{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T15:25:28Z","timestamp":1791991528935,"version":"4.4.0"},"reference-count":27,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Endometriosis is a chronic inflammatory disease with a heterogeneous clinical presentation, in which pain represents the predominant symptom. The association between pain severity and intraoperative disease stage remains unclear, particularly with regard to the rASRM and #ENZIAN classifications. This study aimed to evaluate the relationship between pain intensity at different anatomical sites and the stage of endometriosis according to the rASRM and #ENZIAN systems. Methods: A total of 138 patients with advanced endometriosis undergoing surgical treatment between May 2024 and August 2025 were included. Pain intensity was assessed using a 10-point Numerical Rating Scale (NRS) for pelvic pain, pain during defecation, pain during micturition, and pain during or after sexual intercourse. The stage of endometriosis was evaluated intraoperatively according to the rASRM and #ENZIAN classifications. Non-parametric statistical tests and Spearman\u2019s rank correlation coefficient were applied. A p-value &lt; 0.05 was considered statistically significant. Results: No significant correlation was found between overall pelvic pain intensity and disease stage according to the rASRM classification. However, significant differences in pain during micturition were observed depending on rASRM stage (p = 0.004). In the #ENZIAN-based analysis, significant associations were identified between selected anatomical areas and specific pain symptoms, particularly pain during micturition, defecation, and sexual intercourse. Conclusions: Pain severity in advanced endometriosis does not consistently correlate with overall disease stage according to rASRM. The anatomical localization of lesions defined by the #ENZIAN classification may better reflect the type and distribution of pain symptoms. These findings should be interpreted in the context of a selected cohort of surgically treated patients with advanced disease and may not be generalizable to patients with milder or non-surgically managed endometriosis.<\/jats:p>","DOI":"10.3390\/jcm15072725","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T02:06:21Z","timestamp":1775441181000},"page":"2725","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Correlation Between Pain Intensity in Different Locations and Intraoperative Stage of Endometriosis According to rASRM and #ENZIAN Classification"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3813-137X","authenticated-orcid":false,"given":"Krzysztof","family":"Przy\u015bliwski","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences and Psychology, University Center for Research and Development in Health Sciences, Collegium Medicum, University of Rzeszow, 35-310 Rzesz\u00f3w, Poland"},{"name":"Medicover Wilan\u00f3w Hospital, Medicover Healthcare Services, 02-972 Warszawa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Pliszkiewicz","sequence":"additional","affiliation":[{"name":"Medicover Wilan\u00f3w Hospital, Medicover Healthcare Services, 02-972 Warszawa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Jacko","sequence":"additional","affiliation":[{"name":"Medicover Wilan\u00f3w Hospital, Medicover Healthcare Services, 02-972 Warszawa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8816-0290","authenticated-orcid":false,"given":"Anna","family":"Bogaczyk","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Gynecology Oncology and Obstetrics, Faculty of Medicine, University of Rzeszow, 35-959 Rzesz\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogumi\u0142 Pawe\u0142","family":"Siekierski","sequence":"additional","affiliation":[{"name":"Medicover Wilan\u00f3w Hospital, Medicover Healthcare Services, 02-972 Warszawa, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4798-3986","authenticated-orcid":false,"given":"Tomasz","family":"Kluz","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Gynecology Oncology and Obstetrics, Faculty of Medicine, University of Rzeszow, 35-959 Rzesz\u00f3w, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/S0140-6736(21)00389-5","article-title":"Endometriosis is a chronic systemic disease: Clinical challenges and novel innovations","volume":"397","author":"Taylor","year":"2021","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Poordast, T., Alborzi, S., Askary, E., Tavabe, M.S., Najib, F.S., Salehi, A., Vardanjani, H.M., Haghighat, N., and Leilami, K. (2022). Comparing the quality of life of endometriotic patients\u2019 before and after treatment with normal and infertile patients based on the EHP30 questionnaire. BMC Womens Health, 22.","DOI":"10.1186\/s12905-022-02052-x"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1007\/s13669-017-0187-1","article-title":"Endometriosis: Epidemiology, Diagnosis and Clinical Management","volume":"6","author":"Parasar","year":"2017","journal-title":"Curr. Obstet. Gynecol. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Shen, D., Li, J., Hu, P.W., Qi, C., and Yang, H. (2024). Global, regional, and national prevalence and disability-adjusted life-years for endometriosis in 204 countries and territories, 1990\u20132019: Findings from a global burden of disease study. Res. Sq., preprint.","DOI":"10.21203\/rs.3.rs-3857347\/v1"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e070750","DOI":"10.1136\/bmj-2022-070750","article-title":"Pathophysiology, diagnosis, and management of endometriosis","volume":"379","author":"Horne","year":"2022","journal-title":"BMJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1196\/annals.1434.007","article-title":"Endometriosis and infertility: Epidemiology and evidence-based treatments","volume":"1127","author":"Ozkan","year":"2008","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_7","first-page":"e28864","article-title":"Endometriosis: A Review of Clinical Diagnosis, Treatment, and Pathogenesis","volume":"14","author":"Chauhan","year":"2022","journal-title":"Cureus"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.bpobgyn.2004.01.007","article-title":"Endometriosis: Epidemiology and aetiological factors","volume":"18","author":"Parazzini","year":"2004","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e20230316","DOI":"10.1590\/1806-9282.20230316","article-title":"Improved quality of life (EHP-30) in patients with endometriosis after surgical treatment","volume":"69","author":"Melo","year":"2023","journal-title":"Rev. Assoc. Med. Bras."