Evaluation of the association between self-reported pre-operative symptoms with surgically diagnosed endometriosis using the #ENZIAN classification in a multi-centre cohort

Elisabeth Reiser, Hans H. Goebel, Georg Göbel, Alexandra Perricos-Hess, Alexandra Perricos, Olaf Buchweitz, M Jaekel, Matthias Jaekel, E. Westphal, Elisa Westphal, Stefan Rimbach, S. Rimbach, Monika Woelfler, Monika Martina Woelfler, Bernhard Kraemer, Thomas Kolben, Sara Dunja Pempelfort, Daria Pashkunova, Julian Metzler, Julian Matthias Metzler, Răzvan Petru Derihaci, Razvan Petru Derihaci, Petra Klein, Elisabeth Janschek, Philipp Guttenberg, Mathis Wuester, Angelika Wolfrum, Vanadin Seifert-Klauss, Vanadin Seifert‐Klauss, Simon‐Hermann Enzelsberger, Simon-Hermann Enzelsberger, Joerg Keckstein, J. Keckstein, René Wenzl, Rene Wenzl, Beata Seeber
Human Reproduction · 2025 · vol. 40(9) , pp. 1643–1650 · doi:10.1093/humrep/deaf120 · PMID:40682308 · W4412521124
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study found that dyschezia is associated with deep infiltrating endometriosis, while severe dyspareunia is associated with adenomyosis, based on #ENZIAN classification of lesions.

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Abstract

STUDY QUESTION: Is there an association between pre-operative symptoms and intraoperatively described localization and size of endometriosis lesions as assessed by the #ENZIAN classification system? SUMMARY ANSWER: Dyschezia is associated with any deep infiltrating endometriosis (DE) lesions; severe dyspareunia is associated with adenomyosis. WHAT IS KNOWN ALREADY: Previous attempts to correlate the common symptoms of endometriosis to the size and localization of lesions have been of moderate success. STUDY DESIGN, SIZE, DURATION: This prospective, multicentre, non-interventional cross-sectional study was conducted between September 2022 and January 2024 at 18 endometriosis centres in Austria, Germany, and Switzerland, enrolling a total of 838 patients with endometriosis. PARTICIPANTS/MATERIALS, SETTING, METHODS: The study included 521 patients with complete information on pre-operative symptoms and intraoperatively diagnosed endometriosis classified by the #ENZIAN classification system. Associations between symptoms and localization of endometriosis lesions were analysed. MAIN RESULTS AND THE ROLE OF CHANCE: Nearly all patients (n = 513) (98.5%) suffered from dysmenorrhea whereas 294 (56.4%), 208 (39.9%), and 102 (19.6%) patients reported dyspareunia, dyschezia, and dysuria, respectively. Dyspareunia rated as ≥8 on a visual analogue scale was reported 3.5-fold more often in patients with adenomyosis only (OR 3.56 [1.38-9.17]) than in those without, while dyschezia was almost twice as likely in those with any form of DE (OR 1.86 [1.3-2.65]). LIMITATIONS, REASONS FOR CAUTION: A larger study population is needed to clinically define relevant sub-groups based on localization of lesions. WIDER IMPLICATIONS OF THE FINDINGS: The findings of the present study identify adenomyosis as a strong driver of pain, especially dyspareunia, making awareness of its high prevalence of utmost importance. Few direct associations between symptoms and lesions were identified. Endometriosis-related symptoms, especially when chronic, are multi-factorial and cannot be readily correlated to specific lesion sites. STUDY FUNDING/COMPETING INTEREST(S): This study received no external funding and all the authors declare they have no conflicts of interest pertaining to this study. TRIAL REGISTRATION NUMBER: Clinical Trials NCT05624567.

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Outcome instruments

VAS-pain MUSA rASRM Enzian

Condition tags

mesh:D004412mesh:D004414mesh:D004715mesh:D017699endometriosisadenomyosisdie_deep_infiltratingdysmenorrheadyspareunia

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (23)

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