The effect of vaginal pelvic organ prolapse surgery on sexual function

Long-term outcomes and quality of life after Manchester procedure for pelvic reconstructive surgery in women with cervical elongation

OBJECTIVE

Native-tissue techniques for Pelvic Organ Prolapse (POP) repairs, such as the Manchester Procedure (MP), have recently been revitalized. However, there are conflicting opinions regarding correcting cervical elongation support by the MP, and the risk of possible poor outcomes and postoperative complications. Therefore, this study aimed to investigate anatomical and patient-reported outcomes during one year after MP.

DESIGN

Prospective cohort study.

SETTING

This study was conducted on women who underwent the MP for cervical elongation between 2010 and 2020.

PATIENTS

Women with apical compartment prolapse up to stage 3 due to cervical elongation.

INTERVENTIONS

Manchester Procedure.

MEASUREMENTS

Pre and postoperative evaluations by POP Quantification (POP-Q) system were performed, and patients filled out the quality-of-life questionnaires including Pelvic Floor Distress Inventory Short Form 20 (PFDI-20), and POP/Urinary Incontinence Sexual Questionnaire (PISQ-12) before and 12 months after the procedure. Anatomical outcomes were measured by POP-Q and the changes in POP-related symptoms were evaluated and reported.

MAIN RESULTS

33 participants were recruited in the study. Significant anatomical improvements were obtained in all compartments after the surgery. After 12 months in POP-Q examination, the mean (±SD) of Ba was changed from +1.82 (±1.71) to -1.18 (±1.50), C was changed from -1.25 (±2.81) to -6 (±1.82), and D from -6.30 (±1.42) to -7.1 (±1.25) respectively (P < 0.001). POP-Q stage 0-1 was obtained inof7% in the apical compartment (C <  -1), but only in 45.4% in the anterior compartment (Ba <  -1). A significant reduction in symptom scores was obtained for PFDI-20 (P < 0.01) and PISQ-12 (P = 0.011).

CONCLUSIONS

Our findings suggest that the MP provides adequate apical support with improvement in anatomic and subjective findings for patients with cervical elongation.

Current Perspectives in Vaginal Laxity Measurement: A Scoping Review

This scoping review aimed to identify and categorize the available measurement options for vaginal laxity (VL), their indications of use, and whether these measurements can sufficiently provide objective clinical judgment for cases indicated for vaginal rejuvenation with many treatment options nowadays. Systematic searches were conducted on five electronic databases, manually searching articles' bibliographies and predetermined key journals with no date or study design limitations. We included all studies involving VL in their inclusion criteria, treatment indications, and outcome parameters. We used the Arksey and O'Malley frameworks as the guideline in writing this scoping review. Of the 9,464 articles identified, 66 articles and 11,258 subjects were included in the final analysis. The majority of studies were conducted in obstetrics and gynecology (73%), followed by plastic surgery (10%), medical rehabilitation (4.5%), dermatology (4.5%), and others (8%). Most studies originated from the North American region (30%). The following measurement tools were used: (1) interviews, (2) questionnaires, (3) physical/digital examinations, (4) perineometers, and (5) others. Our results suggested that subjective perception of laxity confirmed by directed interview or questionnaire is sufficient to confirm VL. Additional evaluation of pelvic floor muscle through digital examination or perineometer or other preferred tools and evaluation of sexual function through validated questionnaire (Female Sexual Function Index, Female Sexual Distress Scale-Revised, etc.) should follow to ensure holistic care to patients. Future research on the psychometric properties (reliability and validity) of commonly used measurements and the correlation in between subjective and objective measurements should be initiated before their clinical applications.

Female Sexual Dysfunctions and Urogynecological Complaints: A Narrative Review

Female sexual dysfunctions represent a real widespread problem, usually faced from a psychological point of view; however, millions of women worldwide are impacted by pelvic floor dysfunction, personal shame and social taboos, however, continue to inhibit free conversation on the subject. Women's quality of life is considerably improved by screening, diagnosing, and controlling urogenital and sexual issues. This review aims to provide a critical perspective of urogenital conditions and common disturbances in female sexual function associated with these issues. It also includes a discussion of postpartum pelvic dysfunction.

Female Sexual Functioning in Women With a Symptomatic Pelvic Organ Prolapse; A Multicenter Prospective Comparative Study Between Pessary and Surgery

BACKGROUND

Female pelvic organ prolapse (POP) has a negative effect on female sexual functioning and with an increasing life expectancy female sexual dysfunction caused by POP will be an arising global issue.

