Quality of Sexual Life Before and After Pelvic Organ Prolapse Surgery

Importance: Although surgery for pelvic organ prolapse (POP) is generally associated with an improvement in sexual function, knowledge on specific changes is limited.

Objectives: The aim of this study was to describe and compare changes in sexual activity and function during a 5-year follow-up period after POP surgery.

Study design: This was a nationwide cohort study of 3,515 women operated on for POP in 2015 in Finland. Sexual activity and function were assessed preoperatively and 6 months, 2 years, and 5 years after native tissue and mesh-augmented surgery using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form (PISQ-12).

Results: The PISQ-12 score improved significantly at 6-month follow-up, regardless of surgical approach. Negative emotional reactions (relative risk [RR], 0.21; 95% confidence interval [CI], 0.13-0.36), orgasm intensity (RR, 4.23; 95% CI, 2.94-6.07), and avoidance of sexual intercourse due to fear of incontinence (RR, 0.25; 95% CI, 0.15-0.43) or bulging (RR, 0.11; 95% CI, 0.07-0.17) improved remarkably at 6 months and remained up to 5 years after surgery. Satisfaction (RR, 1.10; 95% CI, 1.04-1.18), coital pain (RR, 0.71; 95% CI, 0.51-0.99), and coital incontinence (RR, 0.48; 95% CI, 0.15-0.43) improved only at 6-month follow-up. Among women with deteriorated sexual function, the decline was associated with loss of excitement and satisfaction, increased coital pain, and partner's erectile problems. Partner-related factors and lack of sexual desire were main reasons for sexual inactivity both preoperatively and postoperatively.

Conclusions: Considering patient's sexual wellbeing and informing them of the expected changes in individual sexual function items are important aspects of preoperative counseling. This may reduce false hopes regarding the effect of surgery on sexual function and improve postoperative patient satisfaction.