Sexual Function After Rectocele Repair

Abstract

Introduction Pelvic organ prolapse is a common condition among women with a prevalence of 11% and may affect the anterior, posterior, or apical compartment with a negative impact on sexual function. Aim Aim of the current study was to evaluate sexual function before and after surgical rectocele fascial repair in sexually active patients who suffer from symptomatic rectoceles. Main Outcome Measures Female Sexual Function Index (FSFI) and anatomical outcome after rectocele repair. Methods Between December 2000 and December 2009, we asked sexually active female patients who were to undergo rectocele fascial repair for symptomatic rectoceles to participate in this study. The patients were gynecologically examined before and after surgery and prolapse staging was performed using the ICS-Pelvic Organ Prolapse Staging. Patients were asked to fill in the FSFI before surgery and at 6 months follow-up. For statistical analysis, Graph Pad Prism version 5.0 for Windows was used (Graph Pad, La Jolla, CA, USA). Student’s t-test was used after normality tests to compare groups and α was set 0.05. Results Sixty-eight patients were included in this study. Median age was 72 years (range 47–91), median parity of 2 (range 0–3) and median body mass index was 29 kg/m2 (range 23–31). Main complaints preoperatively were painful prolapse feeling (n = 52), dyspareunia (n = 59), and a feeling of vaginal heaviness (n = 39). One patient who had suffered from postoperative infection that resulted in excessive scar tissue of the posterior wall suffered from de novo dyspareunia. Statistical analyses (paired t-test) showed significant improvement for desire (P < 0.001), satisfaction (P < 0.0001), and pain (P < 0.0001) and no significant changes for arousal (P = 0.0897), lubrication (P = 1), and orgasm (P = 0.0893). Conclusion Posterior fascial repair improves some domains of sexual function but not all in sexually active patients with symptomatic rectoceles, and local oestrogene treatment may contribute to this finding.

The influence of prolapse surgery on sexual activity of women

“…Research so far shows miscellaneous results. Six studies support our finding [3,7,10,11,13,14], however, several studies found deterioration [8,[19][20][21][22]. The latter was particularly associated with implant surgery in the first three months postoperatively.…”

“…Research on the influence of POP surgery on the sexual functioning shows conflicting results. Results range from improvement, [3,[7][8][9][10][11][12][13][14] to unchanged, [15][16][17] and deterioration of sexual functioning postoperatively [3,[18][19][20][21][22].…”

Effects of Vaginal Prolapse Surgery on Sexuality in Women and Men; Results from a RCT on Repair With and Without Mesh

“…First, several prospective observational studies using the FSFI as measure for sexual function after nonmesh vaginal POP surgery found significant improvement in different domains [20,26–28]. One study described improvement on almost all domains, except for pain, which significantly deteriorated [26].…”

“…The recent study by Brandner et al. reported improvement in desire, pain, and satisfaction after rectocele repair [28]. Again a different population including only sexually active women with a partner, receiving both primary and secondary repair were included.…”

The Effect of Prolapse Repair on Sexual Function in Women

“…A study by Brandner et al. prospectively evaluated sexual function in 68 women, 6 months following posterior repair using the FSFI questionnaire [17]. They showed significant improvement in desire, satisfaction, and pain but not in arousal, lubrication, and orgasm.…”