Sexual function after vaginal surgery for pelvic organ prolapse and urinary incontinence

The effect of transobturator tape surgery on female sexual function: a systematic review and meta-analysis

PURPOSE

We aimed to review the literature regarding the effects of trans obturator tape surgery (TOT) on sexual functions in women with stress urinary incontinence (SUI) to reveal compact data and to reach more consistent and reliable results.

METHODS

PRISMA statement was used in the current review. The databases of PubMed (Medline), Science Direct, and Cochrane Central Register of Controlled Trials were detected independently. We evaluated the studies comparing the preoperative and postoperative sexuality parameters related to the TOT procedure in females. Studies presenting the mean and standard deviation(SD) of global and sub-item Female Sexual Function Index(FSFI) were included in the current study.

RESULTS

We identified 783 studies in full publications or abstract forms using the methodology above and the search terms. Finally, eight studies were included in the meta-analysis. The pooled analysis of the mean difference demonstrated that the total sexual function scores of the patients improved after TOT surgery.

CONCLUSION

The data collected from the current meta-analysis suggest that TOT surgery improves female sexual function.

A Comprehensive Evaluation of Sexual Life in Women After Laparoscopic Sacrocolpopexy using PISQ-IR

INTRODUCTION AND HYPOTHESIS

Although laparoscopic sacrocolpopexy is a recommended procedure for sexually active women, its full impact on sexual life remains underexplored. This study is aimed at comprehensively assessing changes in the quality of sexual life and the prevalence of dyspareunia in women 1 year after laparoscopic sacrocolpopexy.

METHODS

This prospective observational study enrolled women undergoing laparoscopic sacrocolpopexy for pelvic organ prolapse stage≥ 2. Included were women with a completed Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA Revised (PISQ-IR) questionnaire before and at 1 year after surgery. Individual domains of the PISQ-IR were compared separately. Dyspareunia, single summary PISQ-IR and PISQ-12 scores were additionally compared in sexually active women. Statistical analyses included paired signed rank, Wilcoxon, Median, Chi-squared, and Fisher tests (p < 0.05).

RESULTS

Between February 2015 and December 2019, a total of 333 women were included. Mean age was 61.0 ± 11.2 and 141 (42%) reported being sexually active at baseline. At 12 months postoperatively, sexual activity was preserved in 110 (78%) of these women and an additional 26 women (14%) became sexually active. Both single-summary PISQ-IR (3.4 vs 3.6, p < 0.01) and PISQ-12 (36.0 vs 38.1, p < 0.01) scores increased significantly. The only variable that was associated with deteriorated scores postoperatively was a higher BMI. Individual domain analyses revealed significant improvement in condition-specific and condition-impact domains, except for the desire domain, which deteriorated. Prevalence of dyspareunia decreased post-surgery from 21.8% to 16.4%, p < 0.05. Newly sexually active women were older, had shorter vaginal length preoperatively, but lower PISQ-IR scores postoperatively than sexually inactive women pre- and postoperatively. Women ceasing sexual activity were older and had lower preoperative PISQ-IR scores than sexually active women pre- and postoperatively.

CONCLUSIONS

Although the overall rate of sexually active women and sexual desire declined 12 months after sacrocolpopexy, overall sexual function scores improved and the prevalence of dyspareunia decreased.

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.

Sexual Activity and Dyspareunia 1 Year After Surgical Repair of Pelvic Organ Prolapse

OBJECTIVE

To describe sexual activity and risks for dyspareunia after pelvic organ prolapse surgery.

METHODS

This was a secondary analysis of data from four randomized trials conducted between 2002 and 2018. Standard assessments and validated measures of sexual function were assessed at baseline and at 12 months postoperatively. Anterior apical surgeries were grouped by approach: transvaginal native tissue repairs, transvaginal mesh or graft-augmented repairs, and abdominal sacrocolpopexy. Additional surgeries, which included posterior repair, hysterectomy, and slings, were analyzed. Bivariate analyses and logistic regression models identified risk factors for postoperative dyspareunia.

RESULTS

Of the 1,337 women enrolled in the trials, 932 had sufficient outcome data to determine dyspareunia status. Of these before surgery, 445 (47.8%) were sexually active without dyspareunia, 89 (9.6%) were sexually active with dyspareunia, 93 (10.0%) were not sexually active owing to fear of dyspareunia, and 305 (32.7%) were not sexually active for other reasons. At 12 months, dyspareunia or fear of dyspareunia was present in 63 of 627 (10.0%); occurred de novo in 17 of 445 (3.8%) and resolved in 136 of 182 (74.7%). Multivariable regression demonstrated baseline dyspareunia as the only factor associated with postoperative dyspareunia (adjusted odds ratio 7.8, 95% CI 4.2-14.4). No other factors, including surgical approach, were significantly associated with postoperative dyspareunia. Too few had de novo dyspareunia to perform modeling.

CONCLUSION

Dyspareunia is common in one in five women before undergoing prolapse surgery. Surgical repair resolves dyspareunia in three out of four women with low rates of de novo dyspareunia at less than 4%. Preoperative dyspareunia appears to be the only predictor of postoperative dyspareunia.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT00065845, NCT00460434, NCT00597935, and NCT01802281.

Sexual activity and function of women with severe pelvic organ prolapse subjected to a classical vaginal surgery. A Multicentre study

INTRODUCTION AND OBJECTIVE

Pelvic organ prolapse (POP) is related with female sexual dysfunction. The present study aimed to determine the impact of POP corrective surgery on the sexual life of women with advanced POP.

MATERIALS AND METHODS

A prospective, multicentre cohort study was designed, including patients with grade≥II, symptomatic POP, who underwent vaginal surgery with traditional procedures. Sexual activity and function were assessed by PISQ-IR before surgery and 12 months after.

RESULTS

We included 355 women; 322 had data from the follow-up visit. The mean (SD) age was 64.8 (9.9) years. At baseline, 170 women were sexually active and 185 were not. After surgery, 29 women (16.8%) became sexually active and 20 (12.8%) ceased sexual activity. Before surgery, 42.3% reported not having sexual intercourse due to bladder, bowel or POP problems; and 11.4% after surgery. At baseline visit, 25.3% had no sexual activity due to pain, however, at follow-up visits, this percentage was 8.5%. A statistically significant improvement was observed in 5 out of 6 scales of the PISQ-IR in sexually active women.

