Consistently inconsistent: interest in sexual function

Abstract

wall,” 1 in which Drs Hale and Fenner describe symptoms of posterior vaginal wall prolapse, describing dyssynergic defecation, constipation, splinting, tenesmus, etc and rightfully bemoan that “. patient expectations are not met by standardized surgical procedures.” Although I laud the authors for memorializing the lack of global success of these site specific repairs, I posit that one of the reasons for failure is a disconnect between patient and provider in history taking and focus of repair when no attention is paid to sexual complaints and when no effort is made during the surgical repair to address sexual concerns. We may say we do not hear sexual complaints from our patients, but none will come our way if we fail to ask. A “don’t ask/don’t tell” philosophy appears to be routine in many if not most patient/physician interactions. We must expand our horizons to incorporate sexual concerns and address these in our repairs to include a multilayered closure to minimize vaginal diameter and approximate the levator musculature, well support the pelvic floor, strengthen and elevate the perineal body, and moderate the size and appearance of the introitus with an aesthetically mindful repair. 2 To ensure a greater success rate, in addition to personalizing the repair technique, I submit that addressing and incorporating our patients’ sexual concerns into repair planning and execution, in addition to incorporation of preand postoperative pelvic floor physical therapy, will significantly improve the overall success rates.