13: Sexual function after pelvic organ prolapse surgery: A systematic review comparing different approaches to pelvic floor repair

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OBJECTIVE Women consider preservation of sexual activity and improvement of sexual function as important goals following pelvic organ prolapse (POP) surgery. The aim of this systematic review is to compare sexual activity and function before and after prolapse surgery between specific approaches to POP surgery including native tissue (NT) repairs, transvaginal synthetic mesh (TVM), biologic grafts (BG), and sacrocolpopexy (SCP). DATA SOURCES MEDLINE, Embase, and clinicaltrials.gov databases from inception to March 2021. STUDY ELIGIBILITY CRITERIA Prospective comparative cohort and randomized studies of POP surgeries were included that reported specific sexual function outcomes: baseline and post-operative sexual activity, dyspareunia, and validated sexual function questionnaire scores. Four comparisons were made: TVM vs. NT, SCP vs. NT, TVM vs. SCP, and BG vs. NT. STUDY APPRAISAL AND SYNTHESIS METHODS Studies were double screened for inclusion and extracted for population characteristics, sexual function outcomes, and methodological quality. Evidence profiles were generated for each surgery comparison by grading quality of evidence for each outcome across studies using a modified GRADE system. RESULTS Screening of 3651 abstracts was performed and identified 77 original studies. The overall quality of evidence was moderate to high. There were 26 studies comparing TVM vs. NT, 5 comparing SCP vs. NT, 5 comparing TVM vs. SCP, and 7 comparing BG vs. NT. For TVM vs NT, no statistical differences were found in baseline or post-operative sexual activity, baseline or postoperative total dyspareunia, persistent dyspareunia, and de novo dyspareunia. PISQ-12 change scores were not different between TVM vs. NT (net difference -0.3; 95% CI -1.4 to 0.8). For SCP vs. NT, baseline or postoperative sexual activity, baseline or postoperative total dyspareunia, de novo dyspareunia, and PISQ-12 score differences were not different. For BG vs. NT, baseline or postoperative sexual activity, baseline or postoperative total dyspareunia, and PISQ-12 changes were also not different. For TVM vs. SCP, there was no difference in sexual activity and sexual function score change. Based on two studies, post-operative total dyspareunia was more common in TVM than SCP (27.5% vs. 12.2%, OR 2.72, 95% CI 1.33 to 5.58). Prevalence of post-operative dyspareunia was lower than pre-operative dyspareunia after all surgery types. CONCLUSIONS Sexual function comparisons are most robust between TVM and NT repairs and show similar prevalence of sexual activity, de novo dyspareunia, and sexual function scores. Total dyspareunia is higher after TVM compared to SCP. Although sexual function data are sparse in the other comparisons, no other differences in sexual activity, dyspareunia, and sexual function score change were found.