Departments of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, the University of Calgary, Calgary, Alberta, Canada, the University of New Mexico, Albuquerque, New Mexico, Salinas Valley Memorial Healthcare System, Salinas, California, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Albert Einstein College of Medicine, Bronx, New York, the University of Florida, Jacksonville, Florida, UT Health, San Antonio, Texas, HCA/UCF Consortium, Gainesville, Florida, UT Southwestern Medical Center, Dallas, Texas, and Albany Medical Center, Albany, New York; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; and the Department of Women's Health, University of Texas at Austin Dell Medical School, Austin, Texas.
Obstet Gynecol. 2020 Nov;136(5):922-931. doi: 10.1097/AOG.0000000000004125.
We aimed to systematically review the literature to describe sexual activity and function before and after prolapse surgery.
We searched MEDLINE, EMBASE, and ClinicalTrials.gov databases from inception to April 2018.
Prospective, comparative studies of reconstructive pelvic organ prolapse (POP) surgeries that reported sexual function outcomes were included. Studies were extracted for population characteristics, sexual function outcomes, and methodologic quality. Data collected included baseline and postoperative sexual activity, dyspareunia, and validated sexual function questionnaire scores. Change in validated scores were used to categorize overall sexual function as improved, unchanged, or worsened after surgery.
TABULATION, INTEGRATION, AND RESULTS: The search revealed 3,124 abstracts and identified 74 articles representing 67 original studies. The overall quality of evidence was moderate to high. Studies reporting postoperative results found higher rates of sexual activity than studies reporting preoperative sexual activity in all POP surgeries except sacrospinous suspension, transvaginal mesh, and sacrocolpopexy. The prevalence of dyspareunia decreased after all prolapse surgery types. The risk of de novo dyspareunia ranged from 0% to 9% for all POP surgeries except posterior repair, which lacked sufficient data. Overall sexual function based on PISQ-12 (Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-12) scores improved for mixed native tissue repairs, anterior repairs, uterosacral suspensions, sacrospinous suspensions, and sacrocolpopexy; scores were similar for posterior repairs, transvaginal mesh, and biologic grafts. Sexual function did not worsen after any POP surgeries.
Sexual function improves or remains unchanged after all types of reconstructive POP surgeries and does not worsen for any surgery type. Prevalence of total dyspareunia was lower after all POP surgery types, and de novo dyspareunia was low ranging 0-9%. This information can help surgeons counsel patients preoperatively.
PROSPERO, CRD42019124308.
本研究旨在系统回顾文献，描述脱垂手术前后的性行为和功能。
我们检索了 MEDLINE、EMBASE 和 ClinicalTrials.gov 数据库，检索时间截至 2018 年 4 月。
纳入了报告性功能结局的重建性盆腔器官脱垂（POP）手术的前瞻性、对照研究。提取研究的人群特征、性功能结局和方法学质量。收集的数据包括基线和术后性行为、性交痛和经过验证的性功能问卷评分。使用经过验证的评分变化将术后整体性功能分为改善、不变或恶化。
表格、综合和结果：搜索共显示 3124 篇摘要，确定了 74 篇文章，代表 67 项原始研究。证据的总体质量为中等到高度。除了骶棘韧带固定术、经阴道网片修补术和经阴道骶骨固定术外，所有 POP 手术中，报告术后结果的研究比报告术前性行为的研究报告更高的性行为发生率。所有脱垂手术类型的性交痛发生率均降低。除了后修补术（缺乏足够的数据），所有 POP 手术的新发性交痛风险为 0%-9%。基于 PISQ-12（盆腔器官脱垂/尿失禁性功能问卷-12）评分，混合固有组织修复术、前修补术、子宫骶骨悬吊术、骶棘韧带固定术和经阴道骶骨固定术的整体性功能改善；后修补术、经阴道网片修补术和生物移植物的评分相似。任何 POP 手术都不会导致性功能恶化。
所有重建性 POP 手术类型后性功能改善或保持不变，任何手术类型都不会恶化。所有 POP 手术类型后总性交痛的发生率较低，新发性交痛的发生率较低，为 0%-9%。这些信息可以帮助外科医生在术前为患者提供咨询。
PROSPERO，CRD42019124308。
