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Objective Endometriosis is a complex disease, and pain is an important component of the syndrome. One of the most used methods to assess pain is the visual analogue scale (VAS). The aim of the present research was to study the pain experienced by patients who referred to our unit for endometriosis, using the VAS to understand the variables that could influence it. Methods We have conducted a prospective study from February 2012 to December 2016, enrolling 388 patients who referred to a university hospital, in Florence, Italy. We have included in the present study patients during their follow-up for endometriosis; we have also included patients who underwent surgery with a histological diagnosis of endometriosis. We have collected sociodemographic and clinical information regarding age, body mass index (BMI), smoking habit, number of pregnancies, and endometriosis staging. Finally, we have administered the VAS for several symptoms. Results Dysmenorrhea was the symptom associated with the highest perception of pain (mean VAS score of 5.76). The logistic regression showed that the stage of endometriosis could influence the pain associated to constipation and to dysuria. The linear regression showed that age could influence the pain associated to constipation, to dyspareunia, and to dysmenorrhea. A positive correlation was found between dysmenorrhea and chronic pelvic pain (CPP), between dysmenorrhea and dyspareunia, and between constipation and dysuria. Conclusion Using a validated method, the VAS, we have studied the pain experienced by a group of patients with a history of endometriosis and observed that smoking habit and BMI did not influence the VAS scores, and that dysmenorrhea was associated with the highest perception of pain.

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Background: On 14 May 2013, Angelina Jolie (AJ), revealed herself to be the carrier of a BReast CAncer 1 (BRCA1) gene mutation and announced her decision to undergo a prophylactic mastectomy, followed by a laparoscopic bilateral salpingo-oophorectomy. This review explores the impact of the ‘Angelina Jolie Effect’ in order to reveal whether her announcement led to a change in the attitude of patients, and in decisions regarding healthcare options focusing especially on referrals, on genetic tests and on prophylactic mastectomies. Methods: Between January–February 2017, we performed a systematic search in PubMed using the key search term ‘Angelina Jolie’. We searched for studies published between 2013 and 2017, reporting data on number of BRCA1/2 tests, number of referrals for breast or ovarian cancer and number of performed mastectomies, before and after AJ’s disclosure. We considered eligible for inclusion all cross-sectional, retrospective, prospective studies written in English. Results: The literature search yielded 27 publications. After the analysis of title, abstracts and full text, we identified eight manuscripts for inclusion in the review. The studies were conducted from 2011 to 2015 in the USA, Austria, Australia, Canada and the UK. The announcement generated an increase of referrals for breast/ovarian cancer with peaks of +285%, an increase of BRCA tests with a peak of +80%, but did not lead to a significant increase of prophylactic mastectomies. Patients with a lower level of education asked for information about cancer, and most patients became more aware of breast reconstruction post-mastectomy. Conclusion: Celebrity disclosures, such as AJ’s revelation of her BRCA status and her decision for a prophylactic mastectomy, can influence patients’ behaviour leading to important effects on attitudes towards screening. Organisations should assist patients appropriately, but at the same time should consider the available resources, and should interface with journalists and the social media in order to guarantee the validity of the information.