Obstet Gynecol Sci.  2018 Sep;61(5):605-614. 10.5468/ogs.2018.61.5.605.

Interrelationships among endometriosis-related pain symptoms and their effects on health-related quality of life: a sectional observational study

  • 1Departments of Gynecology and Anesthesia, Fernandes Figueira National Institute for Women, Children and Youth Health (IFF), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. marlon@iff.fiocruz.br, marlon.iff@gmail.com
  • 2Crispi Institute of Minimally Invasive Surgery, Rio de Janeiro, Brazil.
  • 3Department of Urology, Lagoa Federal Hospital, Rio de Janeiro, Brazil.
  • 4Department of Urology, Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil.


To assess the correlation between different pain symptoms and different domains of women's health-related quality of life (HRQoL).
Seventy-seven women with deep infiltrating endometriosis were successively enrolled between June 2011 and August 2013 while being prepared to undergo laparoscopy due to pain and/or infertility. We quantified the intensities of dysmenorrhea, deep dyspareunia, chronic pelvic pain, and dyschezia (menstrual and non-menstrual) using a 11-point visual analog scale (VAS: 0-10) and the validated full versions of the Short Form 36 (SF36) and Endometriosis Health Profile (EHP30) questionnaires to assess HRQoL. The pain symptoms were considered simultaneously in a hierarchical agglomerative clustering method (exploratory multivariate approach) and the associations among scores were tested by bivariate correlation.
Dysmenorrhea showed the lowest similarity on to the multivariate cluster analysis and no statistically significant correlation with the other pain symptoms: deep dyspareunia (P=0.244), chronic pelvic pain (P=0.108), menstrual dyschezia (P=0.238), and non-menstrual dyschezia (P=0.380). Dysmenorrhea and chronic pelvic pain were the main symptoms correlated with all domains of the SF36 and the EHP30 (core instrument) questionnaires (P < 0.05).
Dysmenorrhea and chronic pelvic pain were independent factors associated with HRQoL.


Dysmenorrhea; Dyspareunia; Dyschezia; Pelvic pain; Woman's health

MeSH Terms

Observational Study*
Pelvic Pain
Quality of Life*
Visual Analog Scale
Women's Health


  • Fig. 1 Dendrogram of hierarchical agglomerative clustering analysis using average linkage to group variables based on squared Euclidean distance (n=77). The ratio of the rescaled distances (z-score) is the same as the ratio of the original distances.

  • Fig. 2 Boxplot showing scores (quartiles) of the different health-related quality of life scales: Short Form 36 (SF36; 0 represents the worst health status) and Endometriosis Health Profile (EHP30; 0 represents the best health status). SF36 domains: Physical Functioning (PF), Physical-Role Functioning (PRF), Bodily-Pain (BPain), General Health Perception (GHP), Vitality (VIT), Social-Role Functioning (SRF), Emotional-Role Functioning (ERF), and Mental Health (MH). EHP30 core instrument: Pain, Control and Powerlessness (CP), Social Support (SS), Emotional Well-Being (EWB), and Self-Image (SI). EHP30 supplementary optional modules: Work, Sexual Relationship (SR), Feelings About Medical Profession (FAMP), Feelings About Treatment (FAT), and Feelings About Infertility (FAI). EHP-30 Relationship with Child/Children domain was not assessed due to the major prevalence of nulliparous women (62.2%; 95% confidence interval, 52.2–76.1).


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