Sexual function after robot-assisted prolapse surgery: a prospective study

Abstract

Introduction and hypothesisFemale pelvic organ prolapse (POP) can severely influence sexual function. Robot-assisted surgery is increasingly used to treat POP, but studies describing its effect on sexual function are limited. The objective of this study was to evaluate sexual function after robot-assisted POP surgery.MethodsThis prospective cohort study included all patients who underwent a robot-assisted sacrocolpopexy (RASC) or supracervical hysterectomy with sacrocervicopexy (RSHS). Exclusion criteria were unknown preoperative sexual activity status or concomitant surgery. In sexually active women, sexual function was measured with the translated validated version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Changes in sexual activity were scored. Prolapse stages were described using the simplified Pelvic Organ Prolapse Quantification (S-POP) system.ResultsA total of 107 women were included (median follow-up 15.3 months). No difference was found in the total number of sexually active women before and after surgery [63 (58.9%) vs. 61 (63.5%), p = 0.999]. Significantly fewer women avoided sexual intercourse postoperatively compared with preoperatively. Preoperatively, sexual intercourse was avoided due to vaginal bulging (2% vs. 24%, respectively, p = 0.021). Total mean PISQ-12 scores improved significantly 1 year after prolapse correction (33.5 vs. 37.1; p = 0.004), mainly due to improved scores on the physical and behavioral–emotive domain. No significant difference in pre- and postoperative complains of dyspareunia was found.ConclusionRobot-assisted middle-compartment surgery improved sexual function 1 year after surgery according to enhanced physical and emotional scores. The total number of sexually active women and complains of dyspareunia before and after surgery did not differ.

Sexual function after total laparoscopic hysterectomy or transabdominal hysterectomy for benign uterine disorders: a retrospective cohort

“…Our results are consistent with those reported in a small number of previous studies that directly compared laparoscopic and transabdominal hysterectomy in women with benign (31)(32)(33)(34)(35) or malignant (36,37) uterine disease. Our analysis identified a higher incidence of sexual dysfunction after hysterectomy than some previous studies (10)(11)(12)(13)(14)(15)(16). However, it should be noted that the quality of female sexual life before and after hysterectomy might be affected by numerous factors such as age, ethnicity, family structure, psychologic factors (including body esteem and relationship quality), socioeconomic status and educational background (20,22,38,39).…”

“…There is also evidence that hysterectomy can lead to changes in sexual function, with differing effects depending on whether the underlying condition being treated is benign or malignant (8,9). Most studies have reported that hysterectomy for benign diseases results in an overall improvement in sexual function (10)(11)(12)(13)(14)(15), likely because of the alleviation of symptoms such as abnormal uterine bleeding and pelvic pain (16). However, around 20-40% of patients with benign disease experience a worsening of sexual function after hysterectomy (17)(18)(19), and one study even showed an overall worsening of sexual function (20).…”

Surgical Correction of the Genital Hiatus at the Time of Sacrocolpopexy—Are Concurrent Posterior Repairs Cost-Effective?

“…We pooled the data from 2 studies with a postoperative dyspareunia range of 17-19% to model the probability of postoperative dyspareunia after SCP alone as 18.5%. 11,24 For patients in the SCP + PR group, we obtained the probability of dyspareunia after posterior repair alone or at the time of other prolapse surgery to capture a wide variation in techniques of posterior repair. To account for this variability, we averaged the probability of developing postoperative dyspareunia after PR from 7 studies and modeled the probability of postoperative dyspareunia (persistent and de novo) after SCP + PR as 26.5% (range, 7-36%).…”

Robot-Assisted Laparoscopic Surgery for Pelvic Organ Prolapse among Peri- and Post-Menopausal Women

“…Although the number of patients was small (n = 18), all demonstrated improved thermal genital sensation after RSC [ 21 ]. van Zanten et al [ 22 ] conducted a prospective study of the sexual function of 107 patients who received RSC or robotic RSH [ 22 ]. Sexual function before and after surgery was assessed using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12).…”

“…Sexual function before and after surgery was assessed using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). The PISQ-12 results showed that, the number of women avoiding sex decreased significantly from 24% to 2% after the surgery, while the number of women who reported dyspareunia decreased from 29% to 17% [ 22 ]. A study of sexual function after LSC reported the proportion of patients who avoided sex because of bulging in the vagina decreased from 63.2% to 4.0%, and proportion who reported feeling pain during intercourse decreased from 47.4% to 26.3% [ 23 ].…”