Posterior repair and sexual function

Abstract

OBJECTIVE-The purpose of this study was to determine the effect of posterior repair (PR) on sexual function in patients who have undergone incontinence and/or pelvic reconstructive surgery.STUDY DESIGN-A cohort study of women who underwent incontinence and/or prolapse surgery was performed. Participants completed the pelvic organ prolapse urinary incontinence sexual questionnaire (PISQ) before and after the operation. PISQ scores were compared between women who underwent PR and women who did not. RESULTS-Of 73 study participants, 30 women underwent PR; 43 women did not (no PR).Although there was no difference in dyspareunia between groups pre-op, dyspareunia prevalence post-op was significantly lower in the no PR group. Preoperative PISQ scores were similar between groups. After the operation, both groups significantly improved their PISQ scores, without a difference between groups.CONCLUSION-Although the incidence of dyspareunia differed between PR and no PR groups, overall improvement in sexual function was reflected in improved total PISQ scores that occurred irrespective of PR performance. Keywords dyspareunia; incontinence; posterior repair; prolapse; sexual function Posterior compartment defects arise from abnormalities in rectovaginal connective tissue and its attachments within the pelvis. 1 Repair of this defect includes traditional posterior colporrhaphy, which is performed by plicating the patient's native rectovaginal connective tissue in the midline, or site specific posterior colporrhaphy, which is performed by plicating individual breaks in rectovaginal tissue. 1,2 Controversy exists whether posterior repair (PR) is associated with diminished sexual function or dyspareunia. Some authors have reported increased rates of dyspareunia after PR, whereas other authors have not. [3][4][5][6][7] Some authors have concluded that PR causes sexual dysfunction as a result of its association with dyspareunia. [3][4][5] Our objective was to evaluate prospectively pre-to postoperative changes in sexual function in women who had undergone PR compared with women who did not. MATERIALS AND METHODSThis analysis is based on a previously reported population of women enrolled in a randomized controlled trial that evaluated antibiotic prophylaxis for urinary tract infections after urinary incontinence and/or pelvic organ prolapse surgery. 8 Four sites in this multicenter trial also recruited women to participate in a sexual function study, which has also been described previously. 9 These women form the present study population. We studied sexual function using a condition-specific, validated sexual function questionnaire, the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ). 10 This cohort study compared women who underwent PR with the group of women who did not undergo PR (no PR). Institutional review board approval was given, and written informed consent was obtained.Sexually active patients who had undergone pelvic reconstructive and/or incontinence procedures agreed to answer the PISQ...

Female Sexual Function and Pelvic Floor Disorders

“…Alternatively, the association between pelvic floor disorders and certain aspects of female sexual function may suggest a common etiology, such as pelvic muscle weakness or decreased urogenital sensation. Recent studies suggesting that surgical treatment for pelvic floor disorders may improve sexual function (18,19), but the impact of treatment on sexual function has not been consistently reported (20). Thus, further research is needed to clarify whether certain treatments for pelvic floor disorders are more effective than others in restoring sexual function.…”

Sexual function in women with pelvic floor disorders

“…For example, a study evaluating patients undergoing prolapse repair found that the proportion of patients reporting dyspareunia did not change among those with posterior repair, but among those who did not undergo posterior repair, the proportion with dyspareunia decreased significantly. 13 In a meta-analysis of prolapse repairs using mesh, dyspareunia was reported at approximately 10% postoperatively. 14 …”

Función sexual antes y después de la reparación quirúrgica del prolapso genital

“…Pese a que no era objetivo del estudio comparar la función sexual de acuerdo a los procedimientos quirúrgicos efectuados, este porcentaje de mujeres con dispareunia pudiera estar asociada a la realización de la colporrafia posterior (12,(26)(27)(28)(29). Asimismo, Pauls y cols (22), encontraron que antes de la reparación el abultamiento vaginal era la principal barrera para la actividad sexual, resultado que coincide con el alto porcentaje de mujeres de este estudio que manifestaban esta misma queja (76,6%).…”