Changes in Sexual Function after Treatment for Prolapse Are Related to the Improvement in Body Image Perception

IntroductionIn a previous study, sexual function was related to a woman's self-perceived body image and degree of bother from pelvic organ prolapse (POP).AimsTo evaluate sexual function, prolapse symptoms, and self-perceived body image 6 months following treatment for POP and to explore differences in body image perception and sexual function following conservative and surgical treatment for POP.MethodsAfter institutional review board approval, consecutive women with ≥stage II POP were invited to participate. In addition to routine urogynecologic history and physical examination, including Pelvic Organ Prolapse Quantification (POP-Q), the participants completed three validated questionnaires before, and 6 months after, treatment for POP: Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, Modified Body Image Perception Scale and Prolapse subscale of Pelvic Floor Distress Inventory to assess condition specific bother from POP.Main Outcome MeasuresChanges in sexual function and body image perception following treatment for POP.ResultsA total of 235 women with a mean age of 62 ± 12 years returned for a 6-month follow-up. The majority of our participants had surgical repair for POP (88%). At 6-month follow-up visits, the patients reported significant improvement in sexual function from baseline (33 ± 0.6 vs. 43 ± 0.8, respectively P < 0.0001). Improvement in sexual function, as measured by PISQ-12, was not significant among sexually active patients treated with a pessary compared with those treated surgically (–2.5 ± 5.5 vs. 11.5 ± 1, respectively P < 0.0001). A multivariate linear regression model demonstrated that body mass index and changes in body image perception were the only independent factors associated with changes in PISQ score following POP treatment (β = ?0.5, P < 0.01 and β = ?0.4, P < 0.03, respectively).ConclusionsResolution of POP symptoms after treatment improves women's self-perceived body image and sexual function. Not surprisingly, pessary is less effective in improving sexual function compared with surgical repair of POP. Lowenstein L, Gamble T, Sanses TVD, van Raalte H, Carberry C, Jakus S, Pham T, Nguyen A, Hoskey K, and Kenton K for the Fellow's Pelvic Research Network. Changes in sexual function after treatment for prolapse are related to the improvement in body image perception.     

The Effect of Pelvic Organ Prolapse on Sexual Function in a General Cohort of Women

IntroductionThis is a report about the effects of pelvic organ prolapse on sexual function in women.AimTo determine the effect of pelvic organ prolapse on sexual function in women.MethodsThe study group consisted of 1,267 sexually active women. Baseline characteristics, medical and obstetric history of the patients were recorded. All women underwent vaginal examination to determine the degree of prolapse by pelvic organ prolapse quantification (POPQ) system. Of 1,267 women, 342 (27.0%) had prolapse stage ≥2.Main Outcome Measure(s)The Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire short form (PISQ-12) scores of the women were recorded.Result(s)Women with genital prolapse had lower PISQ-12 scores than women without it. The difference resulted mainly from urinary incontinence during sexual activity, fear of incontinence and avoidance of intercourse due to prolapse. Multivariate analyses showed that genital prolapse was one of the confounding factors for sexual function.Conclusion(s)Pelvic floor dysfunction is a multi-faceted problem because it has both anatomical and functional aspects. Although pelvic organ prolapse had an effect on some aspects of sexuality, it has no effect on certain aspects of sexual function such as orgasm and sexual satisfaction. Tok EC, Yasa O, Ertunc D, Savas A, Durukan H, and Kanik A. The effect of pelvic organ prolapse on sexual function in a general cohort of women.     

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

Introduction

Women’s sense of attractiveness and body image, and the impact of pelvic organ prolapse (POP) over these constructs, are likely influenced by social and cultural background.

盆腔脏器脱垂患者尿动力学检查80例临床分析

目的:探讨女性盆腔脏器脱垂(POP)患者的尿动力学特点及临床意义.方法:对2005年7月至2009年3月80例因POP行手术治疗患者进行尿动力学检查,其中有尿失禁症状38例,尿路刺激症状20例,排尿困难14例,无任何排尿异常8例.结果:尿失禁症状、尿路刺激和排尿困难尿动力检查符合率分别为73.7%(28/38),55.0%(11/20)和71.4%(10/14).Aa位于-1～+1 cm之间时尿动力检查诊断尿失禁率高达66.7%.根据患者症状及尿动力学检查结果,80例患者进行相应的手术及药物治疗,均取得较好疗效.结论:尿动力学检查对女性POP合并排尿功能障碍的诊治具有重要意义,Aa位于-1点以下时,无论有无排尿异常,应行尿动力学检查明确有无压力性尿失禁.     

