Wharton Laura, Athey Ruth, Jha Swati
Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK.
Int Urogynecol J. 2022 Feb;33(2):221-233. doi: 10.1007/s00192-021-05059-4. Epub 2022 Jan 4.
Pelvic organ prolapse (POP) is common and associated with sexual dysfunction. Vaginal pessaries are an effective treatment for POP, but their impact on sexual function is not well established. The aim of this systematic review and meta-analysis was to establish the impact of vaginal pessaries used for POP on female sexual function.
Systematic review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. A comprehensive search was conducted across Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, CINAHL, ClinicalTrials.gov , The WHO International Clinical Trials Registry Platform, ProQuest Dissertations & Theses, Open Grey and Scopus Citation Database. Randomised controlled trials and cohort studies that assessed sexual function in women pre- and post-pessary treatment for POP were included, assessed for risk of bias and their results synthesised.
A total of 1,945 titles and abstracts were screened, 104 full-text articles were assessed for eligibility, 14 studies were included in the narrative analysis and 7 studies were included in the meta-analysis. The results suggest that, in sexually active women, there is no evidence of a deterioration in sexual function and some evidence of an improvement.
This review offers reassurance that in sexually active women who successfully use a pessary for treatment of their prolapse, there is no deterioration in sexual function. There is some evidence of an improvement in sexual function, but given the clinical heterogeneity in the studies included, caution should be taken in generalising these findings.
盆腔器官脱垂（POP）很常见，且与性功能障碍有关。阴道子宫托是治疗POP的一种有效方法，但其对性功能的影响尚未明确。本系统评价和荟萃分析的目的是确定用于治疗POP的阴道子宫托对女性性功能的影响。
按照系统评价和荟萃分析的首选报告项目指南和清单对文献进行系统评价。在Cochrane对照试验中心注册库（CENTRAL）、Cochrane系统评价数据库、EMBASE、MEDLINE、CINAHL、ClinicalTrials.gov、世界卫生组织国际临床试验注册平台、ProQuest学位论文数据库、Open Grey和Scopus引文数据库中进行了全面检索。纳入评估POP患者使用子宫托治疗前后性功能的随机对照试验和队列研究，评估偏倚风险并综合其结果。
共筛选了1945篇标题和摘要，评估了104篇全文文章的 eligibility，14项研究纳入叙述性分析，7项研究纳入荟萃分析。结果表明，在性活跃女性中，没有证据表明性功能恶化，有一些证据表明性功能有所改善。
本评价提供了保证，即在成功使用子宫托治疗脱垂的性活跃女性中，性功能不会恶化。有一些证据表明性功能有所改善，但鉴于纳入研究的临床异质性，在推广这些发现时应谨慎。
