Effects of genital prolapse surgery on sexuality

International Urogynecology Consultation Chapter 1 Committee 5: relationship of pelvic organ prolapse to associated pelvic floor dysfunction symptoms: lower urinary tract, bowel, sexual dysfunction and abdominopelvic pain

INTRODUCTION AND HYPOTHESIS

This article from Chapter 1 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) establishes the prevalence of lower urinary tract disorders, bowel symptoms, vulvo-vaginal/lower abdominal/back pain and sexual dysfunction in women with POP.

METHODS

An international group of nine urogynecologists/urologists and one medical student performed a search of the literature using pre-specified search terms in Ovid, MEDLINE, Embase and CINAHL from January 2000 to March 2019. Publications were eliminated if not relevant or they did not include clear definitions of POP or the symptoms associated with POP. Definitions of POP needed to include both a physical examination finding using a validated examination technique and the complaint of a bothersome vaginal bulge. Symptoms were categorized into symptom groups for ease of evaluation. The Specialist Unit for Review Evidence (SURE) was used to evaluate for quality of the included articles. The resulting list of articles was used to determine the prevalence of various symptoms in women with POP. Cohort studies were used to evaluate for possible causation of POP as either causing or worsening the symptom category.

RESULTS

The original search yielded over 12,000 references, of which 50 were used. More than 50% of women with POP report lower urinary tract symptoms. Cohort studies suggest that women with POP have more obstructive lower urinary tract symptoms than women without POP. Pain described in various ways is frequently reported in women with POP, with low back pain being the most common pain symptom reported in 45% of women with POP. In cohort studies those with POP had more pain complaints than those without POP. Sexual dysfunction is reported by over half of women with POP and obstructed intercourse in 37-100% of women with POP. Approximately 40% of women have complaints of bowel symptoms. There was no difference in the median prevalence of bowel symptoms in those with and without POP in cohort studies.

CONCLUSIONS

The prevalence of lower urinary tract disorders, bowel symptoms, vulvo-vaginal/lower abdominal/back pain and sexual dysfunction in women with POP are common but inconsistently reported. There are few data on incidence of associated symptoms with POP, and cohort studies evaluating causality are rare or inconsistent. Obstructive voiding, lower abdominal and pelvic pain, and sexual dysfunction are most frequently associated with POP.

A Scoping Study of Psychosocial Factors in Women Diagnosed With and/or Treated for Pelvic Organ Prolapse

OBJECTIVE

Pelvic organ prolapse (POP) is prevalent and can impact women's physical and psychosocial health. To develop interventions that support this population, an understanding of the state of research on psychosocial factors related to POP is essential. We conducted a scoping study focused on the psychosocial experience of women with POP. The purpose of this review was to (1) inventory and describe the current state of knowledge of the psychosocial experience of women with POP, (2) identify gaps in knowledge, and (3) identify targets for future research.

METHOD

Electronic databases PsycINFO, PubMed, EMBASE, and CINAHL were searched through November 1, 2017.

RESULTS

Of 524 titles reviewed, 103 articles met all inclusion criteria. Articles were grouped by the disease period (ie, prediagnosis, diagnosis/preintervention, intervention, follow-up, and mixed) and psychosocial factors. Most articles (n = 73) focused on women undergoing intervention. Articles focusing on the preintervention period was the next largest category (n = 14). Follow-up after intervention (n = 8) and samples of mixed disease periods (n = 7) were less common. One article focused on women before diagnosis. Articles focused on quality of life (QOL; n = 79), sexual function (n = 51), satisfaction (n = 16), body image (n = 13), psychological distress (n = 4), and knowledge (n = 3).

CONCLUSIONS

Research on the psychosocial experience of POP has largely focused on changes in QOL and sexual function. Future research should target emotional experience of women with POP; relationships among QOL, psychological distress, body image, and sexual function; and psychosocial factors related to treatment outcomes.

Sexual function in women before and after surgery for pelvic organ prolapse

OBJECTIVE

The aim of this study was to evaluate sexual function in women before and after surgery for pelvic organ prolapse (POP) using native tissue repair.

DESIGN

A prospective observational study.

SETTING

Danish university hospital, between December 2008 and May 2010.

POPULATION

Eighty-one patients who had a POP operation with native tissue repair performed.

METHODS

The patients completed a validated Danish questionnaire on prolapse, the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire - 12 Short Form (PISQ-12-SF), and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF) before undergoing surgery and six months postoperatively.

MAIN OUTCOME MEASURES

Differences in PISQ-12-SF measures six months after the operation in different types of POP operations.

RESULTS

Preoperatively, the PISQ-12-SF score (mean ± SD) was 35.2 ± 4.6 and postoperatively 38.3 ± 3.9, giving a significant difference of 3.0 ± 3.8. (p < 0.05). Thirty-seven women (72%) improved their PISQ-12-SF score postoperatively, nine (18%) had an equal score, and five (10%) reported a lower score. There was no significant difference in the PISQ-12-SF scores between different operations. The ICIQ-UI-SF showed an overall improvement in incontinence postoperatively with a small correlation to PISQ-12-SF.

CONCLUSIONS

The majority of patients who undergo operation for different kinds of POP using native tissue repair, experience an improvement in their sexual life postoperatively. Most women with preoperative urinary incontinence experienced cure or improvement after POP surgery.