AIM

Improvement in female sexual functioning, measured with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire IUGA-Revised (PISQ-IR), 24-months after pessary or surgery, for both sexually active (SA) and sexually inactive women (NSA) presenting with POP.

METHODS

A multicenter prospective comparative cohort study was conducted in 22 Dutch hospitals. Women referred with moderate to severe POP symptoms and POP stage ≥ 2 were included and chose either pessary therapy or surgical intervention. The PISQ-IR was filled in at baseline and 24-months, the delta of change was calculated and compared between both groups. Multivariate linear regression was performed to adjust for potential confounding factors in the association between the summary score of the PISQ-IR and therapy.

OUTCOMES

Change in PISQ-IR between pessary and surgical intervention.

RESULTS

The delta of change at 24-months was calculated for 198 women in the pessary group and 129 women in the surgery group. SA women in the surgery group reported statistically significant more improvement on the condition-specific (-0.19 95%CI -0.35; -0.03, P = .02), and condition-impact (-0.48 95%CI -0.69; -0.28, P < .001) domains as well as on the summary score (-0.15 95%CI -0.23; -0.08, P < .001) as compared to the pessary group. No significant differences between pessary and surgery were found on the domains for NSA women. After controlling for potential baseline confounders, surgery still had a statistically significant effect on the summary score (B = 0.08; 95%CI interval 0.007-0.15, P = .03). Women having surgery had 2.62 times higher odds of changing from NSA to SA than pessary therapy.

CLINICAL IMPLICATIONS

SA women who clearly express that POP-related symptoms limit their sexual functioning should be counseled that surgery results in a more remarkable improvement.

STRENGTHS & LIMITATIONS

Our strengths include the large sample size, long-term follow-up, the use of the PISQ-IR as a validated outcome tool evaluating both SA and NSA women, and this study reflects real-life clinical practice that enhances the external validity of the findings. A limitation of our study is the considerable proportion of non-responders at 24-months follow-up.

CONCLUSION

Sexual function in SA women with POP is superior in case surgery is performed as compared to pessary therapy. van der Vaart LR, Vollebregt A, Pruijssers B, et al. Female Sexual Functioning in Women With a Symptomatic Pelvic Organ Prolapse; A Multicenter Prospective Comparative Study Between Pessary and Surgery. J Sex Med 2022;19:270-279.

Impact of surgery on quality of life of Ugandan women with symptomatic pelvic organ prolapse: a prospective cohort study

Background

Pelvic organ prolapse (POP) is a significant public health issue that negatively affects the Quality of Life (QOL) of women in both low and high-income countries. About 20% of women will undergo surgery for POP over their lifetime. However, there is a paucity of information on the effect of surgery on QOL especially in resource-limited settings. We therefore assessed the QOL among women with symptomatic POP living in rural southwestern Uganda and the impact of surgery on their quality of life.

Methods

We conducted a prospective cohort study among 120 women with symptomatic POP scheduled for surgery at the urogynecology unit of Mbarara Regional Referral Hospital. The QOL at baseline and at 1 year after surgery in the domains of physical performance, social interaction, emotional state, sexual life, sleep quality, personal hygiene and urinary bladder function was determined using a King’s Quality of Life questionnaire. A paired t-test was used to compare the difference in mean scores at baseline and at 1-year post-surgery.

Results

Of the 120 participants that were enrolled at baseline, 117(98%) completed the follow-up period of 1 year. The baseline QOL was poor. The domains with the poorest QOL were physical, social, sexual, emotional and sleep quality. The mean QOL scores in all the domains and the overall QOL significantly improved 1 year after surgery (p < 0.001). The overall QOL improved by 38.9% after surgery (p < 0.001).

Conclusions

The QOL was poor among women with symptomatic POP and surgery improved the QOL in all the domains of life. We recommend that surgery as an option for treatment of symptomatic POP should be scaled up to improve on the QOL of these women.

Pelvic Floor Dysfunction And Its Effect On Quality Of Sexual Life

INTRODUCTION

Pelvic floor disorders (PFD) are extremely common; 1 in 3 parous women will experience urinary incontinence, 1 in 2 will develop pelvic organ prolapse, whereas 1 in 10 experience fecal incontinence. PFD are often associated with a significant reduction in women's psychological, social, and sexual well-being.

