Pelvic floor muscle function, pain, and symptom burden in women with endometriosis: a pilot case–control study

Abstract

Chronic pelvic pain is one of the most disabling manifestations of endometriosis and is frequently associated with impaired quality of life, bladder dysfunction, and sexual dysfunction. Pelvic floor muscle (PFM) dysfunction may contribute to a potential contributor to symptom persistence; however, objective evidence regarding its role in women with endometriosis is limited. To examine and compare pelvic floor muscle (PFM) function, assessed using vaginal manometry, together with patient-reported measures of pelvic pain, pelvic floor symptoms in women with and without endometriosis. Secondary aims were to explore preliminary between-group differences and examine the associations between PFM function and symptom severity. In this pilot cross-sectional case–control study, 31 women aged 18–45 years were recruited. One participant was excluded from the control group, resulting in a final sample of ; 30 participants, including 15 women with medically confirmed endometriosis and 15 controls. Participants completed the Pelvic Pain Impact Questionnaire (PPIQ), Numeric Rating Scale (NRS) for pain, and Australian Pelvic Floor Questionnaire (APFQ). Pelvic floor muscle function was assessed using intravaginal manometry, including measures of resting pressure, maximal voluntary contraction (MVC), and the number of rapid contractions performed within 30 seconds. Group differences were examined using univariate analyses and analyses of covariance controlling for age, body mass index, and vaginal delivery history. Spearman correlations were calculated to investigate associations between PFM function and patient-reported outcomes. Women with endometriosis reported significantly higher average and maximal pain intensity, greater pelvic pain-related disability, and more severe bladder and sexual symptoms than controls (all p < 0.05). They also demonstrated significantly higher vaginal resting pressure and lower MVC values. After adjustment for covariates, significant group differences remained for pain outcomes, pelvic pain impact, bladder and sexual function, total APFQ score, and resting PFM tone (p < 0.05). MVC was moderately associated with bladder symptoms (ρ = −0.384, p = 0.036), sexual function (ρ = −0.470, p = 0.009), and overall pelvic floor symptom burden (ρ = −0.435, p = 0.016). No significant associations were observed between PFM parameters and pelvic pain-related disability. Women with endometriosis showed higher symptom burden and differences in selected pelvic floor muscle parameters compared with controls without a diagnosed gynaecological disorder. These exploratory findings warrant confirmation in prospective studies with larger sample sizes. ClinicalTrials.gov Identifier: NCT07713108 (01.07.2026)