Tunuguntla Hari S G R, Gousse Angelo E
Division of Female Urology, Voiding Dysfunction, Neuro-Urology and Urodynamics, Department of Urology, University of Miami, School of Medicine, Miami, Florida 33136, USA.
J Urol. 2006 Feb;175(2):439-46. doi: 10.1016/S0022-5347(05)00168-0.
Depending on age it has been estimated that up to 40% of women have complaints of sexual problems, including decreased libido, vaginal dryness, pain with intercourse, decreased genital sensation and difficulty or inability to achieve orgasm. In this review we address the etiologies and incidence, evaluation and treatment of female sexual dysfunction following vaginal surgery for indications such as stress urinary incontinence and pelvic organ prolapse; anterior/posterior colporrhaphy, perineoplasty and vaginal vault prolapse.
Literature on the mechanisms by which vaginal surgery affects female sexual function are discussed along with related pathophysiology to potential causes. The anatomy, neurovascular supply of the clitoris and introitus, and intrapelvic nerve supply are discussed as related to vaginal surgery. Techniques to avoid neurovascular damage during pelvic floor surgery were corroborated by supporting literature. Literature regarding female sexual dysfunction following other procedures, such as vaginal hysterectomy, Martius flap interposition, and vesicovaginal and rectovaginal fistula repair were also discussed.
Current literature does not support an association between vaginal length following vaginal surgery and sexual function. The proportion of women who are sexually active does not appear to be affected by vaginal surgery. Sling surgery for urinary incontinence does not appear to adversely affect overall sexual function, although individual parameters of sexual function scores may vary, eg a significant percent of women report pain during intercourse. Some patients experience improved overall sexual function due to complete relief from coital incontinence
Symptomatic vaginal narrowing is rare even in women undergoing simultaneous posterior repair. Overall sexual satisfaction appears to be independent of therapy for urinary incontinence or prolapse. Data indicate that defect specific posterior colporrhaphy with the avoidance of levator ani plication may improve sexual function. The possible etiological factors for sexual dysfunction following vaginal surgery deserve further investigations.
据估计，根据年龄不同，高达40%的女性存在性问题，包括性欲减退、阴道干涩、性交疼痛、生殖器感觉减退以及难以达到或无法达到性高潮。在本综述中，我们探讨了因压力性尿失禁和盆腔器官脱垂等适应症进行阴道手术后女性性功能障碍的病因、发生率、评估和治疗；前后阴道修补术、会阴成形术和阴道穹窿脱垂。
讨论了阴道手术影响女性性功能的机制相关文献以及与潜在原因相关的病理生理学。讨论了与阴道手术相关的阴蒂和阴道口的解剖结构、神经血管供应以及盆腔内神经供应。支持性文献证实了盆底手术中避免神经血管损伤的技术。还讨论了关于其他手术（如阴道子宫切除术、Martius皮瓣置入术以及膀胱阴道和直肠阴道瘘修补术）后女性性功能障碍的文献。
目前的文献不支持阴道手术后阴道长度与性功能之间存在关联。性活跃女性的比例似乎不受阴道手术影响。用于治疗尿失禁的吊带手术似乎不会对整体性功能产生不利影响，尽管性功能评分的个别参数可能会有所不同，例如相当比例的女性报告性交时疼痛。一些患者由于性交失禁完全缓解，整体性功能得到改善。
即使在同时进行后位修补术的女性中，有症状的阴道狭窄也很少见。总体性满意度似乎与尿失禁或脱垂的治疗无关。数据表明，避免提肛肌折叠的特定缺陷后位阴道修补术可能会改善性功能。阴道手术后性功能障碍的可能病因值得进一步研究。
