Surgical treatment affects perceived stress differently in women with endometriosis: Correlation with severity of pain

Objective To investigate the amount of perceived stress in a group of women with different forms of endometriosis-related pain before and after surgical treatment. Design Prospective clinical trial. Setting University hospital. Patient(s) A group of women (n = 98) referred to our center for chronic pain and suspected of having endometriosis. Intervention(s) All women suspected of having endometriosis with ultrasonography underwent to a clinical evaluation including assessment of perception of stress. Endometriosis was confirmed histologically by laparoscopy. Painful symptoms and perception of stress were recorded 1 month after surgery. Main Outcome Measure(s) Perceived stress scale (PSS) and visual analog scale for painful symptoms before and 1 month after surgery for endometriosis. Result(s) The PSS score before surgery was perceived as "very high" in patients with deep endometriosis (n = 20) or deep endometriosis associated with endometrioma (n = 21); "high" or "medium" PSS was perceived in patients with endometrioma (n = 34) or endometrioma associated with peritoneal endometriosis (n = 23). After the surgical treatment a significant decrease of the "very high" PSS score was shown, as well as when the entire group of patients was considered. When evaluated before and after surgery, according to the severity of pain (dysmenorrhea, dyspareunia, and pelvic pain), a direct correlation was found with the level of PSS. Conclusion(s) Patients with deep endometriosis-related pain (dysmenorrhea, pelvic pain, dyspareunia) showed the highest level of perceived stress, which significantly decreased after surgical treatment.