***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: INTRODUCTION The concept of sexually related personal distress is currently central to the diagnosis of all female sexual dysfunctions ( FSD ) . In the current study , we have focused on validating a slightly revised version of the Female Sexual Distress Scale ( FSDS ) , the FSDS-Revised ( FSDS-R ) , to enhance the sensitivity of the instrument with patients suffering from hypoactive sexual desire disorder ( HSDD ) . In addition , we have attempted to extend the validation generalizability of the scale by demonstrating that both instruments possess reliability and discriminative validity in premenopausal women with HSDD . AIM To assess the validity of the revised version of the FSDS , the FSDS-R , for measuring sexual distress in women with HSDD . METHODS A prospect i ve method ological study carried out at 27 centers in North America enrolled 296 women aged 18 - 50 years with HSDD , another female sexual dysfunction ( FSD ) , or no FSD . The subjects completed the FSDS-R at baseline , day 7 , and day 28 , with a 30-day recall at baseline and with a 7-day recall on days 7 and 28 . MAIN OUTCOME MEASURES Receiver operating characteristic ( ROC ) analyses of FSDS , FSDS-R , and FSDS-R item 13 were used for the differentiation of HSDD from no FSD , while intraclass correlation coefficient ( ICC ) was used to estimate test-retest reliability . Cronbach 's coefficient alpha was used to measure the internal consistency of the FSDS-R and Pearson 's correlation coefficient to assess FSDS , FSDS-R , and FSDS-R item 13 with different recall periods ( 7 and 30 days ) . RESULTS Mean total FSDS , FSDS-R , and FSDS-R item 13 scores with either recall period were significantly higher ( P < 0.0001 ) in women with FSD or HSDD than in women with no FSD , showing both tests had discriminant validity . ROC analysis confirmed these findings , while an ICC of > 0.74 showed the test-retest reliability of both scales , including FSDS-R item 13 alone , and Cronbach 's coefficient alpha of > 0.86 confirmed the internal consistency of both tests . CONCLUSIONS Consistent with the FSDS , the FSDS-R demonstrated good discriminant validity , high test-retest reliability , and a high degree of internal consistency in measuring sexually related personal distress in women with HSDD . FSDS-R item 13 alone also demonstrated good discriminant validity and test-retest reliability OBJECTIVE To examine the effect on pain and quality of life for women with all stages of endometriosis undergoing laparoscopic surgery  compared with placebo surgery . DESIGN A r and omized , blinded , crossover study . SETTING A tertiary referral unit in a district general hospital . PATIENT(S ) Thirty-nine women with histologically proven endometriosis completed the 12-month study . INTERVENTION(S ) Women were r and omized to receive initially either a diagnostic procedure ( the delayed surgical group ) or full excisional surgery ( the immediate surgery group ) . After 6 months , repeat laparoscopy was performed , with removal of any pathology present . MAIN OUTCOME MEASURE(S ) The end points were changes from baseline values of visual analogue pain scores , vali date d quality -of-life instruments ( EQ-5D and SF-12 ) , and sexual activity question naire scores . Patients and assessors of outcomes were blinded to the treatment-group assignment . RESULT ( S ) Significantly more of the 39 women operated on according to protocol reported symptomatic improvement after excisional surgery than after placebo : 16 of 20 ( 80 % ) vs. 6 of 19 ( 32 % ) ; chi(2)(1 ) = 9.3 . Other aspects of quality of life were also significantly improved 6 months after excisional surgery but not after placebo .  Progression of disease at second surgery was demonstrated for women having only an initial diagnostic procedure in 45 % of cases , with disease remaining static in 33 % and improving in 22 % of cases . Nonresponsiveness to surgery was reported in 20 % of cases . CONCLUSION ( S ) Laparoscopic excision of endometriosis is more effective than placebo at reducing pain and improving quality of life . Surgery is associated with a 30 % placebo response rate that is not dependent on severity of disease . Approximately 20 % of women do not report an improvement after surgery for endometriosis STUDY QUESTION Is there a difference between women with endometriosis who underwent laparoscopic surgery with bowel resection or without bowel resection  regarding depressive symptoms , relational adjustment and sexual functioning ? SUMMARY ANSWER Radical surgery for endometriosis in both groups improved the levels of depression and sexual functioning , but only the bowel resection patients showed improvements in relationship satisfaction . WHAT IS KNOWN ALREADY ? : The frequent pain symptoms in endometriosis patients can have an impact on psychological issues , relationships and sexual functioning . There are no data available on depression and relationship adjustment after endometriosis surgery . Sexual dysfunction problems have been described after bowel resection for rectal cancer , but no data are available for endometriosis surgery . STUDY DESIGN , SIZE , DURATION This prospect i ve cohort study included 203 consecutive women operated at the Leuven University Fertility Center ( LUFC ) between 1 September 2006 and 30 September 2008 for moderate ( n = 67 ) or severe ( n = 136 ) endometriosis . The preoperative response rate was respectively 84 % in the bowel resection group and 79 % in the no bowel resection group . PARTICIPANTS , SETTING , METHODS The beck depression inventory ( BDI ) measured depression , the dyadic adjustment scale ( DAS ) measured relationship satisfaction and the short sexual functioning scale ( SSFS ) measured sexual functioning before and 6 , 12 and 18 months after women had laparoscopic surgery at the LUFC , a tertiary referral centre for fertility exploration , treatment and surgery . MAIN RESULTS AND THE ROLE OF CHANCE Both groups had better post-operative outcomes when compared with the preoperative assessment s. Mean BDI and DAS levels were comparable with the normal population . Overall assessment points , the bowel resection patients had better outcomes for DAS ( P < 0.05 ) and SSFS ' arousal ' ( P < 0.05 ) than the no bowel resection patients . At 6 months after the operation , when compared with the no bowel resection group , the bowel resection group reported lower mean levels of BDI ( P < 0.05 ) , a lower incidence of SSFS ' pain during intercourse ' and ' orgasm problems ' ( P < 0.05 ) , and a lower proportion of patients with severe orgasm problems ( P < 0.05 ) . The data show that radical but fertility sparing surgery , with or without bowel resection , for the treatment of endometriosis results in comparable and good psychological outcomes concerning depression levels , relationship satisfaction and sexual functioning . LIMITATIONS , REASONS FOR CAUTION Although the initial response rate was good , response dropped over time and was significantly higher for bowel resection patients compared with the no bowel resection patients ( P = 0.05 ) . A responder/non-responder analysis for the whole study population showed no significant differences concerning pain problems . This reduces the possible risk of ( positive ) bias in the results . WIDER IMPLICATION S OF THE FINDINGS Endometriosis is a complex condition and the focus should not be on a one-dimensional end-organ gynaecological outcome , but should take into account the role of psychological factors in pain-related outcome . To this end , more prospect i ve data are needed on sexual functioning and psychological outcomes BACKGROUND Among subjects with endometriosis and deep dyspareunia ( DD ) , those with endometriosis of the uterosacral ligament ( USLE ) have the most severe impairment of sexual function . This study examines the effect of laparoscopic excision of endometriosis on DD and quality of sex life . METHODS This observational cohort prospect i ve study included 68 women with endometriosis suffering DD ( intensity of pain > or= 6 on a 10-cm visual analogue scale ) . Patients underwent laparoscopic full excision of endometriosis .  Following surgery , they were asked to use nonhormonal contraception devices . Before surgery , at 6- and at 12-month follow-up , patients answered a self-administered question naire based on the Sexual Satisfaction Subscale of the Derogatis Sexual Functioning Inventory . RESULTS At 6- and 12-month follow-up , women with and without USLE had significant improvement in DD .  