AIM

To review the current literature on sexual dysfunction related to PFD.

METHODS

A literature search was conducted using PubMed and key words including sexual dysfunction, prolapse, incontinence, pelvic floor dysfunction, and surgical repair.

MAIN OUTCOME MEASURE

The outcome was to identify the nature and severity of sexual dysfunction in women with PFD.

RESULTS

The prevalence of sexual dysfunction is estimated to be around 30-50% in the general population, whereas in women with PFD, the reported incidence rises to 50-83%. The leading factors cited for the reduction in a woman's sexual experience included worries about the image of their vagina for women with pelvic organ prolapse, dyspareunia and coital incontinence in women with urinary incontinence, and fear of soiling when dealing with anal incontinence. Pelvic floor muscle training has been associated with an improvement in sexual function. 11% of parous women will have surgery for pelvic organ prolapse, yet limited data are available on the impact of surgical intervention on sexual function. Native tissue repair of pelvic organ prolapse is associated with an improvement in sexual function, whereas posterior repair with levatorplasty and vaginal mesh repair can increase the risk of postsurgical dyspareunia. Subtotal hysterectomy is not associated with improved sexual function compared with traditional total hysterectomy.

CONCLUSION

It is clear there is an urgent need for further research on the effects of surgery for PFD on sexual function. To date, most studies have focused on anatomic rather than functional outcomes. Verbeek M, Hayward L. Pelvic Floor Dysfunction and Its Effect on Quality of Sexual Life. Sex Med Rev 2019;7:559-564.

Life after pelvic organ prolapse surgery: a qualitative study in Amhara region, Ethiopia

BACKGROUND

Women living in resource constrained settings often have limited knowledge of and access to surgical treatment for pelvic organ prolapse. Additionally, little is known about experiences during recovery periods or about the reintegration process for women who do gain access to medical services, including surgery. This study aimed to explore women's experiences related to recovery and reintegration after free surgical treatment for pelvic organ prolapse in a resource-constrained setting.

METHODS

The study had a qualitative design and used in-depth interviews in the data collection with a purposive sample of 25 participants, including 12 women with pelvic organ prolapse. Recruitment took place at the University of Gondar Hospital, Ethiopia, where women with pelvic organ prolapse had been admitted for free surgical treatment. In-depth interviews were carried out with women at the hospital prior to surgery and in their homes 5-9 months following surgery. Interviews were also conducted with health-care providers (8), representatives from relevant organizations (3), and health authorities (2). The fieldwork was carried out in close collaboration with a local female interpreter.

RESULTS

The majority of the women experienced a transformation after prolapse surgery. They went from a life dominated by fear of disclosure, discrimination, and divorce due to what was perceived as a shameful and strongly prohibitive condition both physically and socially, to a life of gradually regained physical health and reintegration into a social life. The strong mobilization of family-networks for most of the women facilitated work-related help and social support during the immediate post-surgery period as well as on a long-term basis. The women with less extensive social networks expressed greater challenges, and some struggled to meet their basic needs. All the women openly disclosed their health condition after surgery, and several actively engaged in creating awareness about the condition.

CONCLUSIONS

Free surgical treatment substantially improved the health and social life for most of the study participants. The impact of the surgery extended to the communities in which the women lived through increased openness and awareness and thus had the potential to ensure increased disclosure among other women who suffer from this treatable condition.

The Manchester procedure: anatomical, subjective and sexual outcomes

INTRODUCTION AND HYPOTHESIS

Classical native-tissue techniques for pelvic organ prolapse (POP) repairs, such as the Manchester procedure (MP), have been revitalized because of vaginal mesh complications. However, there are conflicting opinions regarding sufficient apical (mid-compartment) support by the MP and concerns about the risk of dyspareunia. The aims of this study were therefore to investigate anatomical and patient-reported outcomes 1 year after MP.

METHODS

Prospective cohort study of 153 females undergoing an MP for anterior compartment POP between October 2014 and June 2016. Pre- and 1-year postoperative evaluations included POP-Q measurements and the questionnaires Pelvic Floor Distress Inventory Short Form 20 (PFDI-20) and POP/Urinary Incontinence Sexual Questionnaire (PISQ-12).

