Changes in Sexual Activity and Function After Pelvic Organ Prolapse Surgery

Antosh, Danielle D.; Kim-Fine, Shunaha; Meriwether, Kate V.; Kanter, G. S.; Dieter, Alexis A.; Mamik, Mamta M.; Good, Meadow M.; Singh, Rashmi B. Halker; Alas, Alexandriah; Foda, Mohamed A.; Balk, Ethan M; Rahn, David D.; Rogers, Rebecca G.

doi:10.1097/aog.0000000000004125

Cited by 33 publications

(17 citation statements)

References 79 publications

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“…Fear and self-consciousness about their bodies also affected women’s sexual lives and intimate relationships, as has been reported elsewhere [ 66 ]. Research suggests that these issues are likely a product of societal attitudes to women’s bodies rather than the anatomic features of POP [ 67 ] and that sexual function remains unchanged for many women following POP surgery [ 68 , 69 ]. Other research demonstrates an association between increased PA and improved sexual function in peri- and post-menopausal women [ 70 ], which warrants further exploration as a cost effective, low risk intervention, particularly for women with mild to moderate POP.…”

Section: Discussionmentioning

confidence: 99%

Pelvic organ prolapse: The lived experience

Carroll

Sullivan²,

Doody³

et al. 2022

PLoS ONE

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Background Up to 50% of women will develop pelvic organ prolapse (POP) over their lifetime. Symptoms include pain, bulge, urinary, bowel and sexual symptoms affecting all aspects of a woman’s life. This study explores the lived experience of women with POP. Methodology A qualitative study was undertaken. Following institutional ethical approval women from an online peer support group (n = 930 members) were recruited to participate in semi-structured interviews. Inclusion criteria stipulated women (> 18years), pre-menopausal, at least one-year post-partum, diagnosed with POP and aware of their diagnosis. Semi-structured interviews were undertaken with a clinician specialising in pelvic health. A battery of questions was designed to elicit discussion on their experience of being diagnosed with POP and its impact on daily life and relationships. Interviews were carried out via Zoom, recorded and transcribed. Thematic analysis was undertaken. Findings Fourteen women (32–41 years), para 1–3 participated. All had at least one vaginal birth; three had vacuum, four had forceps operative births. All had Grade 1–3 POP. Interviews lasted 40–100 minutes. Three core themes with subthemes were identified; biological/physical, psychological and social. Women were particularly affected in terms of sport and exercise participation, their own perceptions of their ability as mothers and fear of their condition worsening. They described societal attitudes, reporting stigma around POP and women’s pelvic health in general, expectations placed on women to put up with their symptoms and an idealised perception of new motherhood. Conclusions The impact of POP from a biopsychosocial perspective reflects other chronic conditions. Prevention, early education and supports for developing strong self-management approaches would be beneficial for long term management of this condition.

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Section: Discussionmentioning

confidence: 99%

Pelvic organ prolapse: The lived experience

Carroll

Sullivan²,

Doody³

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

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“…Given the intraoperative narrowing of the genital hiatus and the fact that the measurement intraoperatively overestimates the actual genital hiatus postoperatively, the surgeon may consider re-evaluating the size of the genital hiatus after the apical suspension when deciding on the posterior compartment repair. This may be especially true for the patients who are sexually active, as overcorrection of posterior compartment can carry a significant risk of de novo dyspareunia, reported between 9–19% [ 23 , 24 ]. In our study, 50% of women were not sexually active, yet we did not find a difference in the genital hiatus size when comparing sexually active and inactive women.…”

Section: Discussionmentioning

confidence: 99%

How does office assessment of prolapse compare to what is seen in the operating room?

