Abuse history as a modifier of symptom phenotype in endometriosis: Insights from a multidimensional retrospective cohort

INTRODUCTION: Endometriosis is a heterogeneous pain condition with variable symptom expression. Abuse history has been associated with amplified pain, gastrointestinal symptoms, and central sensitization in varying populations; however, whether these effects are compounded in patients with endometriosis and their intersection has not been well studied. Understanding these associations is clinically relevant, as unrecognized psychosocial contributors may compound diagnostic delay and hinder individualized treatment. MATERIAL AND METHODS: In this retrospective cohort study at a tertiary referral center, 235 patients presenting for pelvic pain evaluation (2018-2023) were stratified into four groups according to endometriosis identified on expert transvaginal ultrasound and self-reported abuse history. Ultrasound examinations followed IDEA consensus standards, with validated accuracy at our site for deep and ovarian endometriosis (site sensitivities 85%-100%, specificities ≥97%). Symptoms were assessed using validated measures: visual analog scales for chronic pelvic pain, the Central Sensitization Inventory (CSI), the Gastrointestinal Quality of Life Index (GIQLI), and the Female Sexual Function Index (FSFI). Primary outcomes were pain intensity, central sensitization, and GIQLI scores; secondary outcomes included prevalence of specific GI symptoms and sexual function. Group comparisons used nonparametric and Chi-squared tests with Bonferroni correction. RESULTS: = 0.05, 95% CI: 0.01-0.10) compared with other groups. Nausea (p < 0.001) and bloating (p = 0.008) were also more prevalent in this subgroup. No significant differences were observed for dysmenorrhea, dyspareunia, or FSFI scores (p = 0.091). CONCLUSIONS: A combined history of endometriosis and abuse was associated with a high symptom burden characterized by pain amplification, GI distress, and central sensitization. These findings underscore the importance of early psychosocial screening and trauma-informed care as complements to biomedical management in endometriosis. Prospective studies incorporating validated trauma measures and treatment covariates are warranted to clarify mechanisms and inform multidisciplinary care.