CONCLUSIONS

Symptomatic POP is associated with female sexual dysfunction. Surgical intervention seems to have a positive impact on sexual life among sexually inactive and active women.

Evaluation of sexual function in Brazilian women with and without chronic pelvic pain

Purpose

The aim of this study was to evaluate sexual function in women with chronic pelvic pain (CPP) compared to a control group without CPP and to investigate the factors associated with sexual dysfunction in women with CPP.

Methods

This cross-sectional study included 100 women with CPP and 100 controls. Sexual function was evaluated using the Female Sexual Function Index (FSFI) and depression and anxiety using the Hospital Anxiety and Depression Scale (HADS). A generalized linear model was used to compare the groups with respect to the overall FSFI score and the scores obtained for each FSFI domain. Multiple logistic regression analysis was used to identify the factors associated with sexual dysfunction in the study group.

Results

Anxiety was present in 66.0% of women with CPP in the study group compared to 49.0% of the controls (P=0.022). Depression was detected in 63.0% of women with CPP in the study group and in 38.0% of the controls (P=0.001). Sexual dysfunction was identified in 81.0% of the women with CPP in the study group compared to 58.0% of the controls (P=0.003). Following adjustment, the women with CPP had significantly lower mean scores compared to the controls in the FSFI domains of desire (3.0±1.3 vs 3.6±1.3; P=0.038), arousal (2.6±1.6 vs 3.4±1.9; P=0.002), lubrication (3.2±1.9 vs 3.7±2.3; P=0.011), orgasm (3.0±1.9 vs 3.6±2.2; P<0.002), and pain (2.5±1.7 vs 3.4±2.2; P<0.001). There was no difference between the groups for the satisfaction domain (P=0.337) or for the overall score (P=0.252). A positive and independent association was found between depression and sexual dysfunction in the women with CPP (P=0.012).

Conclusion

In the women with CPP, sexual dysfunction was more common, and the scores in most of the sexual function domains were poorer than in the control group. Concurrently, depression was found to be positively associated with sexual dysfunction in the women with CPP.

Recovering sexual satisfaction after prolapse surgery: a secondary analysis of surgical recovery

INTRODUCTION AND HYPOTHESIS

We compared pre- and postoperative sexual function scores in sexually active women undergoing pelvic organ prolapse (POP) surgery.

METHODS

Planned secondary analysis of women enrolled in the Restricted Convalescence: Outcomes Following Urogynecologic Procedures study, a randomized trial of postoperative activity after POP surgery. All participants could return to sexual activity at 6 weeks. Participants completed the Pelvic Floor Distress Inventory (PFDI), the Patient-Reported Outcomes Measurement Information System (PROMIS) profile, and the Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaires at baseline and 3 months. GRISS is a validated 28-item survey for heterosexual couples that contains seven subscales to assess sexual function. Higher scores represent worse sexual function.

RESULTS

Thirty-seven sexually active women were assessed. Mean age ±  standard deviation (SD) was 56 ± 11, most of whom (92%) were Caucasian; 78% had undergone minimally invasive sacrocolpopexy, and the remainder had native tissue vaginal repairs. GRISS scores improved 3 months after surgery [4.5 ± 2.6 to 3.6 ± 2.2, p < 0.001; mean decrease of 0.9, 95% confidence interval (CI) 0.36-1.36]. PFDI scores improved from 122 ± 53 at baseline to 28 ± 31 at 3 months (p < 0.001). Higher GRISS scores were correlated with higher PFDI scores (Spearman's rho = 0.35, p = 0.03) at baseline and 3 months (Spearman's rho = 0.31, p = 0.03). Several GRISS subscales improved after surgery: partner avoidance (p = 0.01), vaginismus (p = 0.02), noncommunication (p = 0.01), dissatisfaction (p = 0.03), and anorgasmia (p = 0.001). However, sexual infrequency (p = 0.08) and nonsensuality (p = 0.4) did not change. Fifty-one percent had sexual dysfunction before surgery, which decreased to 32% after surgery (p = 0.04).

CONCLUSION

Sexual function and satisfaction are significantly improved 3 months following POP surgery. Improved sexual function is correlated with improved pelvic floor symptoms.

Modified laparoscopic pectopexy: short-term follow-up and its effects on sexual function and quality of life

INTRODUCTION AND HYPOTHESIS

This study examined the early outcomes of laparoscopic (LS) pectopexy and evaluated its effects on female sexual function and quality of life (QoL).

METHODS

Twenty-two patients with apical prolapse who underwent LS pectopexy were included. Outcomes of the procedure were noted; the Female Sexual Function (FSFI) and Prolapse Quality of Life (P-QOL) questionnaires were completed preoperatively and 6 months postoperatively.

RESULTS

There was no evidence of recurrent prolapse or constipation; the percentages of exacerbation of cystocele, rectocele, de novo stress urinary incontinence (SUI), and de novo urgency (UUI) were 4.5%, 9.0%, 4.5%, and 4.5%, respectively (mean follow-up 10.41 months). FSFI and P-QOL scores improved significantly (p < 0.05) postoperatively.

CONCLUSIONS

LS pectopexy shows promising results for pelvic organ prolapse (POP) surgery with comparable outcomes. It also improved the FSFI and P-QOL scores in POP patients.

Transvaginal Bilateral Sacrospinous Fixation after Second Recurrence of Vaginal Vault Prolapse: Efficacy and Impact on Quality of Life and Sexuality

Objective

Our aim was to study the efficacy of transvaginal bilateral sacrospinous fixation (TBSF) and its impact on quality of life (QoL) and sexual functions in women affected by second recurrences of vaginal vault prolapse (VVP).

Materials and Methods

We performed a prospective observational study on 20 sexually active patients affected by second recurrence of VVP, previously treated with monolateral sacrospinous fixation. TBSF was performed in all the patients. They had been evaluated before the surgery and at 12-month follow-up through pelvic organ prolapse quantification (POP-Q) system, Short Form-36 (SF-36), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12).

Results

At 12-month follow-up, 18 out of 20 (90%) patients were cured of their recurrent VVP. No major intra- and postoperative complications occurred. We found a significant improvement in 4/5 POP-Q landmarks (excluding total vaginal length), SF-36, and PISQ-12 scores.

