研究背景：盆腔疼痛（Pelvic pain）是下腹部和骨盆内一个或多个部位有关的疼痛，可表现为下腹部、腰骶部等坠胀/疼痛，性交痛或接触性疼痛等，具有表现形式多样、位置复杂、程度不一的特点。患者往往难以准确表达自己的疼痛体验，导致诊疗受限，影响其长期疼痛管理。目前国内尚无量表来评估患者的整体盆腔疼痛，妇科及盆腔疼痛症状量表（Questionnaire about Gynaecological and Pelvic Pain Symptoms, ENDOPAIN-4D）是专门为盆腔疼痛女性患者开发的患者报告结局测量工具，具有较强的盆腔特异性，可以准确评估盆腔疼痛的部位、性质和程度，该量表已有法语/英语、波斯语版本，信效度良好，尚无中文版本，引进ENDOPAIN-4D量表可以填补目前工具适用性不足的空白，满足临床需求。

研究目的：汉化妇科及盆腔疼痛症状量表并对其进行心理测量学检验；运用中文版妇科及盆腔疼痛症状量表探究子宫内膜异位症/子宫腺肌症患者的盆腔疼痛现状及其影响因素。

研究方法：本研究包含两部分。第一部分：（1）获取原作者汉化授权后，遵循改良版Brislin翻译模型对ENDOPAIN-4D进行中文翻译；（2）遵循认知性访谈法研究报告框架，采用目的抽样法，选取2023年10月至12月北京协和医院妇科病房24名子宫内膜异位症/子宫腺肌病患者作为访谈对象开展2轮认知性访谈，对中文版ENDOPAIN-4D的条目进行修改订正；（3）采用便利抽样法，于2023年12月至2024年4月在北京协和医院妇科门诊及病房招募352名子宫内膜异位症/子宫腺肌病患者，填写中文版ENDOPAIN-4D、整体疼痛评估量表，对中文版ENDOPAIN-4D进行心理测量学检验。第二部分：采用便利抽样法，于2024年5月至2025年2月在北京协和医院妇科门诊及病房招募386名子宫内膜异位症/子宫腺肌病患者，填写中文版ENDOPAIN-4D、疼痛应对策略问卷、领悟社会支持量表、抑郁简表等，探究子宫内膜异位症/子宫腺肌病患者的盆腔疼痛现状及其影响因素。

研究结果：第一部分：（1）参照24名受访者认知性访谈意见，修订中文版ENDOPAIN-4D的引导语和15个问题条目，妥善解决目标人群对量表理解程度，语义、文化对等上的认知偏差问题；（2）心理测量学指标显示：中文版ENDOPAIN-4D内部一致性信度良好（Cronbach's α=0.874），间隔两周后测试显示较高的时间稳定性（重测信度系数0.952）；在内容效度验证方面，条目I-CVI处于0.9至1.0区间，S-CVI/Ave达到0.987；探索性因子分析成功析出4个特征根大于1的公共因子（与原量表结构吻合），累计解释方差率达61.17%；验证性因子分析表明量表各条目的标准化因子载荷范围为 0.35~0.90（所有条目 p < 0.01），修订后的拟合结果为χ²/df=2.409、RMSEA=0.063、GFI=0.900、CFI=0.934、IFI=0.934、TLI=0.922；中文版ENDOPAIN-4D与中文版全球疼痛量表评分呈显著正相关（r=0.523, P<0.01）。最终中文版ENDOPAIN-4D包含自发性盆腔疼痛、性交痛、肠道疼痛和/或症状、其他症状以及附加题（生育困扰程度），共21个条目。第二部分：386名子宫内膜异位症/子宫腺肌病患者的ENDPAIN-4D量表的疼痛得分为（73.12±34.08）分，疼痛应对策略得分为（91.42±19.24）分，领悟社会支持量表得分为（44.60±10.12）分，患者健康问卷得分为（7.20±2.93）分。单因素分析显示，不同年龄阶段、学历、婚姻状况、疾病分型、盆腔疼痛年限、疾病确诊年限，有无流产的患者盆腔疼痛差异均具有统计学意义（P<0.05）。Person相关性分析显示，患者的盆腔疼痛总得分与社会支持、抑郁、“再解释”“勇敢面对”“灾难化”“分散注意力”疼痛应对策略呈显著正相关（P<0.05），与“忽视”疼痛应对策略呈显著负相关（P<0.05）。多元线性回归分析显示：深部浸润型、疾病确诊年限、抑郁、灾难化疼痛应对以及忽视疼痛应对是患者疼痛的独立影响因素（P＜0.05）。

研究结论：（1）中文版妇科及盆腔疼痛症状量表具有良好的信效度，适用于我国子宫内膜异位症/子宫腺肌病患者的盆腔疼痛测量。（2）子宫内膜异位症/子宫腺肌病患者的盆腔疼痛处于中等水平，其疼痛严重程度受其疾病分型、疾病确诊年限、抑郁情绪以及疼痛应对策略的影响。