Long-Term Experience with Modified McCall Culdoplasty in Women Undergoing Vaginal Hysterectomy for Pelvic Organ Prolapse

ObjectiveThe incidence of post-hysterectomy vault prolapse following native tissue repair has been reported to be as high as 43%. The optimal way to maintain vault support is unknown. Our aim was to evaluate the long-term efficacy of modified McCall culdoplasty during vaginal hysterectomy for symptomatic uterine prolapse in preventing the recurrence of vaginal vault prolapse.MethodsWe conducted a retrospective chart review involving 490 patients who underwent vaginal hysterectomy with modified McCall culdoplasty, with or without a concomitant stress incontinence procedure, between January 2008 and December 2018 at Mount Sinai Hospital in Toronto. Data analyzed included patient demographics, preoperative prolapse staging, intraoperative and postoperative complications, and postoperative subjective and objective success rates.ResultsA total of 490 patients underwent vaginal hysterectomy with modified McCall culdoplasty. The mean follow-up period was 2.8 years. The objective success rate of vault support was 97.1%, and the subjective success rate was 94.1%. The total rate of reoperation for recurrence of vault prolapse was 1.0%. The objective cystocele recurrence rate was 8.6%, and 2.4% of these cases required reoperation. The objective rectocele recurrence rate was 4.7%, with 1.2% requiring reoperation. Unilateral ureteric kinking requiring intraoperative release of the McCall suture was recorded for 2.9% of patients. Overall, there was significant improvement in urinary, bowel, and prolapse symptoms post procedure.ConclusionThis cohort of patients who underwent modified McCall culdoplasty had low rates of vault prolapse recurrence and prolapse symptoms. The modified McCall culdoplasty technique practised at our institution is safe and effective in preventing post-hysterectomy vault prolapse.     

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

IntroductionComparison of female sexual function following anterior and total transvaginal mesh (TVM) surgery has never been reported.AimTo compare the sexual function after anterior and total TVM repair for the treatment of pelvic organ prolapse (POP).Main Outcome MeasuresThe short forms of Urogenital Distress Inventory (UDI‐6) and Incontinence Impact Questionnaire (IIQ‐7), and the Female Sexual Function Index (FSFI).MethodsOne 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.ResultsThere 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).ConclusionsTVM 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.     

Pelvic Radiotherapy and Sexual Function in Men and Women

IntroductionDespite the decrease in overall cancer incidence and mortality rates in developed countries since the early 1990s, cancer remains a major public health problem. Sexual dysfunction is one of the more common consequences of cancer treatment.AimTo shortly review the literature and level of evidence on sexual dysfunction in men and women following pelvic radiotherapy.Main Outcome MeasuresMale and female sexual dysfunction.MethodsLiterature review.ResultsSexual dysfunction in cancer patients is multidimensional and may result from biological, psychological, and social factors. Anatomic changes caused by surgery and/or radiotherapy, physiological changes following hormonal manipulation, and the secondary effect of medical intervention may impede or preclude sexual functioning, even when sexual desire is intact. Pelvic irradiation constitutes the primary or adjuvant treatment for a large number of both female and male cancers. No randomized controlled trials could be identified regarding the effect of radiotherapy on sexual dysfunction. However, prospective and clinical controlled trials all demonstrated a severe negative effect on sexual functioning in men and women following radiotherapy for a pelvic cancer.Following pelvic radiotherapy for prostate cancer, a positive effect of phosphodiesterase type 5 inhibitors on erectile dysfunction has been demonstrated, whereas no significant effect on female sexuality was found. Few studies evaluated treatment of female sexual dysfunction following radiotherapy; hormone replacement therapy and the use of vaginal dilator in combination with psycho‐educational support is recommended.ConclusionPelvic radiotherapy plays a significant negative role in the complex scenario of male and female sexual dysfunction. The literature has focused on sexual dysfunction and intervention in prostate and cervical cancer patients. Sexual dysfunction following pelvic radiotherapy for cancer in other pelvic organs, e.g., bladder, rectum, and anus, requires more attention in future studies. Health care providers should pay attention to and provide psychological and medical support regarding sexual dysfunction to all patients who have received pelvic radiotherapy. Incrocci L and Jensen PT. Pelvic radiotherapy and sexual function in men and women. J Sex Med 2013;10(suppl 1):53–64.     

