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International Urogynecology Journal

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01-11-2013 | POP Surgery Review

Pelvic organ prolapse and sexual function

Authors: Viviane Dietz, Christopher Maher

Published in: International Urogynecology Journal | Issue 11/2013

Abstract

Introduction and hypothesis

The aim was to review the impact of pelvic organ prolapse surgery on sexual function.

Methods

Every 4 years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials [RCT] systematic reviews), level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 (case reports). The highest level of evidence was utilised by the committee to make evidence based recommendations based upon the Oxford grading system. Grade A recommendation usually depends on consistent level 1 evidence. Grade B recommendation usually depends on consistent level 2 and/or 3 studies, or “majority evidence” from RCTs. Grade C recommendation usually depends on level 4 studies or “majority evidence” from level 2/3 studies or Delphi process expert opinion. Grade D “no recommendation possible” would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without formal analytical process, such as by Delphi.

Results

With regard to the anterior compartment, the use of mesh is associated with neither a worsening in sexual function nor an increase in de novo dyspareunia compared with traditional anterior colporrhaphy (grade B). There is insufficient information to provide evidence-based recommendations on sexual function after vaginal mesh in the posterior compartment or after new lightweight or absorbable meshes (grade D).

Conclusion

There is a paucity of data on the impact of prolapse surgery on sexual function. Sexual function and dyspareunia rates are similar after anterior polypropylene mesh and anterior colporrhaphy (grade B). We recommend using validated questionnaires measuring sexual function in women before and after prolapse surgery and reporting sexual activity and dyspareunia rates pre- and post-intervention in all patients.

Basson R, Berman J, Burnett A et al (2000) Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. J Urol 163(3):888–893PubMedCrossRef

Pauls RN, Segal JL, Silva WA, Kleeman SD, Karram MM (2006) Sexual function in patients presenting to a urogynecology practice. Int Urogynecol J Pelvic Floor Dysfunct 17(6):576–580PubMedCrossRef

Baessler K, O’Neill SM, Maher CF et al (2010) A validated self-administered female pelvic floor questionnaire. Int Urogynecol J 21(2):163–172PubMedCrossRef

Rogers RG, Kammerer-Doak D, Villarreal A, Coates K, Qualls C (2001) A new instrument to measure sexual function in women with urinary incontinence or pelvic organ prolapse. Am J Obstet Gynecol 184(4):552–558PubMedCrossRef

Rosen R, Brown C, Heiman J et al (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26(2):191–208PubMedCrossRef

Ghielmetti T, Kuhn P, Dreher EF, Kuhn A (2006) Gynaecological operations: do they improve sexual life? Eur J Obstet Gynecol Reprod Biol 129(2):104–110PubMedCrossRef

Rogers RG, Kammerer-Doak D, Darrow A et al (2006) Does sexual function change after surgery for stress urinary incontinence and/or pelvic organ prolapse? A multicenter prospective study. Am J Obstet Gynecol 195(5):e1–e4PubMedCrossRef

Komesu YM, Rogers RG, Kammerer-Doak DN, Barber MD, Olsen AL (2007) Posterior repair and sexual function. Am J Obstet Gynecol 197(1):101e1–101e6CrossRef

Jeng CJ, Yang YC, Tzeng CR, Shen J, Wang LR (2005) Sexual functioning after vaginal hysterectomy or transvaginal sacrospinous uterine suspension for uterine prolapse: a comparison. J Reprod Med 50(9):669–674PubMed

10.

Dietz V, van der Vaart CH, van der Graaf Y, Heintz P, Schraffordt Koops SE (2010) One-year follow-up after sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: a randomized study. Int Urogynecol J 21(2):209–216PubMedCrossRef

11.

Vollebregt A, Fischer K, Gietelink D, van der Vaart CH (2011) Primary surgical repair of anterior vaginal prolapse: a randomised trial comparing anatomical and functional outcome between anterior colporrhaphy and trocar-guided transobturator anterior mesh. BJOG 118(12):1518–1527PubMedCrossRef

12.

