Sexual Function Before and After Vesicovaginal Fistula Repair

Abstract

Introduction Women with vesicovaginal fistulas often experience a disruption in their normal lives, including sexual relationships, because of urinary incontinence. Aim Although surgery repairs the urinary leakage, it is not known how surgery might affect sexual function positively or negatively. Methods 119 women were enrolled before surgery and interviewed including a revised Female Sexual Distress Scale (FSDS-R) score and examined for vaginal length, caliber, and pelvic floor strength. Main Outcome Measures Approximately one third of women return to normal sexual function after repair, although a minority experience de novo dysfunction. Results 115 women completed follow-up 6 to 12 months after surgery. Approximately one third (35.6%, n = 41) stated that intercourse had returned to the way it was before a fistula. Forty-four women (40%) report sexual problems after the fistula developed; 15% due to incontinence and 23.5% due to pain. Fourteen women (12.2%) stated that they experienced problems with intercourse since surgery; 50% due to incontinence during intercourse and 50% due to pain. Nineteen of the participants (16.5%) scored in the range of dysfunction as assessed by the FSDS-R tool after surgery. Fibrosis did not significantly change and was not found to be associated with sexual function. Vaginal length was found to decrease on average by 5 mm. Of the variables examined, the factors statistically significantly associated with dysfunction included a larger-size fistula as determined by the Goh classification (> 3 cm diameter) and decreased vaginal caliber. FSDS-R scores drastically decreased from before to after surgery and the reason for problems with intercourse changed from leaking urine before surgery to lack of partner and concern for HIV infection. Clinical Implications Women with large fistulas and decreased vaginal calibers are at high risk for sexual dysfunction and should be counseled appropriately preoperatively and offered surgical and medical interventions. Strengths & Limitations Physical parameters were combined with qualitative interviews and FSDS-R scores to contextualize sexual health before and after surgery. Limitation is the brief follow-up of 6-12 months after surgery as many women were still abstaining from sexual activity. Conclusion Sexual dysfunction is a complex issue for women with obstetric fistulas; although many women do not continue to experience problems, several need ongoing counseling and treatment.

A review of surgical procedures to repair obstetric fistula

“…estimated that approximately 30% of fistula patients require vaginoplasty at the same time as surgery owing to lack of adequate healthy vaginal tissue or distorted anatomy from the amount of scarring that has taken place. A recent study found that around one‐third of patients felt that intercourse returned to its pre‐fistula state after surgical repair . In this cohort, 12% (n=14) experienced de novo sexual dysfunction, half of whom attributed this to pain and half to ongoing incontinence during intercourse.…”

Vesicovaginal fistula: Review and recent trends

“…Sexual outcomes following VVF repair have been analyzed in recent studies. [7475] Mohr et al evaluated 91 patients undergoing VVF repair and reported a post surgery continence rate of 82% (transvaginal) and 90% (transabdominal) at 6 months of follow-up. Also, the sexual function in the 64 sexually active patients was significantly improved post surgery, but neither approach was superior to the other.…”

“…However, recent studies have shown that sexual activities can be resumed as early as 6 weeks. [75] Adequate foreplay, avoiding rough sex, and intercourse during menstruation are the general postoperative advice given to these patients.…”

Physical etiology of sexual dysfunction in obstetric fistula patients: A prospective study

“…Women with obstetric fistulas often report severe sexual dysfunction related to their injury, including pain, dryness, and discomfort . Though many cite improvements after repair, a significant percentage still experience dysfunction.…”

“…Though many cite improvements after repair, a significant percentage still experience dysfunction. In a study of sexual function before and after repair at the FCC in Lilongwe, Malawi, 19 of 115 women (16.5%) experienced dysfunction after repair according to the Female Sexual Distress Scale (FSDS‐R) . Because sexual function is closely linked to a woman's social and economic wellbeing in Malawi, we explored physical indicators of sexual dysfunction to better tailor repair techniques and improve post‐surgical outcomes.…”