Endometriosis is the most common gynecological condition in women of childbearing age and is defined by the presence of endometrial tissue outside the uterine cavity. It occurs in about 2% of women of childbearing age and affects approximately 50-70% of symptomatic women. Typical symptoms are dysmenorrhea, painful intercourse, chronic pelvic pain, and decreased fertility. Interestingly, there is a poor correlation between the extent of the disease and the severity of symptoms. This results in an average delay in diagnosis of 3.3 years (China) to 11.7 years (USA). Deep endometriosis is diagnosed when endometriosis invades the peritoneum to a depth greater than 5 mm and presents as a deep nodule containing fibromuscular tissue, glands and mesenchyme. Deep endometriosis is closely associated with severe pelvic pain. The most important symptom of endometriosis is dyspareunia, defined as pain during intercourse, and is of two types: superficial pain (SD) and deep pain (DD). 60-70% of surgical patients and 50-90% of hormone-treated DIE patients suffer from dyspareunia. In these studies, dyspareunia was four times more common in patients with endometriosis than in normal controls, and five times more common in the peritoneal form than in endometriosis cysts. The painful intercourse is more severe before menstruation and is associated with deep endometriosis invading the uterosacral ligament. Another relevant factor may be the pulling effect of intercourse on the uterosacral ligament invaded by the lesion. Painful intercourse often leads to a reduction in the frequency of intercourse or even avoidance due to the fear of pain, which leads to a feeling of guilt towards the sexual partner. It is also associated with decreased libido and orgasm. What’s more, painful intercourse is closely related to sexual dysfunction and sexual dysfunction. Thus, painful intercourse not only affects physical health, but also the quality of sexual life and the relationship with the sexual partner. In conclusion, there are two options for treating this chronic condition: hormonal and surgical treatment. Although hormonal treatment is effective in treating pain, the side effects and recurrence of some medications must be considered. Surgical treatment strategies involve complete excision of the visible and palpable lesion to obtain pain relief. However, surgery is associated with the risk of intraoperative and postoperative complications. Therefore, the goal of this article is to elucidate the role of surgical excision of endometriosis on painful intercourse and quality of sexual life. We summarized all the included articles on descriptive indicators after surgical excision of endogamy: effect on painful intercourse, number of patients, follow-up, and study design. We did not do a Meta-analysis because of data limitations and the fact that the data varied from article to article. The median operative time ranged from 107 to 228 minutes. 3 cases were converted to open surgery. In one case, the rectum was opened for complete resection because the lesion had invaded the anterior rectal wall, and in two cases, severe adhesions occurred during exposure of the normal anatomy. no operative data or information on conversion to open surgery were reported by Ferrero et al. The proportion of patients with AFS stages I-IV was 42%, 11%, 58%, and 89%, respectively. 2. painful intercourse Follow-up was at month 12, 24, and 60 months, respectively. Only Ferrero et al focused on deep endografts; the remaining two articles did not distinguish between superficial and deep endografts. All studies assessed postoperative painful intercourse by VAS, suggesting a significant improvement in painful intercourse after excision of the lesion. Complications The main complications were blood loss >500 ml (24/135; 17.8%), the need for blood transfusion in 3.7% (5/135), and the need to open the rectum due to extensive lesions (4/135; 3%). Transient urinary retention (3/22; 13.6%), postoperative vaginal bleeding (2/22; 9.1%), vaginal-rectal fistula (1/22; 4.5%), repair of uterine perforation (1/35; 0.74%), etc. 4. Pathological confirmation of endometriosis Among them, only 1 article reported the pathological diagnosis of endometriosis on histology. The other 2 articles did not know whether they ignored the pathological diagnosis or did not find the basis for the diagnosis. Recurrence Only Abbott et al. (2007) reported on postoperative recurrence requiring surgery. After a follow-up of 2-5 years after surgery, 16(12%) of the patients had further surgical treatment. Quality of sexual life and psychological outcomes Surgical treatment of vaginal endometriosis has been controversial, but the results of the MFSQ have shown that pain relief and quality of sexual life improve after surgical treatment. The MFSQ assesses seven different aspects of the subject’s experience of sexual intercourse over the past four weeks using the Likert scale. This scale contains three subscales: sexual satisfaction, sexual difficulties, and partner satisfaction. After 12 months of postoperative follow-up, sexual satisfaction increased and sexual difficulties decreased significantly. Only the satisfaction with sexual intercourse with sexual partners did not improve. In this study, health-related quality of life was also assessed by a standard, generalized