Dyspareunia in Older Women

Abstract

Pelvic floor disorders (PFD) are extremely common; 1 in 3 parous women will experience urinary incontinence, 1 in 2 will develop pelvic organ prolapse, whereas 1 in 10 experience fecal incontinence. PFD are often associated with a significant reduction in women’s psychological, social, and sexual well-being.To review the current literature on sexual dysfunction related to PFD.A literature search was conducted using PubMed and key words including sexual dysfunction, prolapse, incontinence, pelvic floor dysfunction, and surgical repair.The outcome was to identify the nature and severity of sexual dysfunction in women with PFD.The prevalence of sexual dysfunction is estimated to be around 30–50% in the general population, whereas in women with PFD, the reported incidence rises to 50–83%. The leading factors cited for the reduction in a woman’s sexual experience included worries about the image of their vagina for women with pelvic organ prolapse, dyspareunia and coital incontinence in women with urinary incontinence, and fear of soiling when dealing with anal incontinence. Pelvic floor muscle training has been associated with an improvement in sexual function. 11% of parous women will have surgery for pelvic organ prolapse, yet limited data are available on the impact of surgical intervention on sexual function. Native tissue repair of pelvic organ prolapse is associated with an improvement in sexual function, whereas posterior repair with levatorplasty and vaginal mesh repair can increase the risk of postsurgical dyspareunia. Subtotal hysterectomy is not associated with improved sexual function compared with traditional total hysterectomy.It is clear there is an urgent need for further research on the effects of surgery for PFD on sexual function. To date, most studies have focused on anatomic rather than functional outcomes.Verbeek M, Hayward L. Pelvic Floor Dysfunction and Its Effect on Quality of Sexual Life. Sex Med Rev 2019;7:559–564.