Title: A thematic synthesis of qualitative studies and surveys of the psychological experience
of painful endometriosis
Version: 2 Date: 09 Oct 2023
Reviewer's report:
SUMMARY
The manuscript „A thematic synthesis of qualitative studies and surveys of the psychological
experience of painful endometriosis” focuses on pain and its biopsychosocial effect on women
living with endometriosis. The results of the synthesis come from qualitative and quantitative
method-based publications.
OVERALL OPINION OF THE MANUSCRIPT
It is a well-written manuscript and a well-designed study, I enjoyed reading it, and thank you
for letting me pre-read it before publication. The idea of writing a thematic synthesis of the
topic examined with qualitative and quantitative methods seems to be a big undertaking, it
is often difficult to achieve that comparison, my opinion is, that the authors managed it in
their manuscript.  It was easy to read, to follow the structure of the manuscript and to topic.
Themes are described as „live” and sensitive key areas of endometriosis. Health professionals,
gynecologists, psychologists, patients, their relatives, friends, and co-workers can benefit greatly
from knowing the results of this manuscript, as they will be able to better understand the nature
of endometriosis and its effects on women living with the disease.
Although I found the topic of the research and the methods forward-looking, I have some
comments, recommendations, interesting questions, and proposals.
RECOMMENDATIONS AND GENERAL COMMENTS, NUMBERED.
Comment 1 - The methodology is very thorough, considered, and careful, with well-documented
steps and methodological background (detailed and repeatable). „Positionality and reflexivity”
is an exciting essence of the study. As for the quantitative data, no statistical analyses were added
to the manuscript. As I know, there are only a few well-designed publications that could be used
for a systematic review, but can the Authors tell anything about the power of correlations they
found? How strong are these correlations? If this is an unanswerable question (see the data and/
or the nature of the study), it is worth noting it as a limitation.
Comment 2 – I liked how the Authors displayed the overlapping topics, which is very important
in this disease. Therefore I recommend that the results of thematic synthesis be summarized
in a table or figure to see the complexity of affected areas in the lives of women living with
endometriosis.
Comment 3 – There is a typo in the first paragraph of the discussion „somatic expresion”.
Comment 4 – In the Introduction, the Authors shared two models, they wanted to „test” in painful
endometriosis, as I read the manuscript I missed the discussion of the biopsychosocial model
in endometriosis.
Comment 5 – If the fear and avoidance model does not work the most appropriately, shall
we think about new models like disease pathway models? How can it be integrated with
endometriosis?
Comment 6 - Considering the above, what kind of intervention would be useful in endometriosis
to cope with pain and other difficulties? Are there any mentionable (pelvic) pain management
techniques?
Comment 7 – What do we do not know yet? What is missing for us to build better interventions?
Comment 8 – Conclusion has a very important message that could also be conveyed on a social
level. It would be interesting to see in the future how endometriosis appears at different levels
of the social environment (like in relationships, families, workplaces, and bigger communities).
To summarize, the strengths of the study are the original choice of topic and the method. After
answering the detailed suggestions, I would recommend the study for submission; and encourage
authors to continue their research topic.