RESULTS

At 1 year, 97% (148/153) attended the follow-up. Significant anatomical improvements (p < 0.01) were obtained in all compartments. Mean Ba was -1.1 (± 1.4), mean C -5.9 (± 1.7) and mean D -7.0 (± 1.2) at follow-up. Point C ≤ -5 was present in 81.1%. POP-Q stage 0-1 was obtained in 99.3% in the mid-compartment (C < -1), but only in 48.6% in the anterior compartment (Ba < -1). A significant reduction in symptom scores was obtained for PFDI-20 (p < 0.01) and PISQ-12 (p = 0.01). No significant changes were seen in dyspareunia rates (q.5, PISQ-12), but 5.6% reported de novo dyspareunia. Concerning POP symptoms, 96.0% reported being cured or significantly improved.

CONCLUSIONS

The Manchester procedure provides adequate apical support, albeit inferior anatomical anterior compartment results, and 96.0% reported being subjectively cured or substantially better at 1-year follow-up, with no significant change in dyspareunia.

Polish translation and validation of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR)

Introduction and hypothesis

The aim of the study was to translate into Polish the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), which evaluates sexual function in sexually active (SA) and not SA (NSA) women with pelvic floor disorders (PFD), and to validate the Polish version.

Methods

After translation, back-translation and cognitive interviews, the final version of PISQ-IR was established. The study group included 252 women with PFD (124 NSA and 128 SA). All women underwent clinical evaluation and completed the PISQ-IR. For test–retest reliability, the questionnaire was administered to 99 patients twice at an interval of 2 weeks. The analysis of criterion validity required the subjects to complete self-reported measures. Internal consistency and criterion validity were assessed separately for NSA and SA women for the PISQ-IR subscales.

Results

The mean age of the women was 60.9 ± 10.6 years and their mean BMI was 27.9 ± 4.9 kg/m². Postmenopausal women constituted 82.5% of the study group. Urinary incontinence (UI) was diagnosed in 60 women (23.8%), pelvic organ prolapse (POP) in 90 (35.7%), and UI and POP in 102 (40.5%). Fecal incontinence was reported by 45 women (17.9%). The PISQ-IR Polish version proved to have good internal consistency in NSA women (α 0.651 to 0.857) and SA women (α 0.605 to 0.887), and strong reliability in all subscales (Pearson’s coefficient 0.759–0.899; p < 0.001). Criterion validity confirmed moderate to strong correlations between PISQ-IR scores and self-reported measures in SA subscales, as well the SA summary score, and weak to moderate correlations in NSA women.

Conclusions

The PISQ-IR Polish version is a valid tool for evaluating sexual function in women with PFD.

Electronic supplementary material

The online version of this article (10.1007/s00192-017-3539-5) contains supplementary material, which is available to authorized users.

A UK questionnaire survey of current techniques used to perform pelvic organ prolapse repair

INTRODUCTION AND HYPOTHESIS

Evidence-based medicine should result in better standardisation of practice. This study aims to evaluate whether there remains variation in surgical techniques in native tissue and graft/mesh repairs of pelvic organ prolapse (POP) in UK practice.

METHODS

A questionnaire survey was conducted to describe current surgical techniques for native tissue and graft/mesh POP repairs performed by a cohort of UK surgeons recruiting to a large multicentre prolapse trial (PROSPECT).

RESULTS

The questionnaire return rate was 90% (n = 56 out of 62). Substantial variations in surgical techniques were seen at every step of the procedure. Native tissue repair: most surgeons used infiltration, 95% (n = 53 out of 56), but the volume used varied (10-80 ml). All but one surgeon performed a midline incision; this surgeon performed an elliptical incision. The depth of tissue dissection varied, being both above and below the vaginal muscularis (fascia). Fascial repair methods included midline, closure of separate fascial defects, paravaginal repair and rectal/levator plication. Graft/mesh repairs: many different products and manufacturers were used. There was variation in the method of attachment of graft/mesh inserts and their placement in relation to the fascia. For both native tissue and graft/mesh repairs, the method of fascial dissection, suturing methods and suture material varied. Most surgeons inserted a pack, 91% (n = 50 out of 55), soaked in varying substances before use.

CONCLUSIONS

There is considerable variation between UK-based surgeons in the surgical techniques used to perform both native tissue and graft/mesh-augmented POP repairs. Further research is required to determine whether these differences influence outcome.

