Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.
Beijing Key Laboratory of Female Pelvic Floor Disorders, Beijing 100044, China.
J Sex Med. 2023 Apr 27;20(5):645-650. doi: 10.1093/jsxmed/qdad020.
The effects of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) on sexual activity and female sexual dysfunction (FSD) remain unknown. How female sexual function is affected by surgery to treat SUI and/or POP remains controversial.
The objectives of this study were to identify the prevalence of FSD and potential risk factors in women with POP and/or SUI and to assess whether pelvic floor surgery leads to alterations in female sexual function.
This investigation was prospective and observational. Informed consent was obtained from women who were scheduled to undergo pelvic floor surgery to manage POP and/or SUI at Peking University People's Hospital, which is an urban medical center. Sexual function was assessed by an investigator preoperatively and 12 months postoperatively.
Sexual activity and sexual function before and after surgery were investigated with potential risk factors. Sexual function was measured by 2 validated questionnaires: the Female Sexual Function Index and the PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form).
A total of 233 women were recruited, and all were ethnically Chinese. The average age was 63 years (range, 31-83), and 47.2% were sexually active. The lack of sexual activity before surgery was associated with increasing age (mean ± SD, 56.3 ± 9.5 vs 68.4 ± 8.1 years; P < .001) and postmenopausal status (70.0% vs 97.6%, P < .001). Among the sexually active women, 62.7% were diagnosed with FSD. Increasing age (58.6 ± 9.6 vs 52.3 ± 7.8 years, P < .001) and postmenopausal status (82.6% vs 48.8%, P < .001) were associated with the presence of FSD. Overall there was no significant difference between the PISQ-12 score before and 12 months after surgery (34.7 ± 6.7 vs 33.9 ± 6.6, P = .14). Lubrication of the vagina (P = .044) was an independent factor associated with the improvement in quality of sexual life after surgery. Menopause negatively affected the improvement in quality of sexual life after surgery (P = .024).
Menopause and lubrication of the vagina might affect the improvement in sexual function after surgery.
Strengths include the prospective design, validated questionnaires, and adequate follow-up time. As a limitation, this study is a single-center study that included only Chinese patients with advanced POP/SUI, so it may not be generalizable to other populations.
Nearly half of women with symptomatic POP and/or SUI are still sexually active. Increasing age and menopause are associated with a lack of sexual activity. Premenopausal status and better lubrication of the vagina before surgery might lead to an improvement in sexual function after pelvic floor surgery.
盆腔器官脱垂（POP）和压力性尿失禁（SUI）对性行为和女性性功能障碍（FSD）的影响仍不清楚。治疗 SUI 和/或 POP 的手术如何影响女性性功能仍存在争议。
本研究旨在确定患有 POP 和/或 SUI 的女性中 FSD 的患病率和潜在危险因素，并评估盆底手术是否会导致女性性功能发生改变。
本研究为前瞻性、观察性研究。在北京大学人民医院计划行盆底手术治疗 POP 和/或 SUI 的女性均获得了知情同意，该医院是一家城市医疗中心。在术前和术后 12 个月由研究人员评估女性的性功能。
共纳入 233 名女性，均为汉族。平均年龄为 63 岁（范围 31-83 岁），47.2%有性生活。术前缺乏性生活与年龄增长（平均±标准差，56.3±9.5 岁比 68.4±8.1 岁；P<0.001）和绝经状态（70.0%比 97.6%；P<0.001）有关。在有性生活的女性中，62.7%被诊断为 FSD。年龄增长（58.6±9.6 岁比 52.3±7.8 岁，P<0.001）和绝经状态（82.6%比 48.8%；P<0.001）与 FSD 存在相关。总体而言，手术前后 PISQ-12 评分无显著差异（34.7±6.7 分比 33.9±6.6 分，P=0.14）。阴道润滑（P=0.044）是与术后性生活质量改善相关的独立因素。绝经对术后性生活质量的改善有负面影响（P=0.024）。
绝经和阴道润滑可能会影响术后性功能的改善。
本研究的优势包括前瞻性设计、使用经过验证的问卷和足够的随访时间。局限性在于，本研究为单中心研究，仅纳入了患有晚期 POP/SUI 的中国女性，因此可能无法推广到其他人群。
患有症状性 POP 和/或 SUI 的女性中，近一半仍有性生活。年龄增长和绝经与缺乏性生活有关。术前为绝经前状态和阴道更好的润滑可能会导致盆底手术后性功能的改善。