Conclusion

According to our data analysis, TBSF appears to be safe, effective, and able to improve both QoL and sexual functions in patients affected by second recurrence of VVP after previous monolateral sacrospinous fixation.

Prospective observational study of the impact of vaginal surgery (pelvic organ prolapse with or without urinary incontinence) on female sexual function

INTRODUCTION AND HYPOTHESIS

There is a difference of opinion in the literature as to whether pelvic organ prolapse (POP) is a direct cause of female sexual dysfunction (FSD). Sexual function in women is negatively impacted by the presence of urinary symptoms. Thus, sexual dysfunction (SD) might be improved, unchanged, or worsened by pelvic floor surgery.

METHODS

In this study, we observed SD and impact of surgical intervention on female sexual function (FSF) using a validated Prolapse/Urinary Incontinence Sexual Questionnaire Short Form (PISQ-12) in women undergoing surgery for POP with or without urinary incontinence. Two hundred women were recruited and followed up at 6 and 12 months postoperatively.

RESULTS

Sexual function (SF) as measured by the PISQ-12 improved after surgery irrespective of the nature of surgery or the patient's past gynaecology history. Improvement in SF was seen by 6 months (97 patients) postsurgery (P < 0.05), after which (at 12 months; 80 patients) no further change was observed. Improved SF was associated with better patient satisfaction postoperatively.

CONCLUSIONS

Sexual function improved in women following surgery for POP with or withour urinary incontinence, irrespective of the nature of surgery and the patient's past gynecologic history. Results of this study will assist when counselling women with POP with or without urinary incontinence regarding treatment options.

Prevalence and factors associated with urinary incontinence in climacteric

OBJECTIVE

To estimate the prevalence and identify associated factors to urinary incontinence (UI) in climacteric women.

METHOD

In a cross-sectional study with a stratified random sample, 1,200 women aged between 35 and 72 years were studied, enrolled in the Family Health Strategy in the city of Pindamonhangaba, São Paulo. Urinary incontinence was investigated using the International Consultation of Incontinence Questionnaire - Short Form, while associated factors were assessed based on a self-reported questionnaire with socio-demographic, obstetric and gynecological history, morbidities and drug use. The prevalence of urinary incontinence was estimated with a 95% confidence interval (95CI) and the associated factors were identified through multiple logistic regression model performed using Stata software, version 11.0.

RESULTS

Women had a mean age of 51.9 years, most were in menopause (59.4%), married (87.5%), Catholic (48.9%), and declared themselves black or brown (47.2%). The mean age of menopause of women with UI was 47.3 years. The prevalence of UI was 20.4% (95CI: 17.8-23.1%). The factors associated with UI were urinary loss during pregnancy (p=0.000) and after delivery (p=0.000), genital prolapse (p=0.000), stress (p=0.001), depression (p=0.002), and obesity (p=0.006).

CONCLUSION

The prevalence of UI was lower but similar to that found in most similar studies. Factors associated with the genesis of UI were urinary loss during pregnancy and after delivery, genital prolapse and obesity.

Comparison of sexual function between sacrocolpopexy and sacrocervicopexy

Objective

To compare sexual function before and 12 months after between sacrocolpopexy and sacrocervicopexy.

Methods

This retrospective study examined a cohort of 55 sexually active women who underwent either supracervical hysterectomy with sacrocervicopexy (n=28) or total abdominal hysterectomy with sacrocolpopexy (n=27) for stage II to IV pelvic organ prolapse. Pelvic floor support was measured with Pelvic Organ Prolapse-Quantification examination. Pelvic floor function was measured with the Pelvic Floor Distress Inventory-Short Form 20 and sexual function was measured with Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-Short Form 12 (PISQ-12).

Results

Baseline pelvic floor symptoms, demographics and PISQ-12 questionnaire scores were similar between the two groups. Overall improvements in sexual function were seen based on PISQ-12 scores in both groups, but were not statistically significant. No differences were seen in PISQ-12 scores regardless of sparing the cervix or surgical route. Responses to the PISQ-12 question of avoiding sexual intercourse because of vaginal bulging showed significant improvement in both group. No recurrences of prolapse occurred.

Conclusion

In women with pelvic organ prolapse, sexual function after either sacrocolpopexy or sacrocervicopexy was not different. Sexual dysfunction in terms of avoidance of sexual activity because of vaginal bulging was greatly improved in both groups with statistical significance.

Incidence and Risk Factors for Pelvic Pain After Mesh Implant Surgery for the Treatment of Pelvic Floor Disorders

STUDY OBJECTIVE

Our aim was to assess incidence and risk factors for pelvic pain after pelvic mesh implantation.

DESIGN

Retrospective study (Canadian Task Force classification II-2).

SETTING

Single university hospital.

PATIENTS

Women who have undergone surgery with pelvic mesh implant for treatment of pelvic floor disorders including prolapse and incontinence.

INTERVENTIONS

Telephone interviews to assess pain, sexual function, and general health.

MEASUREMENTS AND MAIN RESULTS

Pain was measured by the McGill Short-Form Pain Questionnaire for somatic pain, Neuropathic Pain Symptom Inventory for neuropathic pain, Pennebaker Inventory of Limbic Languidness for somatization, and Female Sexual Function Index (FSFI) for sexual health and dyspareunia. General health was assessed with the 12-item Short-Form Health Survey. Among 160 enrolled women, mean time since surgery was 20.8 ± 10.5 months, mean age was 62.1 ± 11.2 years, 93.8% were white, 86.3% were postmenopausal, and 3.1% were tobacco users. Types of mesh included midurethral sling for stress incontinence (78.8%), abdominal/robotic sacrocolpopexy (35.7%), transvaginal for prolapse (6.3%), and perirectal for fecal incontinence (1.9%), with 23.8% concomitant mesh implants for both prolapse and incontinence. Our main outcome, self-reported pelvic pain at least 1 year after surgery, was 15.6%. Women reporting pain were younger, with fibromyalgia, worse physical health, higher somatization, and lower surgery satisfaction (all p < .05). Current pelvic pain correlated with early postoperative pelvic pain (p < .001), fibromyalgia (p = .002), worse physical health (p = .003), and somatization (p = .003). Sexual function was suboptimal (mean FSFI, 16.2 ± 12.1). Only 54.0% were sexually active, with 19.0% of those reporting dyspareunia.

