What are the novel findings of this work?Pelvic floor physiotherapy appears to be a promising new treatment to improve pelvic floor relaxation, superficial dyspareunia and chronic pelvic pain in women with deep infiltrating endometriosis (DIE). What are the clinical implications of this work?In the context of tailored multidisciplinary care, pelvic floor physiotherapy may represent an additional valid, minimally invasive, innovative and well-tolerated therapeutic option for women with DIE.

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uterosacral and cardinal ligaments, pelvic sidewall (B), recto-sigmoid (C). IEC adds the evaluation of adhesions (D), ovaries (E), bladder (FB), adenomyosis (FA). All compartments were graded in three levels. A numerical score graded the total amount of disease. Rate agreement and reproducibility between the operators were calculated. Results: Multiple rate agreements to classify endometriosis through IEC ranged from substantial to almost perfect (Cohen k 0.658 -1). A lower agreement rate, albeit substantial (Cohen k > 0.65), was detected for A, B, FA and D. The lower agreement in the evaluation of adhesions (D) was due to absence of adhesions in some patients. The lowest agreement, albeit substantial (Cohen k 0.658), was observed for the compartment level A3 (large vaginal or recto-vaginal-septal lesions). Agreement for small nodules (level 1) in compartments A, C and FB seemed to be lower than in other levels. The agreement rate for the total score levels, a reflection of the total extension of the disease, ranged from substantial to perfect. Conclusions: IEC is reproducible and easy to use during ultrasound evaluation of pelvic endometriosis. The standardisation of the diagnosis and extension of pelvic disease represents is crucial for the correct management and surgical approach. IEC is designed as diagnostic tool and as a surgical classification as well. P10.06Pelvic floor morphometry at 3D/4D transperineal ultrasound in women with endometriosis and dyspareunia before and after pelvic floor physiotherapy

We thank Dr Hirsch and his colleagues for their interest in our study 1 and their constructive comments. We agree that the development of core outcome sets is a priority in endometriosis research.In our paper, we reported data about the impact of pelvic floor physiotherapy in women with deep infiltrating endometriosis and superficial dyspareunia 1 . Of the planned outcomes registered in the trial protocol, we reported those related to change in pelvic floor muscle tone, as evaluated by measurement of the levator hiatal area using three/four-dimensional transperineal ultrasound, because we believe these to be of the most relevance to the journal Ultrasound in Obstetrics & Gynecology. As this is the first randomized controlled trial (RCT) evaluating the impact of pelvic floor physiotherapy in women with endometriosis, we chose to give emphasis to the description of the pelvic floor physiotherapy technique, in order to make our outcomes reproducible in future studies, and the use of transperineal ultrasound for the assessment of pelvic floor morphometry. The remaining outcomes, as planned in the study protocol (NCT03572075), will be presented in another paper. However, unpublished data are available subject to approval by our local ethics committee.The core outcome set for endometriosis mentioned by Dr Hirsch and colleagues was reported in the study of Duffy et al. 2 which was published after the registration and completion of our RCT. Nonetheless, we evaluated all these core outcomes, except for quality of life and adverse events. In particular, we assessed endometriosis-associated pain symptoms (chronic pelvic pain, dysmenorrhea, dysuria, dyschezia and dyspareunia) with special focus on the most troublesome symptom, superficial dyspareunia, which seems to be widespread in women with endometriosis and, in the majority of cases, is concomitant with deep dyspareunia 3 . Moreover, the satisfaction of women with the intervention was assessed using a dedicated questionnaire 1 .We are grateful to Dr Hirsch and colleagues for their efforts to develop a core outcome set for endometriosis 2 , which we will take into account in future research.