Female Sexual Function and the Pelvic Floor

Sarit O. Aschkenazi;   Roger P. Goldberg

Disclosures

Expert Rev of Obstet Gynecol. 2009;4(2):165-178. 

In This Article

Female Sexual Function & Pelvic Reconstructive Surgery

Ideally, the goal of pelvic reconstructive surgery is to address each vaginal compartment separately and provide adequate repair to restore the normal anatomy and functionality of the pelvic floor as a whole. An important aspect of this functionality is to maintain, or restore sexual function that may have adversely affected been by the prolapse and/or incontinence. Many studies have assessed sexual function before and after pelvic floor surgery often with conflicting results due to methodology and population differences. An important prospective cohort study by Weber et al. assessed sexual function and anatomic and functional outcomes in women before and after reconstructive pelvic surgery for POP and/or urinary incontinence[59]. The authors found that vaginal length slightly decreased after the procedure but this had no significant adverse effect on sexual function postoperatively. Preoperatively, 66 (82%) women were satisfied with their sexual relationships compared with 71 (89%) who were satisfied postoperatively. The authors concluded that sexual function either improved or remained the same postoperatively in the majority of women. One combination of procedures was associated with a higher risk of dyspareunia, namely that of Burch colposuspension and posterior colporrhaphy. At the time of the study, almost 10 years ago, a Burch colposuspension was considered the gold standard surgical procedure for SUI. However, as we approach the end of the millennium's first decade, this combination of surgeries is less likely to take place, as midurethral slings have practically become the accepted gold standard anti-incontinence procedure, being far less invasive and time-consuming than the Burch procedure, with excellent long-term success rates of more than 10 years. Placing a midurethral sling, tension-free underneath the midurethra instead of the Burch retropubic suspension, avoids the potential loss of vaginal mobility associated with the Burch procedure, especially when combined with a posterior colporrhaphy.

Another study by Pauls et al. assessed the impact of vaginal surgery on postoperative sexual function in women who underwent concurrent anti-incontinence procedures compared with those who did not[60]. Subjects were enrolled prospectively and followed-up after 6 months by completing validated questionnaires, including the FSFI, Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7) and a standardized demographic questionnaire. Of the subjects who returned their postoperative surveys, 98% (48 out of 49) were sexually active. Preoperatively, vaginal bulging was the most bothersome barrier to sexual activity, while postoperatively, this was replaced by vaginal pain. A quarter (n = 12) of subjects stated that vaginal pain postoperatively had a negative impact on their sexual function. The FSFI scores were similar in women with concomitant anti-incontinence procedure versus those without. The authors concluded that, although surgery achieved anatomical and functional improvements, sexual function remained unchanged.

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