Sexual function in women with genital prolapse: A prospective comparative study

Female Sexual Dysfunction Following Vaginal Surgery: A Review

SEXUAL FUNCTION IN WOMEN WITH PELVIC ORGAN PROLAPSE COMPARED TO WOMEN WITHOUT PELVIC ORGAN PROLAPSE

To evaluate the effect of pelvic organ prolapse (POP) on female sexual dysfunction. Cross-sectional, observational study. Gynecological outpatient and urogynecological university clinics in Greece. One hundred and one women with POP seen in the urogynecology clinic (study group) and 70 women without POP seen in the gynecology outpatient department (control group). Women with and without POP completed a condition-specific sexual dysfunction questionnaire (DYSQ) comprising four domains: sexual behavior; physical problems other than urinary incontinence; urinary incontinence problems; and satisfaction. Pelvic organ prolapse was assessed by the International Continence Society Pelvic Organ Prolapse Quantification System grading system. The primary outcome of the study was the assessment of sexual function by DYSQ in women with and without POP. We compared sexual function in women with and without POP and evaluated the extent of the effect of various grades of POP on sexual function. One hundred and seventy-one women were recruited, 101 in the POP group and 70 in the control group. The total and factor-specific DYSQ scores in the POP group were worse than those in the control group (p < 0.001) but did not seem to worsen with an increasing grade of prolapse. Linear regression showed that the best model to describe the DYSQ score includes the presence of POP and years of menopause. These variables explain 15.6% of the total variability in DYSQ scores. The presence of prolapse only partly explains impaired sexual functioning in women with POP. Sexual dysfunction is related to the presence of POP and not the grade of POP.

Arriving at the diagnosis of female sexual dysfunction

Synthetic mesh kits recently adopted in pelvic reconstructive surgeries have achieved great surgical efficacy, but the effects of transvaginal synthetic mesh procedures on women's sexual function are still controversial. This study was conducted to demonstrate sexual function in women before and after surgery with transvaginal mesh (TVM) repair for pelvic organ prolapse (POP). A total of 93 sexually active women scheduled for correcting POP with synthetic mesh kits were recruited. In addition to urogynecological history, pelvic examination by the Pelvic Organ Prolapse Quantification system, and urodynamic testing, consenting participants were asked to complete the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) to evaluate sexual function before and after surgery. At the 3-month urodynamic studies, among the 25 patients with coexistent urodynamic stress incontinence (USI) who had undergone a concomitant transobturator suburethral tape procedure (TOT), 1 (4 %) had persistent USI; 8 of 68 (11.8 %) patients with a negative pessary test developed postoperative USI. Six-month prolapse recurrence rates following TVM alone and TVM with concomitant TOT were 9 and 12 %, respectively. The total PISQ-12 score after surgery showed worse results in the TVM alone group but not in the TVM with concomitant TOT group. The individual scores of PISQ-12 after surgery demonstrated prolapse-related items improved in both TVM groups; sexual function worsened in dyspareunia and behavior domains. Our data revealed that transvaginal synthetic mesh procedures for the treatment of POP generated favorable clinical outcomes, but situations might worsen in dyspareunia and behavior domains, thereby invoking a negative emotional reaction during intercourse after surgery.

Introduction: Polycystic ovarian syndrome is one of the most common causes of infertility in women of reproductive age. It is a combination of chronic anovulation, obesity, and hyperandrogenism that may affect sexual function in women of reproductive age. Objectives: The study aimed to assess the sexual dysfunction, its frequency, and predisposing factors in infertile polycystic ovary syndrome (PCOS) patients. Methods: This descriptive cross-sectional study was conducted among 240 infertile women with a definite diagnosis of PCOS. The study duration was 1 year, from August 2019 to August 2020. Data was collected chronologically by interview, physical examination, and laboratory investigations using a structured questionnaire. The presence of hirsutism was assessed using the modified Ferriman–Gallwey (mFG) scoring system. Sexual function was assessed in the domains of desire, arousal, lubrication, orgasm, satisfaction, and pain using the female sexual function index (FSFI). Patients were also assessed for mental health by the depression, anxiety, and stress scale-21 (DASS-21). Results: Sexual dysfunction was present in 65.4% of patients with the domains of orgasm and arousal were particularly affected (92.9% and 90.0%, respectively). In this study, age and BMI had a significant negative correlation ([Formula: see text] = − 0.55 and [Formula: see text] = − 0.42, respectively) with sexual function. Increasing age and BMI resulted in a significant reduction in sexual function ( [Formula: see text] 0.001 each), including all domains. Patients with symptoms of depression and anxiety were significantly more likely to suffer from sexual dysfunction than those without these symptoms ([Formula: see text] = 0.041 and [Formula: see text] = 0.001, respectively). Hirsutism, serum testosterone (total) level, and stress were found to have no significant effect on sexual function. Conclusions: Infertile patients with PCOS markedly suffer from sexual dysfunction. Improvement of sexual dysfunction not only improves sexuality and quality of life, but also may improve fertility outcomes in infertile PCOS patients.

