Design: Cross-sectional

Setting: Two tertiary hospitals in São Paulo

Patients or Participants: A total of 1116 reproductive-age patients undergoing videolaparoscopy for endometriosis treatment with histological confirmation between 2009 and 2019.

Interventions: Data were prospectively collected on the Redcap platform during pre-operative consultations. Painful symptoms were assessed ranging from 0 to 10 and categorized as mild-moderate pain symptoms (score <7) and severe pain symptoms (score ≥7). Endometriosis location and symptoms were evaluated using Multiple Correspondence Analysis (MCA), with perceptual maps generated using the Burt matrix and squared cosine (Cos²).

Measurements and Main Results: Among the participants, 76.52% reported severe dysmenorrhea, 44.17% severe dyspareunia, 36.65% severe acyclic pelvic pain, 31.81% severe dyschezia, 10.30% severe dysuria, and 41.93% infertility. The locations of endometriosis lesions were retrocervical in 75.0%, peritoneum in 64.60%, and rectosigmoid in 47.40% of cases. The majority had deep endometriosis (83.7%) and stage IV r-ASRM (35.4%). MCA and perceptual maps revealed that superficial lesions were independent of pain symptoms and lesions location. However, there was an association between deep endometriosis lesions and severe symptoms. Severe dyspareunia and severe acyclic pelvic pain were associated. There was an interdependent relation between the absence of rectosigmoid and absence of retrocervical lesions. The presence of rectosigmoid lesions were associated with other deep lesions (mainly vagina, and retrocervical) and ovarian endometriosis. Infertility was not associated with any types of pain symptoms but was related to superficial, round ligament, and tubal lesions.

Conclusion: MCA revealed an association between categories of lesions and symptoms. Specifically, an association was observed between the presence of lesions in the rectosigmoid, ileum, cecum, vagina, bladder, round ligament, and para-rectal areas. Infertility was not associated with any types of pain symptoms but was related only to superficial, round ligament, and tubal lesions.