Psychosocial Factors and Disease Localization as Independent Predictors of Sexual Dysfunction in Women with Endometriosis

<b>Background:</b> This study examines the impact of endometriosis on sexual function, focusing on disease localization, pain severity, and psychosocial factors. It integrates the rASRM and Enzian classification systems to explore anatomical contributions to sexual dysfunction. <b>Methods:</b> In a cross-sectional study, 102 patients with confirmed endometriosis completed an online evaluation. Of these, 77 had surgical and histological confirmation, and 25 had no prior surgery. Thirty-five participants were using hormonal therapy. Validated instruments assessed sexual function, pain intensity (VAS), and psychosocial variables. Analyses included univariate tests and multivariate logistic regression. <b>Results:</b> Deep infiltrating endometriosis involving the sacrouterine ligaments, cardinal ligaments, and pelvic sidewall (Enzian B) was associated with sexual dysfunction, highlighting the anatomical utility of the Enzian system. Surprisingly, those with sexual dysfunction reported lower pain scores (<i>p</i> = 0.024 *). In multivariate analysis (R² = 0.281), no individual factor, including Enzian B involvement or EHP scores, remained significant. No associations were found between sexual dysfunction and anxiety, depression, stress, or relationship satisfaction, though pain was inversely correlated with anxiety (<i>p</i> = 0.025 *). <b>Conclusions:</b> Sexual dysfunction in endometriosis appears multifactorial, not solely driven by lesion burden or pain. A multidisciplinary approach is recommended, addressing anatomical, psychological, and behavioral dimensions.