The effect of prolapse repair on sexual function in women.

INTRODUCTION

Sexual dysfunction is common in women with pelvic organ prolapse (POP). Treatment of symptomatic prolapse often requires surgery. The outcome of prolapse symptoms following surgery is well studied and reported, but evidence on outcomes of sexual function following pelvic reconstructive surgeries is limited.

AIM

The objective of this study was to assess the impact of different forms of surgery for POP on sexual function using prospectively collected data.

METHODS

In this ethically approved project, data were collected prospectively for women undergoing prolapse repair between 2008 and 2010 and were stratified into four groups: "posterior repair,""anterior repair,""anterior repair with vaginal hysterectomy," and "combined anterior and posterior repair." The electronic personal assessment questionnaire-pelvic floor (ePAQ-PF) was used to assess symptoms. The sexual dimension of ePAQ-PF computes domain scores for sexual dysfunction secondary to vaginal symptoms and dyspareunia on a scale of 0-100 (0 = best possible and 100 = worst possible health status). ePAQ-PF was completed in 123 sexually active women both pre- and 3-6 month postoperatively. Results were analyzed using SPSS (SPSS Inc., Chicago, IL, USA). Pre- and postoperative scores for each domain were compared in all groups (Student's t-test). Individual symptoms in these domains were compared using Wilcoxon signed-rank test.

MAIN OUTCOME MEASURES

Change in sexual symptoms and dyspareunia following prolapse surgery in each group.

RESULTS

Women undergoing anterior repair or anterior repair and vaginal hysterectomy reported significant improvement in sexual symptoms and dyspareunia. Women undergoing a posterior repair in isolation had improved sexual function following surgery though improvement in dyspareunia was not significant. Women undergoing combined anterior and posterior repair had the least improvement in sexual function.

CONCLUSIONS

Sexual function improves in women following pelvic reconstructive surgery, but the improvement is more substantial following anterior repair either alone or in combination with a vaginal hysterectomy when compared with posterior repair.