Analysis of changes in sexual function in women undergoing pelvic organ prolapse repair with abdominal or vaginal approaches

Abstract

To examine changes in sexual function after abdominal and transvaginal pelvic organ prolapse repair. Women enrolled in our prospective, longitudinal prolapse database with abdominal sacrocolpopexy (ASC) or transvaginal (TVR) pelvic organ prolapse (POP) repair with or without mesh, between 19 December 2008 through 4 June 2014. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Pelvic Floor Distress Inventory (PFDI -20) were mailed preoperatively, and at 6 and 12months postoperatively. Patients completed Global Response Assessments to rate their overall satisfaction. Two hundred and four of the 300 women met the inclusion criteria: 74 out of 204 (36%) had ASC and 130 out of 204 (64%) had TVR. Seventy-two out of seventy-four ASCs were performed robotically and 2 were open. Baseline demographics were similar except that the ASC patients were significantly younger (60 vs 63, P = 0.019) and had a higher rate of apical repair (77% vs 55%). Thirty-six out of seventy-four ASC (48.7%) and 63 out of 128 TVR patients (49.2%) were sexually active at baseline (P = 0.94). Sixteen out of thirty-eight ASC (42.1%) and 18 out 63 TVR patients (28.6%; P = 0.16) reported dyspareunia at baseline. Seventy-two out of seventy-four ASC (97%) and 86 out of 130 TVR patients (66%) had mesh-augmented repairs. There was no difference in sexual activity or dyspareunia between the groups at the 6- or 12-month follow-up. PISQ and PFDI scores improved significantly in both the ASC and TVR groups over time compared with the baseline (p < 0.0001). Most women in the ASC (77.5%) and TVR (64.8%) groups were satisfied with the results of prolapse surgery at 12months. Sexual function and pelvic floor symptoms improved in a similar manner in patients after abdominal and transvaginal POP surgery.