Sexual Function in Postmenopausal Women With Symptomatic Pelvic Organ Prolapse Treated Either with Locally Applied Estrogen or Placebo: Results of a Double-Masked,Placebo-Controlled,Multicenter Trial

BackgroundLocal estrogen therapy (LET) has beneficial effects on genitourinary atrophy; however it is currently unclear if LET improves sexual function in postmenopausal women with pelvic organ prolapse (POP).AimTo evaluate if LET vs placebo results in an improved sexual function in postmenopausal women with symptomatic POP.MethodsWe performed a secondary analysis of sexual outcomes of a previous randomized controlled trial comparing LET and placebo in 120 postmenopausal women (60/group) with symptomatic POP stage ≥3 and planned prolapse surgery. Women were randomly assigned to receive local estrogen or placebo cream 6 weeks preoperatively. The effect of therapy vs placebo was assessed with ANOVA with interaction effect of time*group and a multivariable linear regression model was built to assess the impact of different variables on sexual function before therapy.OutcomesWe evaluated the sexual function score in sexually active women of our study population using the German Pelvic Floor Questionnaire at recruitment time and again after 6 weeks of treatment.ResultsAmong 120 randomized women, 66 sexually active women remained for final analysis. There was no significant difference in the change of the sexual function score over time between the treatment groups (difference in changes in score from baseline to 6 weeks for Estrogen group vs control group was -0.110 with 95% CI -0.364 to 0.144) Multivariable analysis showed that no independent risk factor for unsatisfying sexual function score could be identified.Clinical ImplicationsBased on our results, LET has no beneficial effect on sexual function in postmenopausal women with POP.Strengths and limitationsMain strength of our study lies in the study design and in the use of a condition- specific questionnaire. As this is a secondary analysis, this study may be insufficiently powered to identify differences in sexual data between groups.ConclusionLET had no impact on female sexuality in postmenopausal women with POP.Marschalek M-L, Bodner K, Kimberger O, et al. Sexual Function in Postmenopausal Women With Symptomatic Pelvic Organ Prolapse Treated Either with Locally Applied Estrogen or Placebo: Results of a Double-Masked, Placebo-Controlled, Multicenter Trial. J Sex Med 2022;19:1124–1130.     

全盆底重建术与传统阴式修补术治疗老年女性盆腔器官脱垂的远期疗效研究

目的：比较全盆底重建术与传统阴式修补术治疗老年女性盆腔器官脱垂（POP）的临床效果以及对远期生活质量的影响。方法：选择2008年2月—2009年2月在中国人民解放军白求恩国际和平医院妇产科进行手术治疗且完成随访的盆腔器官脱垂患者60例,年龄≥55岁,均为绝经后妇女,POP-Q分期为Ⅲ~Ⅳ期。采用网片进行全盆底重建术的30例患者为观察组,采用传统的经阴道全子宫切除术加阴道前后壁修补术的30例患者为对照组。术后5年内定期门诊随访,以POP-Q判断术后疗效,盆底不适调查表简表（PFDI-20）评价术后患者生活质量。结果：观察组和对照组的手术时间[（107.83±13.00）min vs.（127.50±13.25）min],术中出血量[（194.67±21.13）m L vs.（220.67±28.15）m L],住院总费用[（32 488.38±3 408.43）元vs.（13 811.41±2 634.89）元]相比,差异均有统计学意义（P〈0.05）。术后POP-Q重新评分,至术后5年,观察组有1例复发至Ⅱ度,对照组5例复发。2组患者术后1,6个月的PFDI-20评分相比差异无统计学意义（P〉0.05）,而观察组术后1,2,5年的PFDI-20评分低于对照组,差异有统计学意义（均P〈0.05）。结论：与传统经阴道子宫切除术加阴道前后壁修补术相比,全盆底重建术术后复发率低,生活质量改善明显,但费用较高。     

Female Sexual Functioning in Women With a Symptomatic Pelvic Organ Prolapse; A Multicenter Prospective Comparative Study Between Pessary and Surgery

BackgroundFemale 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.AimImprovement 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.MethodsA 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.OutcomesChange in PISQ-IR between pessary and surgical intervention.ResultsThe 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.Clinical implicationsSA women who clearly express that POP-related symptoms limit their sexual functioning should be counseled that surgery results in a more remarkable improvement.Strengths & LimitationsOur 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.ConclusionSexual function in SA women with POP is superior in case surgery is performed as compared to pessary therapy.van der Vaart LR, Vollebregt A, Pruijssers B, et al. Female Sexual Functioning in Women With a Symptomatic Pelvic Organ Prolapse; A Multicenter Prospective Comparative Study Between Pessary and Surgery. J Sex Med 2022;19:270–279.     

