{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T03:04:05Z","timestamp":1780628645406,"version":"3.54.1"},"reference-count":44,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background\/Objectives: This study evaluates the 1-year follow-up outcomes after minimally invasive nerve-sparing surgery for the complete excision of deep endometriosis (DE), with a specific focus on deep dyspareunia. Cases with undesirable outcomes were explored in detail to better understand the evolution of this cornerstone endometriosis-related symptom. This approach supports personalized medicine initiatives by seeking to stratify patients into likely surgical responders and non-responders. Methods: This is an interdisciplinary retrospective observational study assessing 195 consecutive cases. Inclusion criteria comprised women with an established diagnosis of DE who had been sexually active in the 6 months prior to surgery. Because pregnancy and postpartum can interfere with the longitudinal assessment of deep dyspareunia, women in these phases during follow-up were excluded. Additionally, individuals who had not been sexually active in the preceding 6 months for reasons unrelated to deep dyspareunia were excluded. Deep dyspareunia was measured using an 11-point (0\u201310) self-reported Numerical Rating Scale (NRS). Hierarchical clusters were established based on preoperative scores: NONE (NRS = 0), MILD (1 \u2264 NRS \u2264 3), MODERATE (4 \u2264 NRS \u2264 6), and SEVERE (NRS \u2265 7). Results: In the SEVERE cluster, 82.2% (95% CI: 72.4\u201392.0) of women improved by \u22653 points. In the NONE cluster, 70.1% (95% CI: 60.3\u201379.2) remained asymptomatic. Although improvements in deep dyspareunia were statistically significant across the total sample, individual trajectories were not uniform; the response was considered undesirable in 34 cases (17.4%; 95% CI: 12.1\u201322.8). The frequency of preoperatively asymptomatic women (NRS = 0) developing De Novo deep dyspareunia (NRS \u2265 3) at the 1-year follow-up was estimated at 14.9% (95% CI: 8.0\u201322.7). These results highlight the marked phenotypic and clinical heterogeneity in patient trajectories and the inherent unpredictability of adverse responses. Conclusions: Postoperative pain outcomes likely result from a complex interplay among surgical, myofascial, neurological, psychological, inflammatory, and hormonal factors. While surgery remains an effective and safe approach for treating pain, our findings underscore that even preoperatively asymptomatic patients should receive targeted counseling regarding the unexpected risk of developing postoperative deep dyspareunia.<\/jats:p>","DOI":"10.3390\/jpm16060307","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T01:23:21Z","timestamp":1780622601000},"page":"307","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Deep Dyspareunia One Year After Nerve-Sparing Endometriosis Surgery: An Observational Study Highlighting Undesirable Outcomes"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5250-6578","authenticated-orcid":false,"given":"Nilton","family":"de Nadai Filho","sequence":"first","affiliation":[{"name":"Department of Women\u2019s Health\u2014Fernandes Figueira National Institute for Women, Children and Youth Health\u2014Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4371-4754","authenticated-orcid":false,"suffix":"Jr.","given":"Claudio Peixoto","family":"Crispi","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s Health\u2014Fernandes Figueira National Institute for Women, Children and Youth Health\u2014Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3000-7070","authenticated-orcid":false,"given":"Bruna Rafaela","family":"Santos de Oliveira","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s Health\u2014Fernandes Figueira National Institute for Women, Children and Youth Health\u2014Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio Peixoto","family":"Crispi","sequence":"additional","affiliation":[{"name":"Crispi Institute for Minimally Invasive Surgery; Rio de Janeiro 22640-102, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8568-324X","authenticated-orcid":false,"given":"Marlon de Freitas","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s Health\u2014Fernandes Figueira National Institute for Women, Children and Youth Health\u2014Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1056\/NEJMra1810764","article-title":"Endometriosis","volume":"382","author":"Zondervan","year":"2020","journal-title":"N. 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