There is lack of information on couple's sexual relation during pregnancy and also the lack of a national written training protocol in this regard in Iran. State authorities want to develop and implement such a protocol. Therefore, this study aimed to determine the effectiveness of a sex education package on the sexual function of pregnant women. 88 women in their 8 to 14 weeks of pregnancy were randomly allocated into two groups of intervention and control. In the intervention group a midwife carried out sex education in two 60 minutes lecture sessions and group discussions for the participants. Moreover, educational booklets were distributed at the end of the first session and couple's questions were answered by telephone. In the control group women were taught nutritional education with the same procedure. Sexual function was evaluated using the female sexual function index (FSFI) before and four weeks after the education. Paired t-test, student's t-test and chi square were used to analyze the data. There were no significant differences among the groups in terms of their baseline characteristics, including mean sexual function scores before the education. After the education the mean of the total score of sexual function was significantly higher in the intervention group compared with the control group [mean difference 7.0 (95% CI 4.1, 9.9)]. Such a significant difference also existed in all the six domains of sexual function, i.e. desire, arousal, lubrication, orgasm, satisfaction and pain (p < 0.001). Providing such sexual education during routine prenatal care may improve couples' sexual health during pregnancy.

Assessment of Body Image, Sexual Function, and Attractiveness in Women With Genital Prolapse: A Cross-Sectional Study With Validation of the Body Image in the Pelvic Organ Prolapse (BIPOP) Questionnaire

BackgroundWe aimed to evaluate the socio-demographic characteristics of women with female genital mutilation/cutting (FGM/C) and the results of FGM/C due to pelvic floor dysfunction.ResultsThe prevalence of FGM/C was 87.2% in Sudan and Type 3 (50.4%) was the most prevalent, followed by Type 2 (35%) and Type 1 (8.5%). In the multinominal logistic regression analysis performed to show the effect of FGM/C on pelvic organ prolapse (POP), it was observed that FGM/C frequency in POP group 2 was statistically similar when POP group 1 was taken as reference category. In the evaluation for symptomatic POP (POP group 3), risk of developing POP in patients without FGM/C was significantly lower than patients with type 3 FGM/C with a rate of 82.9% (OR(odds ratio): 0.171 (p: 0.002), (Confidence Interval (CI) %95; 0.058–0.511). Risk of developing POP rate in patients with type 1 FGM/C was 75% (OR:0.250 (p: 0.005), CI %95; 0.094–0.666) and in patients with type 2 FGM/C was 78.4% (OR:0.216 (p: 0.0001), CI%95; 0.115–0.406). In the multinominal logistic regression analysis including other variables affecting POP, when group 1 was taken as the reference category, it was found that the possibility of developing mild POP (group 2) decreased in FGM/C type 1 and 2 compared to FGM/C type 3 but it was not statistically significant. However, the evaluation for the symptomatic POP group showed up a significantly lower risk of developing POP in patients with type 2 FGM/C compared to patients with type 3 FGM/C, with a rate of 58.4%. (OR:0.419 (p: 0.016), CI%95; 0.206–0.851) (Table 3). In addition, older age was found to be significant risk factor for increasing symptomatic POP (p: 0.003).ConclusionsType 2 and 3 FGM/C continues to be an important health problem in terms of complications that may develop in advanced ages as well as many short-term complications as a result of mechanical or physiological deterioration of the female genital anatomy.

PurposeThe aim of this study was to evaluate sexual function in women with chronic pelvic pain (CPP) compared to a control group without CPP and to investigate the factors associated with sexual dysfunction in women with CPP.MethodsThis cross-sectional study included 100 women with CPP and 100 controls. Sexual function was evaluated using the Female Sexual Function Index (FSFI) and depression and anxiety using the Hospital Anxiety and Depression Scale (HADS). A generalized linear model was used to compare the groups with respect to the overall FSFI score and the scores obtained for each FSFI domain. Multiple logistic regression analysis was used to identify the factors associated with sexual dysfunction in the study group.ResultsAnxiety was present in 66.0% of women with CPP in the study group compared to 49.0% of the controls (P=0.022). Depression was detected in 63.0% of women with CPP in the study group and in 38.0% of the controls (P=0.001). Sexual dysfunction was identified in 81.0% of the women with CPP in the study group compared to 58.0% of the controls (P=0.003). Following adjustment, the women with CPP had significantly lower mean scores compared to the controls in the FSFI domains of desire (3.0±1.3 vs 3.6±1.3; P=0.038), arousal (2.6±1.6 vs 3.4±1.9; P=0.002), lubrication (3.2±1.9 vs 3.7±2.3; P=0.011), orgasm (3.0±1.9 vs 3.6±2.2; P<0.002), and pain (2.5±1.7 vs 3.4±2.2; P<0.001). There was no difference between the groups for the satisfaction domain (P=0.337) or for the overall score (P=0.252). A positive and independent association was found between depression and sexual dysfunction in the women with CPP (P=0.012).ConclusionIn the women with CPP, sexual dysfunction was more common, and the scores in most of the sexual function domains were poorer than in the control group. Concurrently, depression was found to be positively associated with sexual dysfunction in the women with CPP.

