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

Surgery For Stress Incontinence & Sexual Function

Several studies have demonstrated that surgical resolution of urinary incontinence leads to improvement of sexual function by the mere fact of becoming continent[76]. Similarly, another study compared sexual function in women with urinary incontinence and POP and sought to determine the effects of therapy on sexual function.[56] Women with prolapse or detrusor overactivity stated that pelvic floor symptoms were a reason for sexual inactivity more often than women with other conditions. The authors found that prolapse was more likely than urinary incontinence to result in sexual inactivity and to be considered as adversely affecting sexual relations. However, overall sexual satisfaction appeared to be independent of diagnosis of or therapy for both urinary incontinence and prolapse.

There is also documentation that anti-incontinence surgery can cause sexual dissatisfaction owing to dyspareunia and/or orgasmic dysfunction postoperatively[77]. One study examined the effect of the Burch retropubic colposusupension with a sacrocolpopexy on sexual function, postoperatively[78]. This study included data from 224 patients originally enrolled in the colpopexy and urinary reduction efforts (CARE) trial[79]. There was no increase in dyspareunia after the Burch procedure. Owing to the prospective randomization, this study was able to assess the effect on sexual function of an abdominal sacrocolpopexy alone or in combination with a Burch procedure, with reduced selection bias.

In recent years, retropubic and transobturator suburethral tape has become the treatment of choice for surgical repair of stress incontinence. A few studies have assessed the effect of tension-free vaginal tape (TVT) on female sexual function, with conflicting results.

A prospective observational study on 29 subjects using the validated FSFI questionnaire showed there was no change in overall sexual function after midurethral polypropylene sling placement[80]. Another retrospective study using a nonvalidated questionnaire created for the purpose of the study, found no change in sexual function in 72% of women after TVT placement, while there was worsening in 14%, which included loss of libido as the main reason for the sexual dysfunction[81]. A cross-sectional study, using a nonvalidated questionnaire, included data on 52 women, aged between 60 years, who were followed for a mean of 1.5 years after TVT placement[82]. The study cohort included 40% sexually active women. Of these, a third stated improvement in sexual function after surgery, in 14% there was worsening and 52% stated no change. The meta-analysis mentioned earlier found that the impact of POP reconstructive surgery on continence issues was limited and inconclusive[64]. The authors concluded that 10% of women developed new urinary incontinence after surgery. There was a lower risk of new postoperative stress incontinence with the addition of a TVT to a standard anterior repair (RR: 5.5; 95% CI: 1.36-22.32). The addition of a Burch retropubic colposuspension to an abdominal sacrocolpopexy reduced the risk of postoperative de novo stress incontinence by more than twofold (RR: 2.13; 95% CI: 1.39-3.24). Unfortunately, data on other outcomes, such as sexual function, morbidity and economic consideration, of adding these anti-incontinence procedures as routine were too few for evaluation.

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