Department of Obstetrics, Gynecology & Reproductive Sciences, UC San Diego Health Systems, San Diego, California; Social, Statistical & Environmental Sciences, RTI International, Research Triangle Park, North Carolina; the Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; the Department of Obstetrics & Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas; the Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania; the Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama; the Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
Obstet Gynecol. 2020 Sep;136(3):492-500. doi: 10.1097/AOG.0000000000003992.
To describe sexual activity and risks for dyspareunia after pelvic organ prolapse surgery.
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.
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.
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.
ClinicalTrials.gov, NCT00065845, NCT00460434, NCT00597935, and NCT01802281.
描述盆腔器官脱垂手术后的性行为和性交困难风险。
这是对 2002 年至 2018 年期间进行的四项随机试验数据的二次分析。在基线和术后 12 个月时，评估了标准评估和经过验证的性功能测量。根据入路将前顶手术分为经阴道固有组织修复、经阴道网片或移植物增强修复和腹式骶骨阴道固定术。还分析了包括后修补术、子宫切除术和吊带在内的其他手术。使用二元分析和逻辑回归模型确定了术后性交困难的危险因素。
在参加试验的 1337 名女性中，有 932 名女性有足够的结局数据来确定性交困难的状态。在这些女性中，手术前有 445 名（47.8%）无性交困难且有性行为，89 名（9.6%）有性交困难且有性行为，93 名（10.0%）因担心性交困难而无性行为，305 名（32.7%）因其他原因而无性行为。在 12 个月时，627 名女性中有 63 名（10.0%）存在性交困难或担心性交困难；445 名女性中有 17 名（3.8%）为新发，182 名女性中有 136 名（74.7%）得到解决。多变量回归显示，基线性交困难是与术后性交困难相关的唯一因素（调整后的优势比 7.8，95%置信区间 4.2-14.4）。包括手术方法在内的其他因素与术后性交困难均无显著相关性。新发性交困难的人数太少，无法进行建模。
在接受脱垂手术前，每五名女性中就有一名患有性交困难。手术修复可使四分之三的女性解决性交困难，新发性交困难的比例低于 4%。术前性交困难似乎是术后性交困难的唯一预测因素。
ClinicalTrials.gov，NCT00065845、NCT00460434、NCT00597935 和 NCT01802281。