Background: Pelvic pain refers to pain in one or more areas of the lower abdomen and pelvis, which may manifest as discomfort or pain in the lower abdomen, lumbosacral region, dyspareunia, or contact pain. It is characterized by diverse manifestations, complex locations, and varying intensities. Patients often struggle to accurately describe their pain experience, leading to limitations in diagnosis and treatment, which affects long-term pain management. Currently, there is no domestic scale to comprehensively assess pelvic pain in patients. The Questionnaire about Gynaecological and Pelvic Pain Symptoms (ENDOPAIN-4D) is a patient-reported outcome measurement tool specifically developed for female patients with pelvic pain, offering strong pelvic specificity and accurately evaluating the location, nature, and severity of pelvic pain. The scale has been validated in French/English and Persian versions with good reliability and validity, but a Chinese version is not yet available. Introducing the ENDOPAIN-4D scale can fill the gap in current assessment tools and meet clinical needs.

Objectives: (1) To translate and culturally adapt the ENDOPAIN-4D into Chinese and evaluate its psychometric properties; (2) To investigate the current status and influencing factors of pelvic pain in patients with endometriosis/adenomyosis using the Chinese version of ENDOPAIN-4D.

Methods: This study consists of two parts.Part 1:(1) After obtaining authorization from the original author, the ENDOPAIN-4D was translated into Chinese following the modified Brislin translation model.(2) Guided by the cognitive interview reporting framework, purposive sampling was used to recruit 24 endometriosis/adenomyosis patients from the gynecology ward of Peking Union Medical College Hospital (October–December 2023) for two rounds of cognitive interviews to refine the Chinese version.(3) Convenience sampling was employed to recruit 352 endometriosis/adenomyosis patients from the gynecology outpatient and inpatient departments (December 2023–April 2024) to complete the Chinese ENDOPAIN-4D and the Global Pain Scale for psychometric validation.

Part 2:Convenience sampling was used to recruit 386 endometriosis/adenomyosis patients (May 2024–February 2025) to complete the Chinese ENDOPAIN-4D, Coping Strategies Questionnaire, Multidimensional Scale of Perceived Social Support, and Patient Health Questionnaire-9 to explore pelvic pain status and influencing factors.

Results:Part 1: (1) According to the results of the cognitive interviews with 24 respondents, the instructions and 15 items of the Chinese version of ENDOPAIN-4D were revised, properly addressing the cognitive biases of the target population in terms of scale comprehension, semantic and cultural equivalence. (2) Results of psychometric testing: The Cronbach's α coefficient of the Chinese version of ENDOPAIN-4D was 0.874, and the test-retest reliability was 0.952; the content validity index of each item (I-CVI) of the scale was 0.9-1.00, and the scale-level content validity index achieving near-perfect concordance (S-CVI/Ave=0.987). Exploratory factor analysis (EFA) corroborated the original four-factor structure, extracting four latent dimensions with eigenvalues >1.0 that collectively explained 61.17% of the observed variance. Confirmatory factor analysis (CFA) further validated the structural coherence, revealing standardized factor loadings spanning 0.35-0.90 across all items, meeting established thresholds for model acceptability; confirmatory factor analysis showed that the standardized factor loadings of the items of the scale ranged from 0.35 to 0.90 (all items p < 0.01), and the revised fitting results were χ²/_df = 2.409, RMSEA = 0.063, GFI = 0.900, CFI = 0.934, IFI = 0.934, TLI = 0.922; the Chinese version of ENDOPAIN-4D was significantly positively correlated with the score of the Chinese version of the Global Pain Scale (r = 0.523, P < 0.01). The final Chinese version of ENDOPAIN-4D includes spontaneous pelvic pain, dyspareunia, bowel pain and/or symptoms, other symptoms, and an additional question (degree of fertility distress), with a total of 21 items.Part 2: The pain score of the ENDPAIN-4D scale for 386 patients with endometriosis or adenomyosis was (73.12 ± 34.08) points, the score of the pain coping strategies was (91.42 ± 19.24) points, the score of the PSSS was (44.60 ± 10.12) points, and the score of the PHQ-9 was (7.20 ± 2.93) points. Univariate modeling identified significant heterogeneity in pelvic pain manifestations across demographic strata (age cohorts, educational attainment, marital status) and clinical parameters (disease categorization, symptom duration, diagnostic latency, abortion history status), with all comparative analyses reaching statistical significance (P < 0.05). Pearson correlation analysis showed that the total pelvic pain score of patients was significantly positively correlated with social support, depression, "reinterpretation", "facing bravely", "catastrophizing", and "distraction" pain coping strategies (P < 0.05), and was significantly negatively correlated with the "ignoring" pain coping strategy (P < 0.05). Multiple linear regression analysis showed that deep infiltrating type, duration of disease diagnosis, depression, catastrophizing pain coping, and ignoring pain coping were independent influencing factors of patients' pain (P < 0.05).

Conclusions:(1) The Chinese ENDOPAIN-4D demonstrates good reliability and validity and is suitable for assessing pelvic pain in Chinese endometriosis/adenomyosis patients. (2) Pelvic pain in these patients is moderate and influenced by disease subtype, diagnosis duration, depression, and pain coping strategies.