Correlation Between Pain Intensity in Different Locations and Intraoperative Stage of Endometriosis According to rASRM and #ENZIAN Classification

J Clin Med. 2026 Apr 3;15(7):2725. doi: 10.3390/jcm15072725.

ABSTRACT

Background/Objectives: Endometriosis is a chronic inflammatory disease with a heterogeneous clinical presentation, in which pain represents the predominant symptom. The association between pain severity and intraoperative disease stage remains unclear, particularly with regard to the rASRM and #ENZIAN classifications. This study aimed to evaluate the relationship between pain intensity at different anatomical sites and the stage of endometriosis according to the rASRM and #ENZIAN systems.

Methods: A total of 138 patients with advanced endometriosis undergoing surgical treatment between May 2024 and August 2025 were included. Pain intensity was assessed using a 10-point Numerical Rating Scale (NRS) for pelvic pain, pain during defecation, pain during micturition, and pain during or after sexual intercourse. The stage of endometriosis was evaluated intraoperatively according to the rASRM and #ENZIAN classifications. Non-parametric statistical tests and Spearman's rank correlation coefficient were applied. A p-value < 0.05 was considered statistically significant.

Results: No significant correlation was found between overall pelvic pain intensity and disease stage according to the rASRM classification. However, significant differences in pain during micturition were observed depending on rASRM stage (p = 0.004). In the #ENZIAN-based analysis, significant associations were identified between selected anatomical areas and specific pain symptoms, particularly pain during micturition, defecation, and sexual intercourse.

Conclusions: Pain severity in advanced endometriosis does not consistently correlate with overall disease stage according to rASRM. The anatomical localization of lesions defined by the #ENZIAN classification may better reflect the type and distribution of pain symptoms. These findings should be interpreted in the context of a selected cohort of surgically treated patients with advanced disease and may not be generalizable to patients with milder or non-surgically managed endometriosis.

PMID:41977023 | DOI:10.3390/jcm15072725