Changes in female sexual function after pelvic organ prolapse repair: role of hysterectomy

INTRODUCTION AND HYPOTHESIS

Incontinence and pelvic organ prolapse (POP) have an impact on sexuality. Few studies evaluate the impact of hysterectomy on sexual function. We designed the present observational prospective longitudinal cohort study in order to evaluate the impact of uterus preservation after POP repair on sexual function.

METHODS

Between January 2006 and January 2011, 107 patients with POP, mean age 58 ± 8.9 years, underwent colposacropexy with or without hysterectomy. All the women without uterine disease were offered the chance to preserve the uterus. All patients gave written informed consent and completed the Female Sexual Function Index (FSFI) questionnaire, before and after surgery, provided detailed case history, underwent urogynaecological examination and urodynamic assessment and completed the Urogenital Distress Inventory short form (UDI-6) and Incontinence Impact on Quality of Life short form (IIQ-7) questionnaires, and the satisfaction Visual Analogue Scale (VAS). One year after surgery patients repeated the FSFI questionnaire and underwent a clinical check-up. The primary end-point was post-operative sexual function as evaluated by the FSFI, the secondary end-points were objective anatomical and subjective success, defined respectively as no prolapse and no incontinence-related symptoms.

RESULTS

Sixty-eight patients were included: 32 underwent uterus-sparing surgery and 36 hysterectomy plus colposacropexy. After surgery both groups had significant improvements in the total FSFI score and in the domains of desire, arousal and orgasm. The median post-operative scores of desire, arousal, and orgasm domains showed significant improvements in the uterus-sparing group compared with the hysterectomy group. None of the women had a uterine or vault prolapse recurrence.

CONCLUSIONS

Our data demonstrate that POP plays a role in female sexual dysfunction and uterus sparing surgery is associated with a greater improvement in sexual function.

Impact of gynecological surgery on female sexual function

Sexual function is complex and involves interaction of many factors, including emotional connection, body image, intact physical response and partner sexual function. Disease processes such as abnormal uterine bleeding, endometriosis, urinary incontinence and pelvic organ prolapse may have a negative impact on various parameters of sexual health. Gynecological surgery to address these common complaints may correct the pathological process. However, despite improvements in symptoms related to the disease, improvements in sexuality are not guaranteed and occasionally there may be deteriorations. This review will summarize the current literature assessing sexual symptoms following benign gynecological surgery, including hysterectomy, and bilateral salpingo-oophorectomy, tubal ligation, anti-incontinence surgery and pelvic organ prolapse reconstruction with and without mesh. In the majority of cases, sexual function and quality of life benefit from these surgical interventions. However, it is critical that physicians remain aware of the potential for negative outcomes. Subjects who experience worsening should undergo thorough evaluation early in the postoperative period in order to mitigate symptoms. Treatment modalities for sexual dysfunction following surgery should be the focus of future research.

Pelvic organ function in randomized patients undergoing laparoscopic or abdominal hysterectomy

STUDY OBJECTIVE

To assess the incidence of urinary incontinence, bowel dysfunction, and sexual problems after laparoscopic hysterectomy as compared with abdominal hysterectomy.

DESIGN

Randomized controlled trial (Canadian Task Force classification I).

SETTING

Single-center teaching hospital in the Netherlands, experienced in gynecologic minimal access surgery.

PATIENTS

Women with a benign or malignant condition scheduled for hysterectomy where vaginal hysterectomy was not feasible and laparoscopic hysterectomy was possible.

INTERVENTIONS

Laparoscopic (n = 38) and abdominal hysterectomy (n = 38).

MEASUREMENTS AND MAIN RESULTS

Patients were asked before and 3 months after surgery whether they experienced urinary incontinence and completed the validated questionnaires Urogenital Distress Inventory, Incontinence Impact Questionnaire, Defecatory Distress Inventory, and the Questionnaire for screening Sexual Dysfunctions 1 year after surgery. The incidence of urinary incontinence at 3 months after surgery decreased equally in both groups as compared with baseline. De novo urinary incontinence and sexual problems were rare. One year after surgery, a significant treatment effect favoring laparoscopic hysterectomy was found in the Urogenital Distress Inventory and Incontinence Impact Questionnaire, whereas no differences were found in the Defecatory Distress Inventory and Questionnaire for screening Sexual Dysfunctions.

CONCLUSION

Laparoscopic hysterectomy is superior to abdominal hysterectomy with respect to postoperative symptoms of urinary dysfunction.

Psychosomatic obstetrics and gynecology--a neglected field?

PURPOSE OF REVIEW

The purpose of the review was to evaluate recent studies in the field of psychosomatic obstetrics and gynecology for new directions in research.

RECENT FINDINGS

Psychosomatic obstetrics and gynecology covers a wide canvas, and the present review shows extensive research in some areas and large gaps in others. There have been significant developments in the field of pregnancy-related psychiatric morbidity, particularly anxiety states and posttraumatic stress disorder; however, there is a need for better and more specific measurement and screening methods. Among gynecological conditions there have been advances in research on chronic pelvic pain and gynecological cancers, but most other gynecological conditions have been neglected. What is encouraging is the increasing amount of research from the developing world and the focus on common reproductive conditions based on community studies. In addition, in light of the recent findings and concerns related to hormone replacement therapy, research on mood disorders related to menopause is increasing, with refinement in measurements, definitions, and treatment methods.

SUMMARY

While studies on prevalence and risk factors abound, what is missing are well conducted intervention studies. The next phase of research should focus on preventive and intervention studies that are easily adaptable the world over.