Changes of the quality of sexual life following pelvic organ prolapse surgery

Czech version

Authors: Velický Vladimír ^1,2
Authors‘ workplace: Gynekologicko-porodnické oddělení, Nemocnice Sokolov ¹; Gynekologicko-porodnické oddělení, Fakultní Thomayerova nemocnice, Praha ²
Published in: Ceska Gynekol 2021; 86(3): 167-174
Category: Retrospective study
doi: https://doi.org/10.48095/cccg2021167

Overview

Objective: The aim of the study was to determine the percentage of sexually active women with a higher degree of descent in the anterior and middle compartment (in one compartment at least ≥ III degree) and how the surgical solution affects the quality of sexual life and overall quality of life in women who underwent surgery.

Methods: Patients who underwent prolapse surgery were included in the study. Before the operation, a complete urogynecological examination was performed, including ultrasound examination, history and POP-Q (pelvic organ prolapse quantification system) evaluation, and quality of life questionnaires were completed. We compared the quality of sexual life in sexually active women before and after surgery to ascertain the effect of surgery in this respect.

Results: The study included 128 patients who underwent pelvic organ descent surgery from January 2018 to April 2019. Depending on the type of operation, they were divided into three groups: reconstruction with anterior vaginal implant fixed to the sacrospinous ligament, laparoscopic sacrocolpopexy and sacrospinous vaginofixation according to Amreich-Richter. The differences between the groups in the results of the surgical solution were not statistically significant due to the size of the monitored group. Sexual activity of the patients even in the advanced stage of pelvic organ setup was reported preoperatively by 45.9% of women and postoperatively – after 1 year – by 44.8% of women. Comparing the quality of life preoperatively and postoperatively, there was a very significant improvement in 58.0% of respondents, a significant improvement in 36.0% and a slight improvement in 2.0%: only in 3.0% of women, there was a deterioration (ranging from mild to very significant). Surgical treatment of the descent slightly worsened the quality of sexual life in 20.8% of women, did not change it in 33.3% and significantly improved it in 45.8% of them.

Conclusion: A high percentage of patients are sexually active even at an advanced stage of descent. Comparing the quality of life preoperatively and postoperatively, there was a significant improvement or even complete resolution of the problems associated with descent in most women. For some women, the surgical treatment of the descent may slightly worsen the quality of sexual life; in others, its quality remains at the same level, but the largest section of the studied group feels a significant improvement in the perception of sexual activities.

Keywords:

pelvic organ prolapse – pelvic organ prolapse quantification system – Quality of life – quality of sexual life – PISQ-12

Sources

1. Subak LL, Waetjen LE, van den Eeden S et al. Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol 2001; 98 (4): 646–651. doi: 10.1016/s0029-7844 (01) 01472-7.

2. Grimes WR, Stratton M. Pelvic floor dysfunction. Treasure Island (FL): StatPearls Publishing 2020

3. Dietz HP. Pelvic organ prolapse – a review. Aust Fam Physician 2015; 44 (7): 446–452.

4. Haylen BT, de Ridder D, Freeman RM et al. An International Urogynecological Association (IUGA) /International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 2010; 29 (1): 4–20. doi: 10.1002/nau.20798.

5. DeLancey JO. Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol 1993; 36 (4): 897––909. doi: 10.1097/00003081-199312000-00015.

6. Martan A, Masata M, Halaska M. Ultrasound examination of the lower urinary tract in women. Ceska Gynekol 1997; 62 (6): 350–352.

7. Masata J, Svabik K, Martan A. Ultrasound in urogynecology. Ceska Gynekol 2012; 77 (4): 292–298.

8. Svabik K, Martan A, Masata J et al. Ultrasound appearances after mesh implantation – evidence of mesh contraction or folding? Int Urogynecol J 2011; 22 (5): 529–533. doi: 10.1007/s001 92-010-1308-9.

9. Martan A, Masata J, Halaska M et al. Ultrasound imaging of paravaginal defects in women with stress incontinence before and after paravaginal defect repair. Ultrasound Obstet Gynecol 2002; 19 (5): 496–500. doi: 10.1046/j.1469-0705.2002.00686.x.

10. Martan A, et al. The effect of increasing intra-abdominal pressure on the position of the bladder neck in ultrasound imaging. Geburtshilfe Frauenheilkd 2002; 62 (Suppl 1): 37–41.

11. Drahoradova P, Martan A, Svabik K et al. Longitudinal trends with improvement in quality of life after TVT, TVT O and Burch colposuspension procedures. Med Sci Monit 2011; 17 (2): CR67–CR72. doi: 10.12659/msm.881389.

12. Baxter NN, Rothenberger DA, Lowry AC. Measuring fecal incontinence. Dis Colon Rectum 2003; 46 (12): 1591–1605. doi: 10.1007/ BF02660762.