Application of a Mixed Material Graft to Posterior Intravaginal Slingoplasty Procedure: Preliminary Pilot Series

Good anatomic outcomes have been achieved with transvaginal synthetic materials in pelvic organ prolapse, but mesh-related complications are a major health concern. Therefore, developing new synthetic or biological materials with increased tissue strength and decreased complications are major challenges. This paper presents preliminary pilot series of Posterior Intravaginal Slingoplasty (PIVS) procedure performed with mixed material graft containing both autologous tissue and a synthetic material. Six women with symptomatic Utero-Vaginal Prolapse (UVP) ≥ stage 2 underwent the PIVS procedure. Pelvic floor symptoms were assessed with the Pelvic Organ Prolapse Quantification (POP-Q) system, Pelvic Floor Distress Inventory (PFDI), and the Pelvic Floor Impact Questionnaire (PFIQ) both before the procedure and 36 months after the surgery. There were no mesh-related complications or recurrence and all the patients had good functional and anatomic outcomes. These preliminary results are promising, but further long-term studies with a larger series are needed.

Sexual functioning before and after vaginal hysterectomy to treat pelvic organ prolapse and the effects of vaginal cuff closure techniques: a prospective randomised study

OBJECTIVE

To evaluate sexual function in women before and after vaginal hysterectomy (VH) and to compare the effects of horizontal and vertical vaginal cuff closure on sexual function.

STUDY DESIGN

Women with uterine prolapse of stage 2 or higher were included to this prospective, randomized study. All patients underwent VH with McCall Culdoplasty and patients were randomized into two groups in terms of the vaginal cuff closure technique employed which is either vertically (group 1, right to left) or horizontally (group 2, anterior to posterior). Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12 Short Form was used to assess sexual function before and 6 months after surgery.

RESULTS

A total of 78 women participated, 37 in group 1 and 41 in group 2. Significant improvements in were thus evident in both groups 1 (p=0.000) and 2 (p=0.000) after surgery; no significant between-group differences were evident. Overall, 61 women (78,2%) had improved PISQ-12 scores postoperatively, 11 (14,1%) scored the same pre- and post-operatively, and 6 (7,9%) scored lower postoperatively. Women who reported poorer sexual function postoperatively, or no improvement, had new-onset or worsening dyspareunia and/or incontinence.

CONCLUSION

Most women with uterine prolapse of stage 2 or higher who underwent VH with prolapse repair experienced improved sexual lives postoperatively, regardless of the cuff closure technique used. Although VH to treat POP improves anatomical and sexual concerns, surgery per se may have negative effects on sexual function if new-onset or worsening dyspareunia or incontinence develop.

Analysis of changes in sexual function in women undergoing pelvic organ prolapse repair with abdominal or vaginal approaches

INTRODUCTION AND HYPOTHESIS

To examine changes in sexual function after abdominal and transvaginal pelvic organ prolapse repair.

METHODS

Women enrolled in our prospective, longitudinal prolapse database with abdominal sacrocolpopexy (ASC) or transvaginal (TVR) pelvic organ prolapse (POP) repair with or without mesh, between 19 December 2008 through 4 June 2014. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Pelvic Floor Distress Inventory (PFDI -20) were mailed preoperatively, and at 6 and 12 months postoperatively. Patients completed Global Response Assessments to rate their overall satisfaction.

RESULTS

Two hundred and four of the 300 women met the inclusion criteria: 74 out of 204 (36 %) had ASC and 130 out of 204 (64 %) had TVR. Seventy-two out of seventy-four ASCs were performed robotically and 2 were open. Baseline demographics were similar except that the ASC patients were significantly younger (60 vs 63, P = 0.019) and had a higher rate of apical repair (77 % vs 55 %). Thirty-six out of seventy-four ASC (48.7 %) and 63 out of 128 TVR patients (49.2 %) were sexually active at baseline (P = 0.94). Sixteen out of thirty-eight ASC (42.1 %) and 18 out 63 TVR patients (28.6 %; P = 0.16) reported dyspareunia at baseline. Seventy-two out of seventy-four ASC (97 %) and 86 out of 130 TVR patients (66 %) had mesh-augmented repairs. There was no difference in sexual activity or dyspareunia between the groups at the 6- or 12-month follow-up. PISQ and PFDI scores improved significantly in both the ASC and TVR groups over time compared with the baseline (p < 0.0001). Most women in the ASC (77.5 %) and TVR (64.8 %) groups were satisfied with the results of prolapse surgery at 12 months.

