Objective To study pain symptoms and their correlation with the anatomical location (and extent) of deep endometriosis lesion(s) classified by the Enzian score. Design Prospective multi-centre study Setting Web-based application called EQUSUM (www.equsum.org) to classify and report surgical procedures Population or Sample A total of 419 surgical DE (deep endometriosis) cases Methods Collection of surgical data in DE cases and their endometriosis classification and pain scores. Main Outcome Measures Preoperative reported pain scores in each domain (dysmenorrhea, dyschezia, dysuria, dyspareunia, chronic pelvic pain) were collected along with the Enzian classification. Baseline characteristics, pain scores, surgical procedure and extent of the disease were also collected. Results In general, more extensive involvement of DE does not lead to an increase in numerical rating scale for pain measures. However, dysuria and bladder involvement do show a clear correlation AUC 0.62 (SE 0.04, CI 0.54-0.71, p< 0.01). Regarding the predictive value of dyschezia, we found a weak, but significant correlation with ureteric involvement; AUC 0.60 (SE 0.04, CI 0.53-0.67, p< 0.01). Conclusions Pain symptoms poorly correlate with anatomical locations of deep endometriosis in almost all pain scores, with the exception of bladder involvement and dysuria which did show a correlation. Also dyschezia seems to have predictive value for DE ureteric involvement and therefore MRI or ultrasound imaging (ureter and kidney) is recommended in the preoperative workup in these patients.