Motor Factors Associated with Psychosocial Aspects in Women with Deep Endometriosis

Deep endometriosis (DE) may be associated with chronic pelvic pain, pelvic floor dysfunction, sexual dysfunction, psychological distress, and impaired quality of life, though relationships remain poorly characterized. We investigated associations between pelvic floor and lumbopelvic musculoskeletal impairments and psychosocial outcomes in women with DE.

This cross-sectional study included women aged 18-45 years with DE. Questionnaires assessed quality of life (SF-12), depression (BDI), sexual function (FSFI), kinesiophobia (TSK), and disability (Roland-Morris). Musculoskeletal assessments included vaginal palpation, pain intensity, pressure pain threshold (PPT), flexibility, and functionality. Associations were assessed using Spearman's rho (p < 0.05).

Increased resting pelvic floor muscle tone was observed in 51.1% of participants and myofascial trigger points in 75.6%, more on the left side (71.1%); only 26.7% achieved complete relaxation. PPT was reduced across all muscles, and range of motion was reduced particularly in the hamstrings and iliopsoas. Mean SF-12 scores were 43.92 ± 9.0 (physical) and 54.58 ± 13.61 (mental); 98% had severe depressive symptoms (BDI); mean FSFI score was 24.2 ± 5.6, below the cutoff for sexual dysfunction; kinesiophobia and disability scores were elevated. Higher hypogastric pain was associated with depressive symptoms (ρ = 0.599; p < 0.001); greater disability with worse physical quality of life (ρ = -0.494; p = 0.009); higher kinesiophobia with worse sexual pain (ρ = -0.584; p < 0.001) and depressive symptoms (ρ = 0.438; p = 0.035); and older age with lower mental quality of life (ρ = -0.434; p = 0.038).

Women with DE presented musculoskeletal impairments closely associated with psychosocial impacts, supporting interdisciplinary management addressing pain, motor dysfunction, and psychological support.