# Endometriosis and Sexual Functioning: How Much Do Cognitive and Psycho-Emotional Factors Matter?
## 2 Materials and Methods  
The study was conducted on 187 women: 87 patients with endometriosis (Endometriosis Group--EG), recruited in the [omitted for blinded review] (34.10 \(\pm\) 9.18; ranged 18-56 years), and 100 from the general population (Control Group--CG) (34.58 \(\pm\) 9.27; ranged 18-61 years), recruited using snowball methodology. Both groups completed an anonym mous web survey on the Google. Docs platform assessing psycho-social domains related to female sexuality. The questionnaires were all self-administrated for both groups. For the CG, the web survey was disseminated on institutional websites and social networks (e.g., Facebook, Instagram, and LinkedIn). In turn, participants were asked to share the study on their own social network or with women interested to participate. The inclusion criteria were self-declaring as a woman, identifying as heterosexual, and being a fluent Italian speaker. Later, only women matching with those of the EG were selected for the study. Completion of the questionnaire took approximately 25 min. No remuneration was provided to participants. A multidisciplinary team of gynecologists and psycho-sexologists was involved for EG. Gynecologists recruited eligible participants during consultations, and the psycho-sexologists explained the study's objectives and gave the link for the Google. Docs platform. Patients completed the questionnaire alone, accessing it at home. Inclusion criteria for the EG were: having undergone laparoscopic treatment with histologic confirmation at least three months before the study; taking oral contraceptives or progestogens. The diagnosis of endometriosis was confirmed for all participants by gynecological examination and transvaginal pelvic ultrasound. Exclusion criteria were: not identifying as heterosexual, DIE presence, and treatment with gonadotropin releasing hormone (GnRH) analogues. All subjects gave their informed consent for inclusion before participating in the study. The study was conducted following the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of [omitted for blind review] on 20 September 2017. Data were collected from November 2017 to September 2019. In line with the aim of the present study, 9 self-report measures were administered based on their validity, clarity, and extensive use in the literature. The selected measures are listed here below. An ad hoc sociodemographic form to collect general information, such as age, relationship, and marital status, educational level, work status, children, self-declaration of having any sexual problem (i.e., \"During the past 6 months, have you had any sexual problem?\" and \"How long have you had this sexual problem? ), help-seeking behavior, and treatments. The Short Form of McGill Pain Questionnaire (SF-MPQ) [77] is composed of 15 items (11 sensory and 4 affective) rated on an intensity scale from \"none\" to \"severe.\" This questionnaire collects both quantitative and qualitative information related to the subjective experience of pain. A total score can be calculated as an indicator of pain intensity. For this study, the SF-MPQ adaptation to GPP by [PERSON] and colleagues [12] was used. The SF-MPQ was assessed only in women answering \"yes\" to the question \"In the last 6 months, have you experienced any kind of pain/discomfort located in the genital area (in general or associated with sexual activity)?\" The Cronbach's alpha value for the adapted measure in the present study was 0.87. The Female Sexual Functioning Index (FSFI) [78; 79] is a 19-item questionnaire providing information on the general sexual functioning and, in particular, on six specific dimensions: desire, arousal, lubrication, orgasm, sexual satisfaction, and sexual pain. Higher scores indicate higher sexual functioning. The measure presents acceptable test-retest reliability, internal consistency, validity, and the ability to discriminate between sexually clinical and healthy women [79]. The total score \(\leq\) 26.55 indicates the presence of sexual dysfunctions [79; 80].