Male and Female Sexual Function After Surgical Repair of Female Organ Prolapse

IntroductionFew data are available referring to male and female sexual function after prolapse repair of symptomatic pelvic organ.AimPrimary aim of this study is to determine the male and female sexual function before and after surgery for pelvic organ prolapse.Main Outcome MeasuresWe used the Female Sexual Function Index (FSFI) questionnaire for female patients and for their male partners the Brief Male Sexual Inventory (BMSI) as measurement of sexual function.MethodsWe included sexually active heterosexual couples that were referred to the Department of Urogynaecology because of symptomatic cystocele, rectocele or vault descent. For cystoceles, anterior repair was performed, for rectoceles posterior repair, and for vault descent sacrospinous ligament fixation. FSFI and BMSI questionnaires were distributed before and after pelvic organ surgery and 4 months after. Female clinical examination assessing the degree of prolapse was performed before and 6 weeks after surgery.ResultsA full data set of 70 female questionnaires and 64 male questionnaires could be evaluated. Two cases of female de novo dyspareunia occurred. In women, FSFI scores improved significantly in the domains desire, arousal, lubrication, overall satisfaction, and particularly pain. Orgasm remained unchanged. In men, interest, sexual drive, and overall satisfaction improved significantly. Erection, ejaculatory function, and orgasm remained unchanged. Despite remaining unchanged, erection, strength of erection, ejaculation, and orgasm were not considered problems anymore compared to preoperative BMSI scores.ConclusionSurgery for pelvic organ prolapse improves male and female sexual function in some domains but not in all. Kuhn A, Brunnmayr G, Stadlmayr W, Kuhn P, and Mueller MD. Male and female sexual function after surgical repair of female organ prolapse. J Sex Med 2009;6:1324–1334.     

盆底重建患者术前尿动力学结果的初步分析

目的:总结盆底重建患者的尿动力学特点,以尿动力学为切入点结合PFIQ-7问卷探讨盆底重建术与抗压力性尿失禁(SUI)手术的关系。方法:回顾性分析2012年7月—2014年1月因盆腔器官脱垂(POP)仅行Prolift全盆底重建术129例患者的临床资料,根据是否合并SUI分为POP+SUI组(26例)和POP组(103例),比较2组的尿动力学检查结果及不同年龄段的情况,同时对采用PFIQ-7问卷调查后60例患者(POP+SUI组13例,POP组47例)术前和术后6个月生活质量影响评分进行比较。结果:1POP+SUI组Aa的评分为(2.133±0.417)cm,高于POP组的(1.417±0.612)cm,差异有统计学意义(P=0.027)。22组尿动力学检查中仅尿道功能的最大尿道压均值和最大尿道闭合压异常比例差异有统计学意义(P=0.032;P=0.029)。32组患者各自术前与术后PFIQ-7评分总分差异均有统计学意义(P=0.021;P=0.047),术后2组各项PFIQ-7评分差异均无统计学意义(P>0.05)。结论:建议在盆底重建术前行尿动力学检查,盆底重建同时行抗SUI手术需谨慎,需结合患者的年龄、尿动力学结果及患者的临床症状综合判断。     

Comparative Study to Evaluate the Intersystem Association and Reliability Between Standard Pelvic Organ Prolapse Quantification System and Simplified Pelvic Organ Prolapse Scoring System

Purpose

The purpose of this study was to determine the association between the standard pelvic organ prolapse quantification (POPQ) classification system and the simplified pelvic organ prolapse (S-POP) classification system.

Method

This is an observational study, in which 100 subjects, whose average age was 60 ± 10 years, with pelvic floor disorder symptoms underwent two systems of examinations—POPQ classification system and S-POP classification system at Safdarjung hospital—done by four gynecologists (two specialists and two resident doctors) using a prospective randomized study, blinded to each other’s findings. Data were compared using appropriate statistics.

Results

The weighted Kappa statistics for the intersystem reliability of the S-POP classification system compared with standard POPQ classification system were 0.82 for the overall stage: 0.83 and 0.86 for the anterior and posterior vaginal walls respectively; 0.81 for the apex/vaginal cuff; and 0.89 for the cervix. All these results demonstrate significant agreement between the two systems.

Conclusion

There is almost perfect intersystem agreement between the S-POP classification system and the standard POPQ classification system in respect of the overall stage as well as each point within the same system.