Development and Preliminary Evaluation of the Pelvic Dysfunction Composite Score (PDCS): A Pilot Study in Women with Endometriosis

INTRODUCTION AND HYPOTHESIS: Pelvic floor dysfunctions are common in women with endometriosis. Currently available assessment tools are limited to isolated domains that do not allow for a comprehensive multidimensional evaluation. This study aimed to develop and perform a preliminary validation of a multidimensional composite index for pelvic floor dysfunction based on both subjective and objective measures in women with endometriosis. METHODS: Data were retrospectively analyzed from a previously established cohort of patients who received either medical or medical-surgical treatment for endometriosis. The PDCS comprises three domains (each transformed to a 0-100 scale): subjective anorectal dysfunction (Wexner constipation and incontinence scores), pelvic floor symptoms (PFDI-20), and objective anorectal function (manometric parameters). The score was calculated as the mean of the available domains and stratified into mild (0-33), moderate (34-66), and severe (67-100) dysfunction. Internal structure assessment was based on principal component analysis and Spearman correlations. Clinical validation was assessed by correlating with pain (EHP-30) and sexual function (FSFI). RESULTS: Twenty-nine patients with clinically relevant pelvic dysfunction were assessed [median PDCS 45.2 (IQR 33.3-60.6)]. Patients with a PDCS value of 0 were excluded from the validation analyses. There were no significant differences between treatment groups. PDCS correlated very well with PFDI-20, and moderately with the Wexner domain and manometric findings. The PDCS was significantly correlated with pain burden and sexual function. CONCLUSIONS: The PDCS is a preliminary, multidimensional composite index that integrates symptom burden and anorectal functional findings in women with endometriosis. In the clinical setting, the proposed severity categories should therefore be regarded as exploratory and require validation in larger prospective cohorts before translating the results into practice.