Female pelvic organ prolapse (POP) has a negative effect on female sexual functioning and with an increasing life expectancy female sexual dysfunction caused by POP will be an arising global issue. Improvement in female sexual functioning, measured with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire IUGA-Revised (PISQ-IR), 24-months after pessary or surgery, for both sexually active (SA) and sexually inactive women (NSA) presenting with POP. A multicenter prospective comparative cohort study was conducted in 22 Dutch hospitals. Women referred with moderate to severe POP symptoms and POP stage ≥ 2 were included and chose either pessary therapy or surgical intervention. The PISQ-IR was filled in at baseline and 24-months, the delta of change was calculated and compared between both groups. Multivariate linear regression was performed to adjust for potential confounding factors in the association between the summary score of the PISQ-IR and therapy. Change in PISQ-IR between pessary and surgical intervention. The delta of change at 24-months was calculated for 198 women in the pessary group and 129 women in the surgery group. SA women in the surgery group reported statistically significant more improvement on the condition-specific (-0.19 95%CI -0.35; -0.03, P = .02), and condition-impact (-0.48 95%CI -0.69; -0.28, P < .001) domains as well as on the summary score (-0.15 95%CI -0.23; -0.08, P < .001) as compared to the pessary group. No significant differences between pessary and surgery were found on the domains for NSA women. After controlling for potential baseline confounders, surgery still had a statistically significant effect on the summary score (B = 0.08; 95%CI interval 0.007-0.15, P = .03). Women having surgery had 2.62 times higher odds of changing from NSA to SA than pessary therapy. SA women who clearly express that POP-related symptoms limit their sexual functioning should be counseled that surgery results in a more remarkable improvement. Our strengths include the large sample size, long-term follow-up, the use of the PISQ-IR as a validated outcome tool evaluating both SA and NSA women, and this study reflects real-life clinical practice that enhances the external validity of the findings. A limitation of our study is the considerable proportion of non-responders at 24-months follow-up. Sexual function in SA women with POP is superior in case surgery is performed as compared to pessary therapy.

Living with pelvic organ prolapse (POP) after delivery negatively impacted women's daily living and was detrimental to their psychological health. The purpose of the present study was to explore the effects of POP after delivery on women's sexual function, quality of life (QoL), and psychological health within the first year following delivery. A cross-sectional study was conducted with 640 female participants at obstetric clinic in 2 hospitals in Shenzhen, China. All women completed following questionnaires: short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) on sexual function, Pelvic Floor Distress Inventory-20 (PFDI-20) on well-being and QoL, Symptom Checklist-90-Revised (SCL-90-R) on psychological health, and International Consultation on Incontinence Questionnaire Short Form. Women with symptomatic POP (N= 250) had higher mean scores (P < .05) than those without symptoms (N = 390) in PISQ-12, PFDI-20, and SCL-90-R domains. In the symptomatic POP group (N = 250), the sexually dysfunctional group (N = 137) had significantly higher mean scores (P < .001) than the sexually functional group (N = 113) in PISQ-12, PFDI-20, and SCL-90-R domains. Women with POP duration ≥6months (N = 132) had significantly higher mean scores (P < .001) than women with POP duration <6months (N = 118) in PISQ-12, PFDI-20, and SCL-90-R domains. The multiple linear regression model of PISQ-12 showed that constipation history, regular pelvic floor muscle training, parity, and symptomatic POP were independently correlated with the questionnaire score (P < .05). The significantly pervasive nature of POP often leads to the neglect of a substantial percentage of sexual problems and related emotional suffering, emphasizing the critical importance of raising awareness about this issue among clinicians and the general public. The current study brought attention to significant aspects of postpartum POP; the findings suggest issues concerning POP occurrences and their impacts on sexual function, QoL, and psychological health. Primary constraints are linked to the utilization of self-report assessments. The current study reveals a robust correlation between POP in postpartum women and compromised sexual function, QoL, and psychological health.

Sexual satisfaction in the elderly female population: A special focus on women with gynecologic pathology

The integration of sexual health into the health care services is important. In women attending urogynecological clinics, the urinary function, anorectal function, and anatomical defects are more often evaluated than those related to sexual activity and function. A group of experts in urogynecology, sexuality, and patient reported outcome development, met in a roundtable with the final objective of reviewing what is currently available and what is needed to accurately evaluate sexual function in women with pelvic floor dysfunction. An article was prepared for each of the issued presented during the roundtable and combined into this supplement. This article is a summary of all articles included in this supplement. The pathophysiology of sexual dysfunction as related to pelvic floor disorders has not been well established. Sexuality questionnaires and scales play an integral role in the diagnosis and treatment of female sexual dysfunction. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) is the only validated female sexual function questionnaire specifically developed to assess sexual function in women with urinary incontinence and/or pelvic organ prolapse; however, the PISQ does not screen for sexual activity. The effects of treatments for pelvic floor problems on sexual function have received little attention. There is a need for a validated sexual function measure that evaluates not only the impact of pelvic floor dysfunction on sexual function but also the impact on sexual activity.

Evaluation of Sexual Function in Brazilian Women with Recurrent Vulvovaginal Candidiasis and Localized Provoked Vulvodynia