test called the 15D. It provides 15 multiple-choice questions on health-related indicators such as exercise, mental status, discomfort, sexual activity, and disorders. Each area is divided into five levels of severity, with the final total score ranging from 0 to 1. The lower the score, the lower the health-related quality of life. After 12 months of follow-up following complete surgical removal of the endo-lesion (including removal of the vaginal endo-lesion), there was a significant improvement in the index disorders, discomfort, endurance and sexuality compared to the baseline score, which increased from 0.85 to 0.91. Ferrero et al. studied postoperative and 12-month postoperative painful intercourse and quality of sexual life using two standardized scales. One was the International Sexual Intercourse Satisfaction Index (GSSI), which reflects an individual’s subjective assessment of satisfaction with sexual intercourse. Patients had to assess their overall level of satisfaction with intercourse on a 9-point scale from “best” to “worst”. The second is the Sexual Functioning Inventory, a subscale of sexual satisfaction, which is a multifaceted multidimensional instrument used to assess sexual and psychological functioning status and consists of 10 subscales with single-choice questions on the topics in each subscale. The subscales used consist of 9 items, each of which can be answered on a 6-point Lister scale (1 – strongly consistent; 6 – strongly inconsistent), thus reflecting the level of sexual completion. Abbott et al. reported a significant improvement in painful intercourse and quality of sexual life after 2-5 years of follow-up after laparoscopic endolaparotomy. Sexual pleasure was enhanced and painful intercourse was reduced (note: this is an error in the original). In addition, the quality of life of the patients evaluated by 5D improved, but did not reach normal levels. The Health Status Questionnaire is a proven generalized standard that can be used in the treatment of different diseases and includes four physical and four psychological scales, which also suggest an increase in scores after follow-up. The increase in scores on the physiological component was greater than that on the psychological component, but was not statistically significant. The main objective of this paper was to analyze the effect of surgical excision of all visible endometriotic lesions on painful intercourse and quality of sexual life in patients. Three studies have reported significant improvements in postoperative painful intercourse, and again, in the past few years, complete surgical excision of endografts has become the treatment of choice. However, surgical excision of endografts carries the risk of intraoperative and postoperative complications and should only be performed in a specialized pelvic pain management facility after adequate patient communication and consideration of complications. Despite at least 12 months of postoperative follow-up, the improvement in quality of sexual life was not as pronounced as the improvement in painful intercourse. This suggests that years of painful intercourse can continue to affect the patient’s psychological status. Thus, the focus of attention during intercourse becomes more on the sensitivity to pain than on the enjoyment of intercourse itself. The experience of pain and the loss of pleasure are repeatedly recalled and reinforced by this repeated experience. This process creates a table of perceptions of how negative expectations affect intercourse. Sex is a complex and multifactorial phenomenon. There are three main influencing factors: physical, psychological and social. For this reason, a successful surgery is not enough to make an immediate improvement in sexual function that may have been impaired for a long time. In addition, self-perceptions of inadequate sexual partners, self-esteem disorders, and lowered self-esteem due to painful intercourse also affect sexual function as much as painful intercourse. Since painful intercourse is often a topic of shame for women, gynecologists who manage endometriosis should do their best to provide ways to preserve the patient’s sexual function, as this is the main indicator of improvement for many patients who suffer from this condition. In addition, a detailed analysis of sexuality, especially the patient’s complaints of sexual discomfort, should be an integral part of the endometriosis patient’s medical record. Sexual function should be taken into account not only during the preoperative examination, but also during the postoperative follow-up examination. We also recommend that patients with painful intercourse in endo should be treated in a multifaceted manner at a medical institution, including gynecology, pain medicine, psychology, and joint treatment of sexual function problems. To our knowledge, this is the first systematic review to focus on painful intercourse and improvement in quality of sexual life as measured by a standardized tool after surgical removal of the endoheterosexual lesion. Taken together, the available papers provide evidence that surgical excision of endografts is feasible and a good option to relieve pain and improve sexual quality of life, but the associated risk of preoperative and postoperative complications should also be considered.