Changes in Female Sexual Function following Anterior with and without Posterior Vaginal Mesh Surgery for the Treatment of Pelvic Organ Prolapse

Cheng-Yu Long, Yung-Shun Juan, Ming-Ping Wu, Cheng-Min Liu, Po-Hui Chiang, Eing-Mei Tsai
Journal of Sexual Medicine 2012, 9 (8): 2167-2174
Introduction.  Comparison of female sexual function following anterior and total transvaginal mesh (TVM) surgery has never been reported. Aim.  To compare the sexual function after anterior and total TVM repair for the treatment of pelvic organ prolapse (POP). Main Outcome Measures.  The short forms of Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7), and the Female Sexual Function Index (FSFI). Methods.  One hundred and sixty-five women with symptomatic POP stages II to IV defined by the POP quantification (POP-Q) staging system underwent TVM procedures at our hospitals. Seventy women were included because they were sexually active and had complete follow-up. All subjects were divided into the anterior group (anterior TVM; N = 39) and total group (anterior and posterior TVM; N = 31). Preoperative and postoperative assessments included pelvic examination using the POP-Q system, urodynamic study, and a personal interview to evaluate urinary and sexual symptoms with the short forms of UDI-6 and IIQ-7, and the FSFI. Results.  There was no difference between the two groups as for age, parity, diabetes, hypertension, concomitant procedures, and success rates for TVM and mid-urethral sling in this study (P > 0.05). Regarding the POP-Q analysis, there was a significant improvement at points Aa, Ba, C, Ap, and Bp (P < 0.05) in both groups except for total vaginal length (P > 0.05). The preoperative scores of UDI-6 and IIQ-7 were significantly higher in the total group (P < 0.01), and the UDI-6 and IIQ-7 scores showed significant decreases in both groups postoperatively (P < 0.01). After TVM surgery, the score of the dyspareunia domain worsened significantly in both groups (P < 0.05), and the deteriorated lubrication domain was noted only in the total group (P = 0.042). Conclusions.  TVM procedure creates an effective anatomical restoration of POP, but individual domains of FSFI may worsen. Compared with the anterior group, women of the total group had worse quality of life in term of urinary symptoms preoperatively, and experienced a greater sexual impairment on lubrication following surgery. Long C-Y, Juan Y-S, Wu M-P, Liu C-M, Chiang P-H, and Tsai E-M. Changes in female sexual function following anterior with and without posterior vaginal mesh surgery for the treatment of pelvic organ prolapse. J Sex Med 2012;9:2167-2174.

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