CONCLUSION

One in 6 women reported de novo pelvic pain after pelvic mesh implant surgery, with decreased sexual function. Risk factors included younger age, fibromyalgia, early postoperative pain, poorer physical health, and somatization. Understanding risk factors for pelvic pain after mesh implantation may improve patient selection.

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.

McCall Culdoplasty vs. Sacrospinous Ligament Fixation after vaginal hysterectomy: comparison of postoperative vaginal length and sexual function in postmenopausal women

OBJECTIVES

To compare preoperative and postoperative vaginal length in sexually active postmenopausal women who underwent vaginal hysterectomy with McCall Culdoplasty or Sacrospinous Ligament Fixation and investigate whether these findings are correlated with sexual function.

STUDY DESIGN

Fifty-eight sexually active postmenopausal women planned to undergo vaginal hysterectomy during the reconstructive surgical treatment of stage 2 or 3 uterine prolapse were included. They were classified into two groups according to their self-selections. Twenty-nine women underwent McCall Culdoplasty adjunct to hysterectomy while 29 women had Sacrospinous Ligament Fixation with hysterectomy. Vaginal length was measured before and after vaginal surgery at 6-week and 6-month follow-up. Sexual function were assessed by Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 form, preoperatively and 6 months postoperatively.

RESULTS

It was found that McCall Culdoplasty and Sacrospinous Ligament Fixation adjunct to vaginal hysterectomy shortened vaginal length significantly. And, the decrease in vaginal length was greater in McCall Culdoplasty group compared to Sacrospinous Ligament Fixation group. However, preoperative and postoperative sexual function questionnaire scores were not correlated with vaginal lengths.

CONCLUSION

McCall Culdoplasty or Sacrospinous Ligament Fixation adjunct to vaginal hysterectomy shortens vaginal length postoperatively. However these changes do not affect sexual function in postmenopausal women.

Sexual function in women before and after surgery for pelvic organ prolapse

OBJECTIVE

The aim of this study was to evaluate sexual function in women before and after surgery for pelvic organ prolapse (POP) using native tissue repair.

DESIGN

A prospective observational study.

SETTING

Danish university hospital, between December 2008 and May 2010.

POPULATION

Eighty-one patients who had a POP operation with native tissue repair performed.

METHODS

The patients completed a validated Danish questionnaire on prolapse, the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire - 12 Short Form (PISQ-12-SF), and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) before undergoing surgery and six months postoperatively.

MAIN OUTCOME MEASURES

Differences in PISQ-12-SF measures six months after the operation in different types of POP operations.

RESULTS

Preoperatively, the PISQ-12-SF score (mean ± SD) was 35.2 ± 4.6 and postoperatively 38.3 ± 3.9, giving a significant difference of 3.0 ± 3.8. (p < 0.05). Thirty-seven women (72%) improved their PISQ-12-SF score postoperatively, nine (18%) had an equal score, and five (10%) reported a lower score. There was no significant difference in the PISQ-12-SF scores between different operations. The ICIQ-UI-SF showed an overall improvement in incontinence postoperatively with a small correlation to PISQ-12-SF.

CONCLUSIONS

The majority of patients who undergo operation for different kinds of POP using native tissue repair, experience an improvement in their sexual life postoperatively. Most women with preoperative urinary incontinence experienced cure or improvement after POP surgery.

The Long Term Effect of Elective Colpoperineoplasty on Sexual Function in the Reproductive Aged Women in Iran

Objective. Many women are suffering from sexual dysfunction followed by vaginal laxity in their reproductive age. The aim of this study was to evaluate the long term effect of colpoperineoplasty on sexual function in Iranian reproductive aged women. Methods. This was a prospective observational study in which 79 women with vaginal laxity who were candidate for selective colpoperineoplasty in Jahrom, Iran, were recruited. Data on sexual function was collected via the Female Sexual Function (FSFI) questionnaire preoperatively, six months and 18 months after colpoperineoplasty. The paired t-test, Wilcoxon, Mann-Whitney, and Repeated Measure test were utilized for statistical purposes. Results. Seventy-six women completed the study by 18 months. The mean FSFI score changed from 24.19 ± 3.09 in baseline to 26.92 ± 3.41 after six months (P < 0.001); however dyspareunia and vaginal dryness were increased significantly. After 18 months all areas of sexual function including pain and lubrication improved significantly compared to the 6th month (P < 0.001). Sexual satisfaction was increased significantly six and 18 months after surgery (P < 0.001), and the total score of sexual function increased to 32.61 ± 1.32 after 18 months (P < 0.001). Conclusion. The long term effect of colpoperineoplasty in women who suffer from vaginal laxity is promising. It seems that patient's dissatisfaction of sexual function can be a basis for colpoperineoplasty.

A systematic review and meta-analysis of the impact of native tissue repair for pelvic organ prolapse on sexual function

INTRODUCTION AND HYPOTHESIS

The aim of this review was to investigate the impact of native tissue repair for pelvic organ prolapse (POP) on overall sexual function and dyspareunia.

METHODS

Cochrane Incontinence Group Specialized Register of Controlled Trials, The Cochrane Central Register of Controlled Trials, MEDLINE, and Embase were searched for trials of prolapse surgery assessing sexual function and dyspareunia before and after surgery. We assessed observational studies and randomized controlled trials investigating the impact of surgical correction of POP on sexual function. Surgical interventions assessed were anterior and/or posterior repair with or without a vaginal hysterectomy. Studies including patients undergoing concurrent incontinence surgery or vaginal mesh insertion were excluded from the analysis. Dyspareunia was analyzed separately.

RESULTS

We identified 674 potential citations, of which 14 articles assessed sexual function and/or dyspareunia before and after traditional prolapse surgery. The results suggest evidence for significant improvement in sexual function postsurgery, with a standardized mean difference of -0.55, 95 % confidence interval (CI) -0.68 to -0.43 in favor of surgical correction. Dyspareunia rates were also significantly improved postoperatively, with overall odds ratio of at least 2.5 times as likely as the chances of deterioration.

