Women's Experience of Their First Sexual Encounter After Pelvic Reconstructive Surgery

Abstract

OBJECTIVE: To describe the timing, quality and patient concerns regarding the first sexual encounter after surgery for pelvic organ prolapse (POP) or urinary incontinence (UI). METHODS: Women scheduled to undergo POP or UI surgery who self-identified as sexually active were recruited to this qualitative study. Routine counseling regarding the return to sexual activity was provided 4–6 weeks postoperatively. Participants completed interviews 2–4 months after their surgery. Interviews were tape recorded, de-identified, and transcribed. Transcriptions were coded for major themes by two independent researchers; disagreements were arbitrated by the research team. Analysis was performed using Dedoose software. RESULTS: Twenty patients with an average age of 52.4 years participated. Most identified themselves as White (85%), one quarter had a history of hysterectomy, and 15% had previously undergone pelvic reconstructive surgery. Nineteen (95%) patients resumed intercourse 2–4 months after surgery. Thematic saturation was reached with major themes of Outside Influences, Conflicting Emotions, Uncertainty, Sexual Changes and Stability, Normalization, and Self-Image. First sexual encounter timing was strongly influenced by partners' desires and fears and physician counseling. Fear of damage to repairs affected patients' comfort with return to sexual activity. Although uncertain of how anatomical changes or presence of mesh would affect function, women hoped that changes would be positive, regardless of preoperative sexual function. Some women found their experience unchanged, whereas others reported need for change in sexual position, use of lubrication, and sensation of foreign body. Positive changes included increase in desire, pleasure, and improvement in orgasm. Self-image generally improved after surgery, which increased women's sexual confidence. CONCLUSION: The return to sexual activity after surgery for POP or UI represents a great unknown for many women. Reports of initial sexual activity after surgery are often positive, and physicians strongly influence initial postoperative sexual encounter timing. Frank counseling about patient and partners' fears regarding the effect of repair on sexual activity would likely improve patients' outcomes.

Surgeon Counseling Regarding Return to Sexual Activity After Pelvic Reconstructive Surgery

“…Women reported conflicting emotions, including significant fear, associated with the return to sexual activity. 6 Patients in this study also noted that surgeon counseling significantly influences the timing of return to sexual activity. The authors postulated that improved physician counseling after pelvic reconstructive surgery may similarly improve and prepare patients for resumption of sexual activity.…”

“…4 Surgeons' postoperative counseling strongly influences patients' experiences with return to sexual function after these surgical procedures. 6 Nevertheless, in our qualitative assessment, surgeons more commonly advised patients that their sexual experience would be worsened or different from baseline, and counseling regarding improvement was less frequent. Few prior studies report both preoperative and postoperative rates of sexual activity and dyspareunia, and return to sexual activity after surgery for POP and UI represents an area for future research.…”

“…Several of these themes mirror past research exploring patient-reported themes regarding patients' first postoperative sexual encounters. 6 For example, patients commonly report fear of damage to the surgical repair; similarly, nearly all surgeons discuss the safety of intercourse at the time of postoperative counseling. Women also discuss the influence of their partners on the decision to return to intercourse after surgery, whereas surgeons often mention possible changes and expectations for the partners.…”

“…Women also discuss the influence of their partners on the decision to return to intercourse after surgery, whereas surgeons often mention possible changes and expectations for the partners. Overall, positive experiences of women who resume sexual activity after reconstructive vaginal surgery have been reported, 4,6,11 although the route of and materials used for specific types of surgery influence these results. 12 Taken together, these explorations into health care professional counseling and patient experience during the anticipated first postoperative sexual encounter establish a baseline in our efforts to develop optimal communication on this topic.…”

“…Patient preparedness for sexual activity after pelvic reconstructive surgery has not yet been addressed in the literature. In 2021, Caldwell et al 6 qualitatively examined the first sexual experience of patients following their reconstructive surgery. Women reported conflicting emotions, including significant fear, associated with the return to sexual activity 6 .…”