A recent systematic review found that for patients who underwent pelvic organ prolapse (POP) surgery, pain with sex decreased and overall sexual function improved or was unchanged. The results may inform how surgeons discuss POP surgery with patients.
Better sexual function is a major goal for many women undergoing POP. A study in the journal Neurourology and Urodynamics found that women ranked improvement in sexual function as the third-most important outcome of POP surgery, behind only resolution of vaginal bulge symptoms and improvement in physical function. Few studies have examined sexual function after POP surgery, which led the Society of Gynecologic Surgeons Systematic Review Group to study the topic.
Danielle Antosh, MD, a urogynecologist and Associate Professor of Obstetrics and Gynecology at the Academic Institute, Houston Methodist, Associate Professor at Texas A&M Medical School and Assistant Professor at Weill Cornell Medical College, and fellow investigators reviewed three databases for studies of POP surgeries published through early April 2018. Seventy-four articles representing 67 original studies met the team’s criteria for inclusion. The results were published in Obstetrics & Gynecology.
“The biggest conclusion is that dyspareunia [painful intercourse] was lower after all surgery types, but also total sexual function … based on questionnaire scores either improved or remained similar or unchanged after all of the prolapse surgeries,” Dr. Antosh says. “Not one surgery type caused a worsening in sexual function scores. This is very reassuring to us as surgeons that our surgeries have either a positive or neutral impact on the sexual function of our patients.”
Correcting a Misconception
Dr. Antosh points to increased comfort stemming from resolution of the vaginal bulge and improved body image as reasons for why sexual function is likely to improve or stay the same for women who undergo POP surgery. She says the study findings can reassure prospective surgical candidates.
“Since we’re operating on the vagina, some people may think this has the potential to worsen pain with sex,” Dr. Antosh says. “What was surprising about this review is that many women have pain with sex at baseline before surgery, and those rates drop afterward.”
Dr. Antosh says discussing patients’ goals for sexual function prior to surgery is paramount.