Carey M, Higgs P, Goh J et al (2009) Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial. BJOG 116(10):1380–1386PubMedCrossRef

13.

Nguyen JN, Burchette RJ (2008) Outcome after anterior vaginal prolapse repair: a randomized controlled trial. Obstet Gynecol 111(4):891–898PubMedCrossRef

14.

Sivaslioglu AA, Unlubilgin E, Dolen I (2008) A randomized comparison of polypropylene mesh surgery with site-specific surgery in the treatment of cystocoele. Int Urogynecol J Pelvic Floor Dysfunct 19(4):467–471PubMedCrossRef

15.

Altman D, Vayrynen T, Engh ME, Axelsen S, Falconer C (2011) Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med 364(19):1826–1836PubMedCrossRef

16.

Nieminen K, Hiltunen R, Takala T et al (2010) Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow-up. Am J Obstet Gynecol 203(3):235e1–235e8CrossRef

17.

Milani AL, Withagen MI, Hok S, Nedelcu-van der Wijk I, Vierhout ME (2011) Sexual function following trocar-guided mesh or vaginal native tissue repair in recurrent prolapse: a randomized controlled trial. J Sex Med 8(10):2944–2953PubMedCrossRef

18.

Natale F, La Penna C, Padoa A, Agostini M, De Simone E, Cervigni M (2009) A prospective, randomized, controlled study comparing Gynemesh, a synthetic mesh, and Pelvicol, a biologic graft, in the surgical treatment of recurrent cystocele. Int Urogynecol J Pelvic Floor Dysfunct 20(1):75–81PubMedCrossRef

19.

Paraiso MF, Barber MD, Muir TW, Walters MD (2006) Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. Am J Obstet Gynecol 195(6):1762–1771PubMedCrossRef

20.

Withagen MI, Milani AL, den Boon J, Vervest HA, Vierhout ME (2011) Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse: a randomized controlled trial. Obstet Gynecol 117(2 Pt 1):242–250PubMedCrossRef

21.

Iglesia CB, Sokol AI, Sokol ER et al (2010) Vaginal mesh for prolapse: a randomized controlled trial. Obstet Gynecol 116(2 Pt 1):293–303PubMedCrossRef

22.

Withagen MI, Vierhout ME, Hendriks JC, Kluivers KB, Milani AL (2011) Risk factors for exposure, pain, and dyspareunia after tension-free vaginal mesh procedure. Obstet Gynecol 118(3):629–636PubMedCrossRef

23.

Maher CF, Feiner B, DeCuyper E, Nichlos C, Hickey K, O'Rourke P (2011) Laparoscopic sacral colpopexy versus total vaginal mesh for vaginal vault prolapse: a randomized trial. Am J Obstet Gynecol 204(4):360e1–7

24.

Benson JT, Lucente V, McClellan E (1996) Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol 175(6):1418–1421PubMedCrossRef

25.

Maher C, Feiner B, Baessler K, Adams EJ, Hagen S, Glazener CM (2010) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 4:CD004014PubMed

26.

Fayyad AM, North C, Reid FM, Smith AR (2011) Prospective study of anterior transobturator mesh kit (Prolift) for the management of recurrent anterior vaginal wall prolapse. Int Urogynecol J Pelvic Floor Dysfunct 22(2):157–163CrossRef

27.

Milani R, Salvatore S, Soligo M, Pifarotti P, Meschia M, Cortese M (2005) Functional and anatomical outcome of anterior and posterior vaginal prolapse repair with prolene mesh. BJOG 112(1):107–111PubMedCrossRef

28.

Altman D, Elmer C, Kiilholma P, Kinne I, Tegerstedt G, Falconer C (2009) Sexual dysfunction after trocar-guided transvaginal mesh repair of pelvic organ prolapse. Obstet Gynecol 113(1):127–133PubMed

29.

Su TH, Lau HH, Huang WC et al (2009) Short term impact on female sexual function of pelvic floor reconstruction with the Prolift procedure. J Sex Med 6(11):3201–3207PubMedCrossRef

30.

