Early Relational Experiences and Prenatal Attachment in Endometriosis: The Role of Childhood Trauma and Parental Bonding

Introduction: Endometriosis is increasingly recognised as a condition involving psychosocial dimensions, including current and past relational experiences. This pilot study explores the interplay between childhood trauma, early parental bonding, and prenatal attachment in pregnant women with endometriosis compared to healthy controls. Methods: The sample included 12 pregnant women diagnosed with endometriosis and 26 healthy pregnant women recruited at the IRCC Fondazione San Gerardo (Monza, Italy). Participants completed the Parental Bonding Instrument (PBI), the Childhood Trauma Questionnaire (CTQ-SF), and the Prenatal Attachment Inventory (PAI). Pain-related variables were also collected. Group differences were analysed using chi-square tests, and associations were examined through Spearman correlations. Results: Women with endometriosis were more likely to report a lack of early paternal support than controls (χ² = 13.56, p = .004), while no differences emerged for maternal bonding. A trend-level difference was found for severe physical abuse (χ² = 7.64, p = .054), reported only in the endometriosis group. Within this group, childhood trauma (in particular, higher levels of emotional abuse and neglect) was linked to lower parental care and higher overprotection, particularly maternal. Physical abuse showed strong positive correlations with both maternal and paternal overprotection (ρ = .83). Childhood traumatic experiences correlated positively with dyspareunia before pregnancy (ρ = .60), while lower parental care (maternal and paternal) was associated with higher current general and pelvic pain (up to ρ = −.79, p = .004). Prenatal attachment showed complex patterns: higher trauma exposure was associated with increased intensity of some attachment behaviours (e.g., talking to the fetus, touching the abdomen), alongside alterations in imaginative and future-oriented aspects of bonding. Discussion: Findings highlight the relevance of early caregiving experiences within the family of origin, particularly paternal support care, parental care and protection and childhood trauma in women with endometriosis. These factors appear to be associated with both pain experience and prenatal attachment processes during pregnancy. The results support an integrated biopsychosocial and attachment-based perspective and underline the importance of incorporating psychological dimensions into clinical care for endometriosis during pregnancy.