DISCUSSION

Sexual function is significantly improved and dyspareunia significantly reduced following native tissue prolapse surgery. There were several methodological problems with the quality of the primary research, particularly related to study heterogeneity, use of different outcome measures, and absence of well-designed randomized controlled trials.

Outcomes of robotic sacrocolpopexy: a systematic review and meta-analysis

OBJECTIVES

Robotic sacrocolpopexy has been rapidly incorporated into surgical practice without comprehensive and systematically published outcome data. The aim of this study was to systematically review the currently published peer-reviewed literature on robotic-assisted laparoscopic sacrocolpopexy with more than 6 months of anatomic outcome data.

METHODS

Studies were selected after applying predetermined inclusion and exclusion criteria to a MEDLINE search. Two independent reviewers blinded to each other's results abstracted demographic data, perioperative information, and postoperative outcomes. The primary outcome assessed was anatomic success rate defined as less than or equal to pelvic organ prolapse quantification system (POP-Q) stage 1. A random effects model was performed for the meta-analysis of selected outcomes.

RESULTS

Thirteen studies were selected for the systematic review. Meta-analysis yielded a combined estimated success rate of 98.6% (95% confidence interval, 97.0%-100%). The combined estimated rate of mesh exposure/erosion was 4.1% (95% confidence interval, 1.4%-6.9%), and the rate of reoperation for mesh revision was 1.7%. The rates of reoperation for recurrent apical and nonapical prolapse were 0.8% and 2.5%, respectively. The most common surgical complication (excluding mesh erosion) was cystotomy (2.8%), followed by wound infection (2.4%).

CONCLUSIONS

The outcomes of this analysis indicate that robotic sacrocolpopexy is an effective surgical treatment of apical prolapse with high anatomic cure rate and low rate of complications.

Sexual function after vaginal and abdominal fistula repair

OBJECTIVE

The purpose of this study was to compare clinical outcomes and sexual function between transvaginal and transabdominal repairs of vesicovaginal fistulae (VVF).

STUDY DESIGN

Participants (99 women with VVF at a tertiary referral center) were treated with urinary catheterization for 12 weeks and, if the procedure was unsuccessful, underwent repair using either the transvaginal (Latzko) or transabdominal technique. Objective clinical parameters were analyzed; subjective outcomes were recorded prospectively before surgery and at the 6-month follow-up examination with the use of the female sexual function index to evaluate sexual function and the visual analog scale to measure general disturbance by the fistula.

RESULTS

After bladder drainage for 12 weeks, 8 patients had spontaneous fistula closure. Demographic variables were similar in the transvaginal (n = 60) and transabdominal (n = 31) repair groups. The transvaginal procedure showed significantly shorter operation times, less blood loss, and shorter hospital stay. Continence rates 6 months after surgery were 82% (transvaginal) and 90% (transabdominal). Sexual function in the 64 sexually active patients was significantly improved, and overall disturbance by the fistula was reduced with both operative techniques. Neither surgical intervention was superior to the other regarding sexual function or visual analog scale.

CONCLUSION

Fistula repair improves sexual function and quality of life with no difference attributable to surgical route. Given this and that operating time, blood loss and length of stay are less with the transvaginal approach, the transvaginal approach is preferred in VVF repair if fistula and patient characteristics are suitable.

Male sexual function and pelvic floor surgery of their female partner: A one-year follow-up study

OBJECTIVE

The aim of this study was to examine if sexual function of male partners changed after surgery for pelvic floor disorders and to explore associated factors.

STUDY DESIGN

This was an observational follow-up study at the Gynecological Department at the St Olavs University Hospital, Trondheim. The sample consisted of 35 male partners of women scheduled for pelvic organ prolapse or stress urinary incontinence surgery. Self-administered questionnaires, containing validated instruments as well as exploratory questions, were sent to women and their partners before and one year after pelvic floor surgery. Vaginal dimensions were measured in all women according to the Pelvic Organ Prolapse Quantification System, both before and after the surgery.

MAIN OUTCOME MEASURES

The Brief Sexual Function Instrument and the presence of erectile dysfunction.

RESULTS

One year after pelvic floor surgery, scores for sexual drive, erection and overall satisfaction from the Brief Sexual Function Instrument were unchanged; the ejaculation score (range 0-4) had mildly improved from a range of 4 (median 4) to a range of 3.5 (median 4), (p = 0.014). The proportion of men with erectile dysfunction was unchanged, while the proportion of men reporting vaginal wind had significantly decreased (p = 0.016). None of the baseline factors, subjective experiences or vaginal dimensions at baseline or follow-up were associated with the improved ejaculation score; only a reduction in the proportion of men reporting their partners with dyspareunia (ns) was significantly correlated (Spearman's rho 0.42, p = 0.019).

CONCLUSION

Sexual function of male partners was unchanged or mildly improved after pelvic floor surgery.

Changes in sexual function and comparison of questionnaires following surgery for pelvic organ prolapse

PURPOSE

The aim of this study was to evaluate the effect of surgical repair of pelvic organ prolapse on female sexual function and to assess correlations between the two using two current standardized questionnaires.

MATERIALS AND METHODS

From October 2009 to September 2010, 143 patients with posterior compartment or combined vaginal prolapse were included. We assessed surgical outcomes according to anatomical change in the vagina and results of the Female Sexual Function Index (FSFI) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function questionnaire (PISQ-12) both pre- and postoperatively.

RESULTS

Among the 143 preoperative patients, 99 and 84 patients responded to the PISQ-12 and FSFI, respectively. The mean PISQ-12 score increased after surgery (p<0.001). Specifically, postoperative scores for questions 8 and 12 were higher than their respective preoperative scores (p<0.001). Postoperatively, mean FSFI score changed only slightly (p=0.76), and only the score for the satisfaction domain was improved (p=0.023). In regards to vaginal anatomy, vaginal length was significantly greater postoperatively (6.99±0.18 vs. 7.56±1.08, p<0.001), and postoperative vaginal caliber was narrowed to a two-finger width.

CONCLUSION

In this study, surgery for pelvic organ prolapse was shown to affect female sexual function. Moreover, menopause was associated with a change in postoperative sexual function.

