The effects of vaginal surgery and pelvic floor disorders on female sexual function.

BACKGROUND: The effects of pelvic organ prolapse (POP) and stress urinary incontinence (SUI) on sexual activity and female sexual dysfunction (FSD) remain unknown. How female sexual function is affected by surgery to treat SUI and/or POP remains controversial.

AIM: The objectives of this study were to identify the prevalence of FSD and potential risk factors in women with POP and/or SUI and to assess whether pelvic floor surgery leads to alterations in female sexual function.

METHODS: This investigation was prospective and observational. Informed consent was obtained from women who were scheduled to undergo pelvic floor surgery to manage POP and/or SUI at Peking University People's Hospital, which is an urban medical center. Sexual function was assessed by an investigator preoperatively and 12 months postoperatively.

OUTCOMES: Sexual activity and sexual function before and after surgery were investigated with potential risk factors. Sexual function was measured by 2 validated questionnaires: the Female Sexual Function Index and the PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form).

RESULTS: A total of 233 women were recruited, and all were ethnically Chinese. The average age was 63 years (range, 31-83), and 47.2% were sexually active. The lack of sexual activity before surgery was associated with increasing age (mean ± SD, 56.3 ± 9.5 vs 68.4 ± 8.1 years; P < .001) and postmenopausal status (70.0% vs 97.6%, P < .001). Among the sexually active women, 62.7% were diagnosed with FSD. Increasing age (58.6 ± 9.6 vs 52.3 ± 7.8 years, P < .001) and postmenopausal status (82.6% vs 48.8%, P < .001) were associated with the presence of FSD. Overall there was no significant difference between the PISQ-12 score before and 12 months after surgery (34.7 ± 6.7 vs 33.9 ± 6.6, P = .14). Lubrication of the vagina (P = .044) was an independent factor associated with the improvement in quality of sexual life after surgery. Menopause negatively affected the improvement in quality of sexual life after surgery (P = .024).

CLINICAL IMPLICATIONS: Menopause and lubrication of the vagina might affect the improvement in sexual function after surgery.

STRENGTHS AND LIMITATIONS: Strengths include the prospective design, validated questionnaires, and adequate follow-up time. As a limitation, this study is a single-center study that included only Chinese patients with advanced POP/SUI, so it may not be generalizable to other populations.

CONCLUSION: Nearly half of women with symptomatic POP and/or SUI are still sexually active. Increasing age and menopause are associated with a lack of sexual activity. Premenopausal status and better lubrication of the vagina before surgery might lead to an improvement in sexual function after pelvic floor surgery.