From the The University of Texas at Austin Dell Medical School, Austin, TX.
University of Calgary, Calgary, Alberta, Canada.
Urogynecology (Phila). 2023 Sep 1;29(9):725-731. doi: 10.1097/SPV.0000000000001338. Epub 2023 Feb 4.
Patients highly value surgeon counseling regarding the first sexual encounters after pelvic reconstructive surgery.
We performed a qualitative analysis of usual surgeon counseling regarding return to sexual activity after surgery for pelvic organ prolapse and/or urinary incontinence.
Participating surgeons provided a written description of their usual patient counseling regarding return to sexual activity after pelvic organ prolapse or urinary incontinence surgery. Counseling narratives were coded for major themes by 2 independent reviewers; disagreements were arbitrated by the research team. Analysis was performed utilizing Dedoose software and continued until thematic saturation was reached.
Twenty-two surgeons participated, and thematic saturation was reached. Six major themes were identified: "Safety of Intercourse," "Specific Suggestions," "Surgical Sequelae," "Patient Control," "Partner Related," "Changes in Experience," and "No Communication." Nearly all participating surgeons included counseling on the safety of intercourse and reassurance that intercourse would not harm the surgical repair. Specific suggestions included different positions, use of lubrication, vaginal estrogen use, specific products/vendors, alternatives to (vaginal) intercourse, and the importance of foreplay. Surgical sequelae discussion included possible interventions for complications, such as persistent sutures in the vagina, abnormal bleeding, or de novo dyspareunia. Counseling regarding changes to the patient's sexual experience ranged from suggestion of improvement to an anticipated negative experience. Surgeons more commonly advised patients that their sexual experience would be worsened or different from baseline; discussion of improvement was less frequent.
Surgeon counseling regarding the postoperative return to sexual activity varies among pelvic reconstructive surgeons. Most reassure patients that intercourse is safe after surgery.
患者非常重视外科医生就骨盆重建手术后的第一次性接触提供的咨询。
我们对常规外科医生咨询有关骨盆器官脱垂和/或尿失禁手术后恢复性生活的情况进行了定性分析。
参与的外科医生提供了他们对骨盆器官脱垂或尿失禁手术后恢复性生活的常规患者咨询的书面描述。两位独立审查员对咨询叙述进行了主要主题编码；如有分歧，则由研究团队仲裁。使用 Dedoose 软件进行分析，并持续进行，直到达到主题饱和。
22 名外科医生参与了研究，达到了主题饱和。确定了六个主要主题：“性交安全性”、“具体建议”、“手术后遗症”、“患者控制”、“伴侣相关”、“体验变化”和“缺乏沟通”。几乎所有参与的外科医生都包括了关于性交安全性的咨询，并保证性交不会损害手术修复。具体建议包括不同的姿势、使用润滑剂、阴道雌激素使用、特定产品/供应商、替代（阴道）性交的方法，以及前戏的重要性。关于手术后遗症的讨论包括对并发症的可能干预措施，如阴道内残留缝线、异常出血或新发性性交疼痛。关于患者性体验变化的咨询范围从改善的建议到预期的负面体验。外科医生更常建议患者，他们的性体验会恶化或与基线不同；讨论改善的情况较少。
骨盆重建外科医生在术后恢复性生活方面的咨询情况各不相同。大多数外科医生会让患者放心，手术后性交是安全的。
