Sexual Activity And Dyspareunia 1 Year After Surgical Repair Of Pelvic Organ Prolapse

A significant concern for women and their surgeons is sexual function after pelvic organ prolapse (POP) surgery. Women who prioritize goals and expectations after prolapse surgery rate sexual function just below resolution of bulge symptoms and improvement in physical function. Nonetheless, surgical treatment of POP is aimed at alleviating symptoms and generally is not performed to improve dyspareunia. Many surgeons have counseled women on the potential negative effect of prolapse surgery on sexual function, including de novo dyspareunia. However, emerging evidence suggests that, although de novo dyspareunia occurs in an estimated 10% of women after native tissue POP repair, some women actually have improved sexual function. In 2016, a systematic review of the effect of native tissue POP repair on sexual function estimated a nearly 5-fold greater odds of improved or unchanged dyspareunia compared with worsening symptoms. However, there are few other data on the effect of surgical POP repair on dyspareunia.The aim of this retrospective analysis was to describe changes in sexual activity, dyspareunia rates, and risks for postoperative dyspareunia among women undergoing POP surgeries. The authors performed a secondary analysis of pooled data from 4 multicenter, randomized trials conducted between 2002 and 2018.Participants enrolled in these trials underwent standardized assessments and validated measures of sexual function at baseline and at 12 months postoperatively. Surgical procedures were grouped according to route of repair (abdominal or vaginal), compartment of repair (anterior, apical, and posterior), and the use of native tissue, biologic graft, or mesh material. Additional surgeries analyzed included posterior repair, hysterectomy, and slings. To assess sexual activity and dyspareunia after surgery, participants completed Prolapse Incontinence Sexual Function Questionnaires at baseline and at 12 months. Risk factors for postoperative dyspareunia were identified using bivariate analyses and logistic regression models.A total of 932 of the 1337 women enrolled in the trials had sufficient outcome data to determine dyspareunia status. Of these 932 women, 445 (47.8%) were sexually active without dyspareunia, 89 (9.6%) were sexually active with dyspareunia, 93 (10.0%) were not sexually active because of fear of dyspareunia, and 305 (32.7%) were not sexually active for other reasons. Dyspareunia or fear of dyspareunia was present at 12 months after surgery in 10% (63/627) of patients, occurred de novo in 3.8% (17/ 445), and resolved in 74.7% (136/182) after surgery. The only factor identified on multivariable logistic regression to be associated with dyspareunia 12 months after surgery was baseline dyspareunia; the adjusted odds ratio was 7.8, with a 95% confidence interval of 4.2 to 14.4. No other factors or surgical procedures were significantly associated with persistent dyspareunia at 12 months. Because few women had de novo dyspareunia, modeling could not be performed.This pooled analysis of data from more than 900 women who underwent surgical POP repair shows that 1 in 5 women experienced dyspareunia or fear of dyspareunia before undergoing surgery. Dyspareunia was resolved in 3 of 4 women following surgical repair, and rates of de novo dyspareunia were very low (<4%). The only significant predictive risk factor for persistent dyspareunia at 12 months was the presence of baseline dyspareunia.