Wetta LA, Gerten KA, Wheeler TL 2nd, Holley RL, Varner RE, Richter HE (2009) Synthetic graft use in vaginal prolapse surgery: objective and subjective outcomes. Int Urogynecol J Pelvic Floor Dysfunct 20(11):1307–1312PubMedCrossRef

31.

Moore RD, Beyer RD, Jacoby K, Freedman SJ, McCammon KA, Gambla MT (2000) Prospective multicenter trial assessing type I, polypropylene mesh placed via transobturator route for the treatment of anterior vaginal prolapse with 2-year follow-up. Int Urogynecol J 21(5):545–52CrossRef

32.

Sayer T, Lim J, Gauld JM, et al. (2012) Medium-term clinical outcomes following surgical repair for vaginal prolapse with tension-free mesh and vaginal support device. Int Urogynecol J 23(4):487–493PubMedCrossRef

33.

Sentilhes L, Berthier A, Sergent F et al (2008) Infracoccygeal sacropexy reinforced with posterior mesh interposition for apical and posterior compartment prolapse. Eur J Obstet Gynecol Reprod Biol 137(1):108–113PubMedCrossRef

34.

Zyczynski HM, Carey MP, Smith AR et al (2010) One-year clinical outcomes after prolapse surgery with nonanchored mesh and vaginal support device. Am J Obstet Gynecol 203(6):587e1–587e8CrossRef

35.

Milani AL, Hinoul P, Gauld JM, Sikirica V, van Drie D, Cosson M (2011) Trocar-guided mesh repair of vaginal prolapse using partially absorbable mesh: 1 year outcomes. Am J Obstet Gynecol 204(1):74e1–74e8CrossRef

36.

de Tayrac R, Devoldere G, Renaudie J, Villard P, Guilbaud O, Eglin G (2007) Prolapse repair by vaginal route using a new protected low-weight polypropylene mesh: 1-year functional and anatomical outcome in a prospective multicentre study. Int Urogynecol J Pelvic Floor Dysfunct 18(3):251–256PubMedCrossRef

37.

Jacquetin B, Fatton B, Rosenthal C et al. (2010) Total transvaginal mesh (TVM) technique for treatment of pelvic organ prolapse: a 3-year prospective follow-up study. Int Urogynecol J 21(12):1455–1462PubMedCrossRef

38.

Feiner B, Gietelink L, Maher C (2010) Anterior vaginal mesh sacrospinous hysteropexy and posterior fascial plication for anterior compartment dominated uterovaginal prolapse. Int Urogynecol J 21(2):203–208PubMedCrossRef

39.

Milani AL, Withagen MI, Vierhout ME (2009) Trocar-guided total tension-free vaginal mesh repair of post-hysterectomy vaginal vault prolapse. Int Urogynecol J Pelvic Floor Dysfunct 20(10):1203–1211PubMedCrossRef

40.

Lowman JK, Jones LA, Woodman PJ, Hale DS (2008)Does the Prolift system cause dyspareunia?Am J Obstet Gynecol 199(6):707e1–707e6CrossRef

41.

Hinoul P, Ombelet WU, Burger MP, Roovers JP (2008) A prospective study to evaluate the anatomic and functional outcome of a transobturator mesh kit (prolift anterior) for symptomatic cystocele repair.J Minim Invasive Gynecol 15(5):615–620PubMedCrossRef

42.

Long CY, Hsu CS, Wu MP, Lo TS, Liu CM, Tsai EM (2011) Comparison of the changes in sexual function of premenopausal and postmenopausal women following transvaginal mesh surgery. J Sex Med 8(7):2009–2016

43.

Sergent F, Resch B, Al-Khattabi M, Richourg A, Schaal J, Marpeau L (2011) Transvaginal mesh repair of pelvic organ prolapse by the transobturator -infracoccygeal hammock technique: long-term anatomical and functional outcomes. Neurorol Urodyn 30(3):384–389

Title: Pelvic organ prolapse and sexual function
Authors: Viviane Dietz
Christopher Maher
Publication date: 01-11-2013
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 11/2013
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-013-2176-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pelvic organ prolapse and sexual function

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

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