Effect of colporrhaphy on the Sexual Dysfunction of women with pelvic organ prolapsed

OBJECTIVE

To evaluate the effect of colporrhaphy on sexual problems of women with pelvic organ prolapseis.

METHODOLOGY

Sixty patients with pelvic organ prolapse (cystocele - rectocele) in a quasi-experimental study before and after treatment were included. Presence of pelvic organ prolapseis was assessed by examination in the lithotomy position. Degree of prolapse was determined according to Pelvic organ Prolapse Quantification (POPQ). Their degree of prolapse was marked from 1 to 3 then was colporrhaphy performed. Follow up of patients for sexual satisfaction was performed three and six months after surgery by telephone and interviews. Data were analyzed by SPSS version 15, the McNamara test, T-test, absolute and relative frequency, mean and standard deviation.

RESULTS

In sixty (60) women who were studied the mean and standard deviation of pregnancy and delivery rate were 4.4 ±2.2 and 4±2.1 respectively. About 65% of patients were over 35 years of age, 88.3% of women had the history of vaginal delivery and 10% of them had both the history of vaginal delivery and cesarean section. Score of sexual desire abstaining from sex and orgasm due to vaginal bulge before, 3 months and 6 months after colporrhaphy was significant (p=0.0001), but of sexual arousal scores there was no differences between each other. Mean of sexual satisfaction before operation was 30.75±5.70 and three months after operation it was 33.77±4.24 and six months after operation 36.03±3.5 which according to T-Test there was significant (p=0.0001).

CONCLUSION

Sexual desire, orgasm and sexual satisfaction increased after colporrhaphy, frequency of intercourse and sexual arousal remains unchanged. It appears that colporrhaphy reduce symptoms associated with prolapse which is leading to sexual dissatisfaction and improved sexual satisfaction.

Changes in female sexual function after pelvic organ prolapse repair: role of hysterectomy

INTRODUCTION AND HYPOTHESIS

Incontinence and pelvic organ prolapse (POP) have an impact on sexuality. Few studies evaluate the impact of hysterectomy on sexual function. We designed the present observational prospective longitudinal cohort study in order to evaluate the impact of uterus preservation after POP repair on sexual function.

METHODS

Between January 2006 and January 2011, 107 patients with POP, mean age 58 ± 8.9 years, underwent colposacropexy with or without hysterectomy. All the women without uterine disease were offered the chance to preserve the uterus. All patients gave written informed consent and completed the Female Sexual Function Index (FSFI) questionnaire, before and after surgery, provided detailed case history, underwent urogynaecological examination and urodynamic assessment and completed the Urogenital Distress Inventory short form (UDI-6) and Incontinence Impact on Quality of Life short form (IIQ-7) questionnaires, and the satisfaction Visual Analogue Scale (VAS). One year after surgery patients repeated the FSFI questionnaire and underwent a clinical check-up. The primary end-point was post-operative sexual function as evaluated by the FSFI, the secondary end-points were objective anatomical and subjective success, defined respectively as no prolapse and no incontinence-related symptoms.

RESULTS

Sixty-eight patients were included: 32 underwent uterus-sparing surgery and 36 hysterectomy plus colposacropexy. After surgery both groups had significant improvements in the total FSFI score and in the domains of desire, arousal and orgasm. The median post-operative scores of desire, arousal, and orgasm domains showed significant improvements in the uterus-sparing group compared with the hysterectomy group. None of the women had a uterine or vault prolapse recurrence.

CONCLUSIONS

Our data demonstrate that POP plays a role in female sexual dysfunction and uterus sparing surgery is associated with a greater improvement in sexual function.

Sexual function and quality of life following retropubic TVT and single-incision sling in women with stress urinary incontinence: results of a prospective study

PURPOSE

The objective of this prospective cohort study was to compare effectiveness, morbidity, quality of life (QoL) and sexual function in women treated with tension-free vaginal tape (TVT) versus single-incision sling (SIS) in the treatment of female stress urinary incontinence (SUI).

METHODS

Retropubic TVT sling or SIS was implanted in local anesthesia and patients were followed post-operatively for 6 months. Evaluation was performed to assess post-operative rate of continence, complications, changes in sexual function and patient reported quality of life. Female sexual function was evaluated before and after sling procedure using Female Sexual Function Index (FSFI) in sexually active patients.

RESULTS

From January 2009 to December 2011, 150 patients were enrolled and underwent a procedure to implant the retropubic TVT (n = 75) or the MiniArc(®) and Ajust(®) SIS (n = 75). Overall, 93.3 % of the patients who successfully received SIS demonstrated total restoration (84 %) or improvement of continence (9.3 %) at the 6 month post-operative study visit. In TVT group we found 88 % total continence and 6.7 % improvement, respectively. Improvements were seen in the QoL scores related to global bladder feeling (89.3 %) in SIS group and 96 % for TVT. Post-operative FSFI score improves significantly and were comparable in both groups (SIS pre-operative 24.30 ± 4.56 to 27.22 ± 4.66 (P < 0.001) post-operative; TVT 24.63 ± 6.62 to 28.47 ± 4.41, respectively).

CONCLUSIONS

The SIS procedure appears to be as effective in improving incontinence-related quality of life and sexual function as the TVT through 6 months of post-operative follow-up. No differences in complications and sexual function were demonstrated between the groups.

Sexual function after anterior vaginal wall prolapse surgery

OBJECTIVE

The aim of this study was to compare female sexual function after surgical treatment of anterior vaginal prolapse with either small intestine submucosa grafting or traditional colporrhaphy.

METHODS

Subjects were randomly assigned, preoperatively, to the small intestine submucosa graft (n = 29) or traditional colporrhaphy (n = 27) treatment group. Postoperative outcomes were analyzed at 12 months. The Female Sexual Function Index questionnaire was used to assess sexual function. Data were compared with independent samples or a paired Student's t-test.

RESULTS

In the small intestine submucosa group, the total mean Female Sexual Function Index score increased from 15.5±7.2 to 24.4±7.5 (p<0.001). In the traditional colporrhaphy group, the total mean Female Sexual Function Index score increased from 15.3±6.8 to 24.2±7.0 (p<0.001). Improvements were noted in the domains of desire, arousal, lubrication, orgasm, satisfaction, and pain. There were no differences between the two groups at the 12-month follow-up.

