Fertil Steril"},{"issue":"4","key":"pone.0321922.ref003","doi-asserted-by":"crossref","first-page":"hoab029","DOI":"10.1093\/hropen\/hoab029","article-title":"An international terminology for endometriosis","author":"International Working Group of AAGL, ESGE, ESHRE and WES","year":"2021","journal-title":"Hum Reprod Open"},{"issue":"9","key":"pone.0321922.ref004","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1007\/s00192-017-3531-0","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":"Int Urogynecol J"},{"issue":"5","key":"pone.0321922.ref005","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"},{"key":"pone.0321922.ref006","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1089\/jwh.2017.6432","article-title":"Risk of developing comorbidities among women with endometriosis: a retrospective matched cohort study","volume":"27","author":"ES Surrey","year":"2008","journal-title":"J Womens Health (Larchmt)"},{"issue":"9","key":"pone.0321922.ref007","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1097\/j.pain.0000000000001939","article-title":"The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises","volume":"161","author":"SN Raja","year":"2020","journal-title":"Pain"},{"issue":"3","key":"pone.0321922.ref008","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1017\/S0033291798006667","article-title":"Development of the World Health Organization WHOQOL-BREF quality of life assessment. 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