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"hoab042","DOI":"10.1093\/hropen\/hoab042","article-title":"Health-related quality of life in women with endometriosis: Psychometric validation of the Endometriosis Health Profile 30 questionnaire using confirmatory factor analysis","volume":"2022","author":"Hansen","year":"2021","journal-title":"Hum. Reprod. Open"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"131","DOI":"10.52054\/FVVO.15.2.079","article-title":"Validation of the Turkish version of Endometriosis Health Profile questionnaire (EHP-30) to evaluate the quality of life in women with endometriosis","volume":"15","author":"Darici","year":"2023","journal-title":"Facts Views Vis. Obgyn"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/1757-2215-5-29","article-title":"Health-related quality of life in women with endometriosis: A systematic review","volume":"5","author":"Jia","year":"2012","journal-title":"J. Ovarian Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1093\/humupd\/dmt027","article-title":"The social and psychological impact of endometriosis on women\u2019s lives: A critical narrative review","volume":"19","author":"Culley","year":"2013","journal-title":"Hum. Reprod. Update"},{"key":"ref_14","first-page":"68","article-title":"Quality of life in women with endometriosis: A narrative overview","volume":"111","author":"Barra","year":"2020","journal-title":"Minerva Medica"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.ogc.2012.10.002","article-title":"Endometriosis and infertility: A review of the pathogenesis and treatment of endometriosis-associated infertility","volume":"39","author":"Macer","year":"2012","journal-title":"Obstet. Gynecol. Clin. N. Am."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"100164","DOI":"10.1016\/j.mocell.2024.100164","article-title":"Female reproductive disease, endometriosis: From inflammation to infertility","volume":"48","author":"Park","year":"2025","journal-title":"Mol. Cells"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Della Corte, L., Di Filippo, C., Gabrielli, O., Reppuccia, S., La Rosa, V.L., Ragusa, R., Fichera, M., Commodari, E., Bifulco, G., and Giampaolino, P. (2020). The Burden of Endometriosis on Women\u2019s Lifespan: A Narrative Overview on Quality of Life and Psychosocial Wellbeing. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17134683"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1093\/humrep\/deae298","article-title":"Association between endometriosis and working life among Danish women","volume":"40","author":"Josiasen","year":"2025","journal-title":"Hum. Reprod."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1093\/humrep\/des073","article-title":"The burden of endometriosis: Costs and quality of life of women with endometriosis and treated in referral centres","volume":"27","author":"Simoens","year":"2012","journal-title":"Hum. Reprod."},{"key":"ref_20","unstructured":"G\u00f3rniak, K., and \u0141ucyan, M. (2025). Taka Twoja Uroda. Jak Endometrioza Niszczy \u017bycie Polek, Znak Horyzont."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1177\/22840265241248488","article-title":"Endometriosis and stigmatization: A literature review","volume":"16","author":"Tragantzopoulou","year":"2024","journal-title":"J. Endometr. Pelvic Pain Disord."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Szyp\u0142owska, M., Tarkowski, R., and Ku\u0142ak, K. (2023). The impact of endometriosis on depressive and anxiety symptoms and quality of life: A systematic review. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1230303"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1515\/sjpain-2018-0012","article-title":"The validity of pain intensity measures: What do the NRS, VAS, VRS, and FPS-R measure?","volume":"18","author":"Thong","year":"2018","journal-title":"Scand. J. Pain"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.ejogrb.2021.06.035","article-title":"Structured report for dynamic ultrasonography in patients with suspected or known endometriosis: Recommendations of the International Society for Gynecologic Endoscopy (ISGE)","volume":"263","author":"Djokovic","year":"2021","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.bpobgyn.2020.11.004","article-title":"Classification of deep endometriosis (DE) including bowel endometriosis: From r-ASRM to #Enzian-classification","volume":"71","author":"Keckstein","year":"2021","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1056\/NEJMra1810764","article-title":"Endometriosis","volume":"382","author":"Zondervan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"hoac009","DOI":"10.1093\/hropen\/hoac009","article-title":"ESHRE guideline: Endometriosis","volume":"2022","author":"Becker","year":"2022","journal-title":"Hum. Reprod. Open"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2725\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T11:59:09Z","timestamp":1775649549000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/7\/2725"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,3]]},"references-count":27,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["jcm15072725"],"URL":"https:\/\/doi.org\/10.3390\/jcm15072725","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,3]]}}}