CONCLUSIONS

Small intestine submucosa repair and traditional colporrhaphy both improved sexual function postoperatively. However, no differences were observed between the two techniques.

Vaginal Rejuvenation: An In-Depth Look at the History and Technical Procedure

This article is a comprehensive review of the pelvic cosmetic procedure, vaginal rejuvenation. The review covers the inception, evolution, and challenges involved with the operation. Comparison with the classic procedures from which it was derived as well as similar current procedures designed for pelvic organ prolapse are covered. Indications, patient selection, expected outcomes, and technical aspects of the operation itself are addressed.

Pelvic organ prolapse contributes to sexual dysfunction: a cross-sectional study

OBJECTIVE

To evaluate the effect of pelvic organ prolapse (POP) on female sexual dysfunction.

DESIGN

Cross-sectional, observational study.

SETTING

Gynecological outpatient and urogynecological university clinics in Greece.

POPULATION

One hundred and one women with POP seen in the urogynecology clinic (study group) and 70 women without POP seen in the gynecology outpatient department (control group).

METHODS

Women with and without POP completed a condition-specific sexual dysfunction questionnaire (DYSQ) comprising four domains: sexual behavior; physical problems other than urinary incontinence; urinary incontinence problems; and satisfaction. Pelvic organ prolapse was assessed by the International Continence Society Pelvic Organ Prolapse Quantification System grading system. The primary outcome of the study was the assessment of sexual function by DYSQ in women with and without POP.

MAIN OUTCOME MEASURES

We compared sexual function in women with and without POP and evaluated the extent of the effect of various grades of POP on sexual function.

RESULTS

One hundred and seventy-one women were recruited, 101 in the POP group and 70 in the control group. The total and factor-specific DYSQ scores in the POP group were worse than those in the control group (p < 0.001) but did not seem to worsen with an increasing grade of prolapse. Linear regression showed that the best model to describe the DYSQ score includes the presence of POP and years of menopause. These variables explain 15.6% of the total variability in DYSQ scores.

CONCLUSIONS

The presence of prolapse only partly explains impaired sexual functioning in women with POP. Sexual dysfunction is related to the presence of POP and not the grade of POP.

Prospective follow-up of female sexual function after vaginal surgery for pelvic organ prolapse using transobturator mesh implants

INTRODUCTION

Although the use of transobturator mesh implants for pelvic organ prolapse repair has been shown to be safe and effective, concern exists that the presence of prosthetic material in the vagina may adversely affect sexual function.

AIM

To evaluate the impact of transobturator mesh implantation on sexual function using validated questionnaire.

MAIN OUTCOME MEASURES

Female Sexual Function Index (FSFI), a validated 19-item questionnaire that assesses six domains of sexual function (desire, arousal, lubrication, orgasm, satisfaction, and pain), was used. The questionnaire was administered preoperatively, and at 3, 6, 12, and 24 months postoperatively. Clinical data were also recorded at each time point.

METHODS

Prospective nonrandomized study including 96 women with pelvic organ prolapse (cystocele, rectocele, vault prolapse). Transvaginal anterior or posterior wall repair using transobturator mesh implants with or without concomitant transobturator sling procedure.

RESULTS

Mean age was 51.4 ± 5.2 years. Mean operating time was 47.6 ± 23.4 minutes, and the mean hospitalization period was 3.8 ± 1.6 days. After initial decrease during the first 3 months, patients experienced a steady improvement in their sexual function. At 24 months postoperatively, the total mean FSFI score reached significantly higher values compared to the baseline (P = 0.023). Furthermore, pain-free intercourse improved during the follow-up reaching mean score of 4.27 ± 0.79 (P < 0.05) after 2 years. Pelvic floor examination at 2 years follow-up showed excellent surgical results with only 3.1% of the patients presenting with stage II vaginal wall prolapse.

CONCLUSIONS

Surgical repair of symptomatic pelvic organ prolapse using mesh implants results in improvement of major parameters of sexual function. A worsening in pain with intercourse during the initial months postoperatively lessens after 3 months as healing is completed.

Sexual satisfaction in the elderly female population: A special focus on women with gynecologic pathology

SEXUAL FUNCTION IN AGING WOMEN: Sexuality is an integral part of human expressions. Mental health plays a major role in sexuality. Several psychological interventions are proposed to increase the sexual quality of life in older women with diverse gynecologic pathology. A biopsychosocial approach utilizing brief strategies can be easily implemented in clinics to help women of all ages increase their sexual quality of life. THE IMPACT OF FEMALE PELVIC FLOOR DISORDERS ON SEXUAL FUNCTION IN OLDER WOMEN: Female pelvic floor disorders include urinary incontinence, pelvic organ prolapse, and fecal incontinence. These disorders increase dramatically with increasing age. Urinary incontinence has been demonstrated to have a negative impact on a woman's sexual function. Among sexually active older women with urinary incontinence, 22% report being moderately or extremely worried that sexual activity would cause urine loss. An increased prevalence of sexual distress [9% (6/76) vs. 1.3% (2/216), p=0.005] has been reported in sexually active women over 40 years old with urinary incontinence. Treatment of urinary incontinence can improve sexual function in older women. Among sexually active women (N=53) who underwent midurethral slings procedures for the correction of urinary incontinence, increased coital frequency, decrease fear of incontinence with coitus, decreased embarrassment due to incontinence was reported six months after surgery. Pelvic organ prolapse, a hernia of the vagina resulting in a visible vaginal bulge, has also been associated with a negative impact on sexual function. Women with advanced pelvic organ prolapse (POP-Q stage III or IV) have been demonstrated to have decreased body image reporting that they are more self-conscious about their appearance [adjusted odds ratio (AOR) 4.7; 95% confidence interval (CI) 2.9, 51], feel less feminine (AOR 4.0; 95% CI 1.2, 15) and less sexually attractive (AOR 4.6; 95% CI 1.4, 17) compared with women who have normal pelvic support. Both vaginal and abdominal approaches to surgical correction of pelvic organ prolapse have been demonstrated to improve sexual function. MENTAL HEALTH: Mental health plays a major role in older woman's sexuality. Sexual interest and satisfaction is tied to emotional expressivity, women's self-worth, feelings of depression and loneliness as well as cognitive function. Research has shown that both general practitioners and specialists lack training in sexual assessments. Behavioral health specialists, such as a psychologist, can play an integral role in helping to facilitate communication between the patient and the provider. A main focus of communication training is to facilitate open and genuine conversation between the provider and the patient. Providers are encouraged to ask open ended questions while patients are encouraged to discuss symptoms while coping with an internal state of anxiety. Despite the known prevalence of sexual dysfunction among older women, few studied empirically based interventions have been published with these women. This speaks to the general assumption among medical professionals that having the "sex talk" in older women with gynecological pathology is not important or relevant. A biopsychosocial approach utilizing some of the aforementioned brief strategies can be easily implemented in comprehensive gynecology clinics in order to help women of all ages increase their sexual quality of life.

