Female Sexual Function after Surgery for Stress Urinary Incontinence: Transobturator Suburethral Tape vs. Tension-Free Vaginal Tape Obturator

Abstract

Introduction The transobturator suburethral tape (TOT) and tension-free vaginal tape obturator (TVT-O) procedures are relatively new incontinence treatment procedures. Studies on the influence on sexual function as a result of these procedures are limited. Aim The influence of TOT or TVT-O for the surgical treatment of stress urinary incontinence (SUI) on female sexual function. Methods We evaluated 77 sexually active patients after TVT-O (N=34, mean age 53.2 years) and TOT (OB-TAPE, Porges) (N=44, mean age 52.0 years) placement for SUI based on the responses to a mailed questionnaire 3 months after the operation. Main Outcome Measure Difference in postoperative sexual complaints related to the TVT-O (inside-out) and TOT (outside-in) procedure. Results Postoperative TOT and TVT-O: There was almost no difference in frequency of sexual intercourse and an improvement of the continence during intercourse; continence was reported in 33 patients (42.3%) before and 67 patients (78.4%) after operation. The appreciation of sexual intercourse was improved in 15 patients (19.2%) and worsened in eight patients (10.3%). Postoperative TVT-O vs. TOT: No difference was seen in lost of lubrication, clitoral tumescence reduction, and clitoral sensibility reduction between both procedures. Pain because of vaginal narrowing was seen significantly more in the TOT procedure group. Conclusion Overall, in this study, the technique of TOT gave rise to more sexual dysfunction than TVT-O. However, because of the successful outcome on incontinence, both procedures had, overall, a positive effect on sexual function. The cause of significant more pain during intercourse as a result of vaginal narrowing in the TOT procedure requires further investigation. Like other studies, this study demonstrated that incontinence surgery can have a positive and negative outcome on sexual function. It is important to put this issue in the informed consent.

Impact of gynecological surgery on female sexual function

“…56,8 Several authors have therefore assessed the impact of stress urinary incontinence repair on subsequent sexual function using prospective (Table 1) and retrospective designs. [57][58][59][60][61][62] The results of most studies suggest that sexual symptoms, sexual activity and sexual function either improve or are unchanged following surgery for stress incontinence. Physical improvements of coital incontinence, urinary frequency and interference with sexual activity may be responsible for most benefit.…”

Sexual function among women with stress incontinence after using transobturator vaginal tape, and its correlation with patient’s expectations

“…Different studies report a high incidence of UI during sexual intercourse, of 32-67% of women; its cause is mainly detrusor instability (58) 10 (7 − 12) − 1 ( − 2.0 to 3.0) Too long (1) 10.1 − 0.8 [22,23]. In a previous study sexual function was improved after surgery for SUI due to relief of coital leakage and narrowing of the vagina [13].…”

“…Depression levels can be classified into mild (10)(11)(12)(13)(14)(15)(16)(17)(18), moderate (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) and severe ( > 30). Women were excluded if they were considered to have depression or psychological disorders.…”

Sexual function and health-related quality of life following anterior vaginal wall surgery for stress urinary incontinence and pelvic organ prolapse

“…Lemack and Zimmern 15 report that sexually active women did not appear to be affected by a vaginal suspension procedure for incontinence, though nearly 20% of women considered intercourse to be worse postoperatively. Elzevier 18 compared sexual function after trans-obturator tape outside-in and TVT-O and reported both positive impacts on sexual function in 19.2% of patients, but negative impacts in 10.3% of study participants. In a prospective study, Thakar et al…”