13. Placik OJ, Arkins JP. Plastic surgery trends parallel Playboy magazine: the pudenda preoccupation. Aesthet Surg J 2014; 34 (7): 1083–1090. doi: 10.1177/1090820X14543514.

14. El Haddad R, Svabik K, Masata J et al. Women‘s quality of life and sexual function after transvaginal anterior repair with mesh insertion. Eur J Obstet Gynecol Reprod Biol 2013; 167 (1): 110–113. doi: 10.1016/j.ejogrb.2012.11.005.

15. Rogers RG, Kammerer-Doak D, Villarreal A et al. A new instrument to measure sexual function in women with urinary incontinence or pelvic organ prolapse. Am J Obstet Gynecol 2001; 184 (4): 552–558. doi: 10.1067/mob.2001.111100.

16. Rogers RG, Coates KW, Kammerer-Doak D et al. A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct 2003; 14 (3): 164–168. doi: 10.1007/s00192-003-1063-2.

17. Rogers RG, Rockwood D, Constantine ML et al. A new measure of sexual function in women with pelvic floor disorders (PFD): the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Int Urogynecol J 2013; 24 (7): 1091–1103. doi: 10.1007/s00192-012-2020-8.

18. Lone F, Thakar R, Sultan AH. One-year prospective comparison of vaginal pessaries and surgery for pelvic organ prolapse using the validated ICIQ-VS and ICIQ-UI (SF) questionnaires. Int Urogynecol J 2015; 26 (9): 1305–1312. doi: 10.1007/s00192-015-2686-9.

19. Sumak R, Serdinsek T, But I. Long-term follow-up of native tissue anterior vaginal wall repair: does the POP-Q stage really reflect patients‘ satisfaction rate? Int Urogynecol J 2020; 31 (10): 2081–2088. doi: 10.1007/s00192-020-04353-x.

20. Svabik K, Martan A, Masata J et al. Comparison of vaginal mesh repair with sacrospinous vaginal colpopexy in the management of vaginal vault prolapse after hysterectomy in patients with levator ani avulsion: a randomized controlled trial. Ultrasound Obstet Gynecol 2014; 43 (4): 365–371. doi: 10.1002/uog.13305.

21. Weber AM, Richter HE. Pelvic organ prolapse. Obstet Gynecol 2005; 106 (3): 615–634. doi: 10.1097/01.AOG.0000175832.13266.bb.

22. Bataller E, Ros C, Anglès S et al. Anatomical outcomes 1 year after pelvic organ prolapse surgery in patients with and without a uterus at a high risk of recurrence: a randomised controlled trial comparing laparoscopic sacrocolpopexy/cervicopexy and anterior vaginal mesh. Int Urogynecol J 2019; 30 (4): 545–555. doi: 10.1007/s00192-018-3702-7.

23. Maher C, Feiner B, Baessler K et al. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev 2016; 10 (10): CD012376. doi: 10.1002/14651858.CD012376.

24. Masata J, Dundr P, Martan A. Actinomyces infection appearing five years after trocar-guided transvaginal mesh prolapse repair. Int Urogynecol J 2014; 25 (7): 993–996. doi: 10.1007/s00192-013-2304-7.

25. Neuman M, Masata J, Hubka P et al. Sacrospinous ligaments anterior apical anchoring for needle-guided mesh is a safe option: a cadaveric study. Urology 2012; 79 (5): 1020–1022. doi: 10.1016/j.urology.2012.01.045.

26. Glazener CM, Breeman S, Elders A et al. Mesh, graft, or standard repair for women having primary transvaginal anterior or posterior compartment prolapse surgery: two parallel-group, multicentre, randomised, controlled trials (PROSPECT). Lancet 2017; 389 (10067): 381–392. doi: 10.1016/S0140-6736 (16) 31596-3.

27. Milani R, Frigerio M, Velluci FL et al. Transvaginal native-tissue repair of vaginal vault prolapse. Minerva Ginecol 2018; 70 (4): 371–377. doi: 10.23736/S0026-4784.18.04191-6.

28. Kavvadias T, Schoenfisch B, Brucker SY et al. Anatomical and functional outcomes after hysterectomy and bilateral sacrospinous ligament fixation for stage IV uterovaginal prolapse: a prospective case series. BMC Urol 2020; 20 (1): 126. doi: 10.1186/s12894-020-00694-3.

29. van Zanten F, Brem C, Lenters E et al. Sexual function after robot-assisted prolapse surgery: a prospective study. Int Urogynecol J 2018; 29 (6): 905–912. doi: 10.1007/s00192-018- 3645-z.

30. El-Azab AS, Yousef HA, Seifeldein GS. Coital incontinence: relation to detrusor overactivity and stress incontinence. Neurourol Urodyn 2011; 30 (4): 520–524. doi: 10.1002/nau.21041.