Subjects with USLE reported increased variety in sex life , increased frequency of intercourse , more satisfying orgasms with sex , relaxing more easily during sex and being more relaxed and fulfilled after sex . Similar improvements were observed among women without USLE ; however , for some variables statistical significance was not reached . CONCLUSIONS Surgical excision of endometriosis improves not only DD but also the quality of sex life INTRODUCTION Deep infiltrating endometriosis ( DIE ) is a form of endometriosis in which the lesion penetrates for more than 5 mm under the peritoneal surface . It is a chronic disease which can impair women 's sexual function . There is a growing body of evidence supporting combined surgical/medical treatment in the management of DIE . AIMS The aims of this article are to evaluate the impact of the laparoscopic full excision of endometriosis and postoperative combined oral contraceptives ( COC ) administration on sexual function in patients with DIE and to compare sexual function outcomes of women su bmi tted to intestinal resection and nodule excision .  METHODS It is a prospect i ve cohort study in a tertiary care university hospital on 106 sexually active women , with histologically confirmed DIE , managed by laparoscopy and subsequent COC therapy for 6 months . Patients filled preoperatively and 6-month postoperatively a quality of sexual life question naire , the Sexual Health Outcomes in Women Question naire ( SHOW-Q ) and they ranked their symptom intensity using a 10-point visual analogue scale ( VAS ) . MAIN OUTCOME MEASURES Sexual function was measured through the SHOW-Q scores and pain symptoms through VAS scores . Intraoperative details , type of intervention and perioperative complications were noted . RESULTS Six months after surgery and postoperative COC treatment , a significant improvement was observed in the SHOW-Q domains of pelvic problem interference , sexual satisfaction and desire ( P<0.05 ) . Laparoscopic management of DIE did not change significantly the orgasm area of the sexual functioning ( P=0.7 ) . No significant difference was found in SHOW-Q scores between patients su bmi tted to intestinal resection and patients su bmi tted to intestinal nodule excision ( P>0.05 ) . CONCLUSIONS Sexual desire , satisfaction with sex and pelvic problem interference with intercourse are significantly improved after 6 months from laparoscopic excision of DIE combined with postoperative COC therapy . No difference in sexual outcomes was detected between patients su bmi tted to intestinal resection and nodule excision OBJECTIVE To identify prognostic factors for pain and endometrioma recurrence after complete laparoscopic excision of endometrioma(s ) . DESIGN Prospect i ve observational study . SETTING Tertiary care university hospital . PATIENT(S ) One-hundred sixty-six consecutive women affected by uni- or bilateral ovarian endometrioma(s ) . INTERVENTION(S ) Laparoscopic conservative treatment of endometriosis . MAIN OUTCOME MEASURE(S ) Patient demographic characteristics , surgical findings , and surgical results were prospect ively recorded . Postoperative follow-ups were carried out every 3 months to identify pain and /or endometrioma recurrence for a minimum of 3 years . RESULT ( S ) Dysmenorrheal , dyspareunia , and chronic pelvic pain recurred in 14.5 % , 6 % , and 5.4 % of women , respectively . Prior surgery for endometriosis , adhesion extension , and use of ovarian stimulation drugs ( OSD ) were unfavorable prognostic factors for pain symptoms . Ovarian endometrioma recurred in 9.6 % of cases ; negative factors were prior surgery for endometriosis , OSD , pelvic adhesions , and high American Society for Reproductive Medicine disease scores . Postoperative pregnancy showed a significant protective effect on pain and disease recurrences . CONCLUSION ( S ) Prior surgery , presence of adhesions , and ovulation drugs are negative prognostic factors . Pregnancy has a protective effect on disease and pain recurrence Two hundred and forty‐two postmenopausal women between 35 and 65 years of age requiring hormone replacement therapy for climacteric symptoms were blindly and r and omly allocated to treatment either with transdermal estradiol therapy ( Estraderm * 50 μg/24 h ) ( E ) or placebo ( P ) . The patches were changed twice a week and treatment continued for 12 weeks . No progestogen supplement therapy was given during the study . No previous hormone replacement therapy had been given for the last six months and the women had had their last menstruation more than sin months ago . As a part of a larger study assessing women 's quality of life , a Swedish version of ‘ McCoy 's Sex Scale Question naire ’ was administered at the start of treatment and after 12 weeks . This question naire contains nine items regarding different aspects of sexual life . The difference between the scorings at the start of treatment and after 12 weeks were calculated for each item and the values 
    Output:
    
Laparoscopic excision of endometriosis can improve QoSL .