CONCLUSIONS

Sexual function and pelvic floor symptoms improved in a similar manner in patients after abdominal and transvaginal POP surgery.

Quality of Life and Sexual Function 2 Years After Vaginal Surgery for Prolapse

OBJECTIVE

To longitudinally assess the effect of native tissue vaginal apical prolapse repair with anti-incontinence surgery on quality of life, sexual function, and body image between uterosacral and sacrospinous suspensions.

METHODS

A planned secondary analysis was performed on 374 women enrolled in a randomized trial of the two types of native tissue repair for apical prolapse. Condition-specific and generic quality of life, sexual function, overall and de novo dyspareunia, and body image were assessed using validated instruments at baseline; 6, 12, and 24 months postoperatively; and changes from baseline were assessed and compared between surgical groups. General linear mixed models were used for comparisons and clinically significant differences were assessed using minimum important differences.

RESULTS

Of the women randomized, 82% had outcomes available at 2 years. Overall, clinically and statistically significant improvements in generic and condition-specific quality of life and sexual function were observed after surgery. Dyspareunia rates decreased from 25% to 16% by 24 months with only 3% of all women undergoing treatment. De novo dyspareunia occurred in 5% and 10% by 12 and 24 months, respectively. Body image scores also significantly improved from baseline. There were no clinically meaningful or statistically significant differences between groups for any of these outcomes (all P>.05).

CONCLUSION

Native tissue vaginal prolapse surgery results in statistically and clinically significant improvements in quality of life, sexual function, and body image at 24 months with no significant differences between uterosacral and sacrospinous suspensions. One in 10 women experience de novo dyspareunia but few requested treatment.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, www.clinicaltrials.gov, NCT00597935.

Native vaginal tissue repair for genital prolapse surgical treatment: a minimum of 30 months of results

OBJECTIVE

The aim of this study was to assess the impact of using native vaginal tissue repair as a surgical treatment for pelvic organ prolapse (POP) on quality of life using validated questionnaires.

STUDY DESIGN

Fifty-one women underwent surgical POP repair. All of the women were evaluated by physical examination using the POP-Q, ICIQ-VS and P-QoL questionnaires prior to surgery as well as six and at least 30 months after surgery.

RESULTS

Fifty-one patients returned for assessment at least 30 months after surgery (median 36 months, range 30-50 months). There was significant improvement in most points - Aa, Ba, C, Bp, Ap, and hg - and at the stage of prolapse. There were statistically significant improvements in bulge symptoms after surgery (p<0.001), and significant differences were also seen regarding questions related to urinary and bowel symptoms. Indeed, most quality of life questionnaire domains showed significant differences before and after surgery.

CONCLUSION

Native vaginal tissue repair improved POP-related symptoms and quality of life after 30-50 months of assessment.

Prolapse or incontinence: what affects sexual function the most?

INTRODUCTION AND HYPOTHESIS

Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) adversely affect sexual function in women. Comparative studies of the two subgroups are few and results are conflicting. The aim of this study was to compare the effect of POP and SUI on the sexual function of women undergoing surgery for these conditions.

METHODS

The study population comprised women with POP or SUI in a tertiary referral hospital in the UK. Women who underwent SUI surgery had no symptoms of POP and had urodynamically proven stress incontinence. Patients with POP had ≥ stage 2 prolapse, without bothersome urinary symptoms. Pre-operative data on sexual function were collected and compared using an electronic pelvic floor assessment questionnaire (ePAQ). The incidence of sexual dysfunction and comparison of symptoms in both groups were calculated using the Mann-Whitney U test.

RESULTS

Three hundred and forty-three women undergoing surgery for either SUI or POP were included. Patients were age-matched, with 184 undergoing SUI surgery (age range 33-77 years) and 159 POP surgery (age range 27-78 years; p = 0.869). The overall impact of POP and SUI was not significantly different in the two subgroups (p = 0.703). However, both patients (73 % vs 36 %; p = 0.00) and partners (50 % vs 24 %; p = 0.00) avoid intercourse significantly more frequently in cases with POP compared with SUI. This did not have a significant impact on quality of life.

CONCLUSIONS

The impact of bothersome SUI or POP on sexual function was found to be similar, but patient and partner avoidance in women with POP was greater than those with SUI.