Improved sexual and urinary function in women with sacral nerve stimulation

OBJECTIVES

  Urinary and sexual function improve following sacral nerve stimulation (SNS) for refractory overactive bladder. No significant associations between these changes have been found. Whether improvements in sexual function are independent of or secondary to improvements in urinary function remains unclear. The aim of this study was to analyze changes in urinary and sexual function in a homogeneous sample of patients undergoing SNS for urge urinary incontinence and subsequently identify associations between the two.

MATERIALS AND METHODS

  A prospective database was created. Enrollees underwent a full history and physical examination at the first office visit. Multiple-day voiding diaries with validated and investigator-designed questionnaires were administered at baseline and follow-up as standard implantation procedures and to assess changes in urinary and sexual function, respectively. Analyses were completed using data from patients who were sexually active at baseline and follow-up.

RESULTS

  Statistically significant improvements in urinary and sexual function occurred according to multiple metrics. Patient global impression scales categorized all patients' urinary conditions as improved, with most being less severe. Validated urinary symptom and quality of life scores improved significantly. After treatment, most patients were incontinent less often with sexual activity and felt less restricted from sexual activity by fear of incontinence. Validated quantification of sexual function demonstrated significant improvements in overall sexual function, arousal, and satisfaction. No significant associations between changes in urinary and sexual function were noted; however, trends appeared to exist between the two.

CONCLUSIONS

  Improved sexual function was not significantly associated with improved urinary function after SNS despite apparent trends between the two. Larger samples are required to definitively demonstrate this conclusion.

Sexual function following retropubic TVT and transobturator Monarc sling in women with intrinsic sphincter deficiency: a multicentre prospective study

INTRODUCTION AND HYPOTHESIS

A prospective study comparing the effect of the tension-free vaginal tape (TVT) to the Monarc sling on sexual function in women with urodynamic stress incontinence (USI) and intrinsic sphincter deficiency (ISD) is presented.

METHODS

Eighty-seven sexually active women with USI and ISD were enrolled. Sexual function was assessed pre-operatively and at 6 and 12 months post-operatively by history, PISQ-12, UDI-6 and IIQ-7 questionnaires.

RESULTS

A significant increase was detected in PISQ-12 score following both TVT and Monarc insertion. This score was greater in the TVT group at 6 months but not at 12 months when compared to the Monarc group. A significant decrease in UDI-6 and IIQ-7 score was detected. Specifically, coital incontinence and fear of leakage were reduced in both groups, and no change in dyspareunia or orgasm intensity was found.

CONCLUSIONS

Sexual function improves 6 months after TVT or Monarc sling, and this benefit is maintained at 12 months.

Urogenital complaints and female sexual dysfunction. Part 2

INTRODUCTION

Female sexual dysfunction (FSD) is common in women with urogenital disorders that occur as a result of pelvic floor muscle and fascial laxity.

AIM

Provide a comprehensive review of FSD as it relates to common urogenital disorders including pelvic organ prolapse (POP) and stress urinary incontinence (SUI) and to discuss the impact of the surgical repair of these disorders on sexual function.

METHODS

Systematic search of the medical literature using a number of related terms including FSD, POP, SUI, surgical repair, graft augmentation, complications, and dyspareunia.

MAIN OUTCOME MEASURES

Review of the medical literature to identify the relation between FSD and common urogenital disorders in women and to describe appropriate treatment strategies to improve quality of life (QOL) and sexual function.

RESULTS

FSD is common in women with POP and SUI. Treatment options for POP and SUI include behavioral, pharmacological, and surgical methods which can also affect sexual function.

CONCLUSIONS

Sexual dysfunction is a common, underestimated complaint in women with POP and SUI. Treatment should be tailored toward improving sexual function and QOL. Surgical correction is generally beneficial but occasionally can result in negative alterations in sexual function. Patient selection and methods used for surgical repair are important factors in determining anatomical and functional success.

Sexual function and health-related quality of life following anterior vaginal wall surgery for stress urinary incontinence and pelvic organ prolapse

To assess female sexual function (FSF) and health-related quality of life (HRQOL) following anterior vaginal wall surgeries for stress urinary incontinence (SUI) and pelvic organ prolapse (POP). The retrospective study consisted of 116 patients. Chinese translations of the modified Lemack Questionnaire (not validated) and Pelvic Floor Distress Inventory-Short Form 20 were used to assess FSF and HRQOL, 3 months pre-operatively and 12-24 months (mean 16.8 months) post-operatively. Sixty-one (52.6%, 29 in SUI group and 32 in POP group) of patients were sexually active before and after the operation. Overall, 12 (19.7%, six in SUI group and six in POP group) reported an improvement in overall intercourse satisfaction, 21 (34.4%, 8 in the SUI and 13 in the POP group) were decreased and 28 (45.9%, 15 in SUI group and 13 in POP group) were unchanged. Incidence of coital incontinence decreased significantly in SUI group. Frequency of intercourse decreased, vaginal dryness and pain due to it and asymptomatic vaginal narrowing increased significantly, following the surgery in POP group. There were no statistically significant differences in the frequency of intercourse in SUI group, patients' perception of intercourse, frequency of orgasm and the importance of sex life in both groups. Partner discomfort remained unchanged. HRQOL improved significantly after the operation in both groups. There was no association between HRQOL and FSF in the post-operative period. In most patients, overall FSF did not impaired. All trans-anterior vaginal wall surgery positively impacted on the patients' HRQOL. A prospective study with validated questionnaire is necessary in future.