Wang

Tunitsky-Bitton

2022

Int Urogynecol J

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Introduction and hypothesis It is not known whether the measurements of pelvic organ assessment under anesthesia accurately estimate prolapse severity. We compared Pelvic Organ Prolapse Quantification (POP-Q) measurements in the office to exams under anesthesia. Methods We prospectively enrolled patients undergoing prolapse surgery between February 2020 and July 2020. POP-Qs at rest and with Valsalva were performed at pre- and postoperative visits. POP-Q under anesthesia was performed, without traction, at the start of case (pre-surgical), following apical suspension, and at the end of case (post-surgical). Primary outcome was change in POP-Q between the office and operating room. Due to the COVID-19 pandemic, additional patients were recruited to maintain the follow-up time frame. Results Out of 66 patients, 63 underwent surgery and 33 had postoperative exams within 6 weeks. Mean age was 61.3 ± 11.9 years, and mean BMI was 28.4 ± 6.5 kg/m 2 . Preoperative Aa, Ba, C, Ap, Bp, and D with Valsalva had greater descent than pre-surgical measurements. However, preoperative Gh with Valsalva (4.1 ± 1.3 cm) was not different from pre-surgical Gh (4.0 ± 1.0 cm) ( P = 0.60). Postoperative Aa, Ba, Ap, Bp, and D were not different from post-surgical measurements. In contrast, postoperative Gh at rest (2.3 ± 0.7 cm) and with Valsalva (2.4 ± 0.8 cm) were both narrower than post-surgical Gh (2.8 ± 0.6 cm) ( P < 0.05). Gh was also narrowed after apical suspension (3.6 ± 1.0 cm, P = 0.005) prior to posterior repair. Conclusions Surgeons should rely on preoperative POP-Q for surgical decisions. Gh should be reassessed after apical suspension, and further correction should consider that Gh may be exaggerated compared to the measurement postoperatively when the patient is awake.

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“…Sexual dysfunction in women is frequently associated with pelvic organ prolapse (POP) [85]. In a systematic review [86], the authors found only Level 2 evidence that PFMT can improve women's sexual function, and the literature is scarce about the effect of PFMT on sexual function in women with POP.…”

Section: Sexual Bladder and Anorectal Comorbiditiesmentioning

confidence: 99%

International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training

et al. 2022

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Introduction and hypothesis This manuscript from Chapter 3 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) describes the current evidence and suggests future directions for research on the effect of pelvic floor muscle training (PFMT) in prevention and treatment of POP. Methods An international group of four physical therapists, four urogynecologists and one midwife/basic science researcher performed a search of the literature using pre-specified search terms on randomized controlled trials (RCTs) in Ovid Medline, EMBASE, CINAHL, Cochrane, PEDro and Scopus databases for publications between 1996 and 2021. Full publications or expanded abstracts in English or in other languages with abstracts in English were included. The PEDro rating scale (0–10) was used to evaluate study quality. Included RCTs were reviewed to summarize the evidence in six key sections: (1) evidence for PFMT in prevention of POP in the general female population; (2) evidence for early intervention of PFMT in the peripartum period for prevention and treatment of POP; (3) evidence for PFMT in treatment of POP in the general female population; (4) evidence for perioperative PFMT; (5) evidence for PFMT on associated conditions in women with POP; (6) evidence for the long-term effect of PFMT on POP. Full publications in English or in other languages with abstracts in English and expanded abstracts presented at international condition specific societies were included. Internal validity was examined by the PEDro rating scale (0–10). Results After exclusion of duplicates and irrelevant trials, we classified and included 2 preventive trials, 4 trials in the post-partum period, 11 treatment trials of PFMT for POP in the general female population in comparison with no treatment or lifestyle interventions, 10 on PFMT as an adjunct treatment to POP surgery and 9 long-term treatment trials. Only three treatment studies compared PFMT with the use of a pessary. The RCTs scored between 4 and 8 on the PEDro scale. No primary prevention studies were found, and there is sparse and inconsistent evidence for early intervention in the postpartum period. There is good evidence/recommendations from 11 RCTs that PFMT is effective in reducing POP symptoms and/or improving POP stage (by one stage) in women with POP-Q stage I, II and III in the general female population, but no evidence from 9/10 RCTs that adding PFMT pre- and post -surgery for POP is effective. There are few long-term follow-up studies, and results are inconsistent. There are no serious adverse effects or complications reported related to PFMT. Conclusions There are few studies on prevention and in the postpartum period, and the effect is inconclusive. There is high-level evidence from 11 RCTs to recommend PFMT as first-line treatment for POP in the general female population. PFMT pre- and post-POP surgery does not seem to have any additional effect on POP. PFMT is effective and safe but needs thorough instruction and supervision to be effective.

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Changes in Sexual Activity and Function After Pelvic Organ Prolapse Surgery

Abstract: , et al. Changes in sexual activity and function after pelvic organ prolapse surgery: a systematic review. Obstet Gynecol 2020;136. The authors provided this information as a supplement to their article.

Cited by 33 publications

References 79 publications

Pelvic organ prolapse: The lived experience

Pelvic organ prolapse: The lived experience

How does office assessment of prolapse compare to what is seen in the operating room?

International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training

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