University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
J Sex Med. 2010 Jul;7(7):2509-20. doi: 10.1111/j.1743-6109.2010.01833.x. Epub 2010 Apr 26.
Sexual dysfunction after ileo pouch anal anastomosis (IPAA) is common. The most systematic physical reaction to sexual stimulation is an increase in vaginal vasocongestion. Genital response can be assessed by vaginal pulse amplitude (VPA) using vaginal photoplethysmography.
To assess whether restorative proctocolectomy with IPAA is associated with autonomic pelvic nerve damage and changes in subjective indices of sexual function in women.
Female patients undergoing IPAA between April 2004 and January 2006 were included. During sexual stimulation (visual and vibrotactile) changes in vaginal vasocongestion were measured by vaginal photoplethysmography. Concurrently, quality of life (SF-36) and sexual functioning (FSFI, FSDS) were assessed using validated questionnaires.
Primary endpoint was difference in VPA pre- and postoperatively. Secondary endpoints were differences in feelings of sexual arousal and estimated lubrication pre- and postoperatively and difference in psychological and sexual functioning pre-and postoperatively.
Eleven patients were included. For eight patients (median age 37 [22-49 years]) pre- and postoperative data were collected. VPA analysis showed a significant reduction in vaginal vasocongestion during sexual stimulation postoperatively, P = 0.012. Subjective sexual arousal and estimated lubrication during the experiment, reported psychological and sexual functioning pre- and postoperative were not different.
Vaginal vasocongestion after IPAA was significantly reduced in this small study; indicating that IPAA in women might possibly be associated with autonomic pelvic nerve damage or partial devascularization of the vagina. Subjectively reported sexual arousal, estimated lubrication, psychological and sexual functioning were not diminished. Future research should focus on the possible advantage of a full close rectal dissection in these patients.
回肠贮袋肛管吻合术（IPAA）后常发生性功能障碍。性刺激最系统的生理反应是阴道血管充血增加。阴道血流容积（VPA）可以通过阴道容积描记法评估。
评估 IPAA 直肠结肠切除术是否与自主盆腔神经损伤和女性性功能主观指标改变相关。
纳入 2004 年 4 月至 2006 年 1 月间行 IPAA 的女性患者。通过阴道容积描记法测量性刺激（视觉和振动触觉）时阴道血管充血的变化。同时，使用经过验证的问卷评估生活质量（SF-36）和性功能（FSFI、FSDS）。
主要终点为术前和术后 VPA 的差异。次要终点为术前和术后性唤起和估计润滑的差异以及术前和术后心理和性功能的差异。
共纳入 11 例患者，其中 8 例（中位年龄 37 [22-49] 岁）患者同时收集了术前和术后数据。VPA 分析显示，术后性刺激时阴道血管充血明显减少，P = 0.012。试验期间主观性唤起和估计润滑、术前和术后报告的心理和性功能无差异。
在这项小型研究中，IPAA 后阴道血管充血明显减少；表明女性 IPAA 可能与自主盆腔神经损伤或阴道部分去血管化相关。主观报告的性唤起、估计润滑、心理和性功能未受损。未来的研究应关注在这些患者中全直肠系膜完整剥离的可能优势。
