Native-Tissue Pelvic Prolapse Surgery Improves Sexual Function

A Cleveland Clinic study of women who underwent native-tissue surgery for pelvic organ prolapse demonstrated that the patients experienced improvements in satisfaction about their sexuality and in sexual function regardless of whether hysterectomy was performed.

Results of the analysis were published in March in the journal Sexual Medicine.

“The most important information gleaned from this study is that there was a clinically meaningful improvement in sexual function after native-tissue pelvic organ prolapse surgery with hysterectomy or with uterine preservation,” says Marie Fidela Paraiso, MD, who holds a joint appointment in Cleveland Clinic’s Obstetrics and Gynecology Institute, Urological Institute, and Center for Geriatric Medicine. Dr. Paraiso is one of the study’s five co-investigators.

Improvements at the one-year mark

The research was a planned secondary analysis of a prospective cohort study that evaluated the effect of intraoperative resting genital hiatus size on prolapse recurrence after native-tissue vaginal prolapse surgery. The team looked at 68 adult patients who underwent surgery from 2019 to 2021. Patients undergoing pelvic organ prolapse surgery with apical suspension were able to participate. Those with connective tissue disorder, prolapse repair with mesh, or pregnancy were excluded.

Fifty-nine of the original cohort completed a 12-month follow-up. Of those, 28 (47.5%) had a hysterectomy and 31 (52.5%) did not. Of those who didn’t, 17 underwent a uterine-preserving procedure. Twenty-six patients were sexually active and 33 were not.

One year after surgery, the sexually active patients reported significant improvement in sexual function. Non-sexually active patients reported significant improvement in satisfaction with their sex life, including not feeling sexually inferior or angry because of their prolapse. Ten percent more patients were sexually active after surgery than before surgery.

Additionally, before the surgery, patients identified prolapse as the primary reason they avoided sexual activity. A year later, lack of a partner or having a partner with sexual dysfunction was the most common primary reason for avoiding surgery.

Results of the study align with previous research showing that prolapse surgery improves sexual function. One of the study goals, however, was to expand the field of instruments used to measure sexual function so that results could be assessed for both sexually active and non-sexually active patients. The researchers used the Pelvic Organ Prolapse—Urinary Incontinence Sexual Function Questionnaire (PISQ-IR) to measure change in sexual function over time for patients who were sexually active. Those who were non-sexually active before surgery were evaluated using answers to select PISQ-IR questions.

Clinically important difference scores

The team also established minimal clinically important difference scores to translate results into improvement as perceived by patients. Overall, says Dr. Paraiso, “the clinical implications are that patients should not resist native-tissue surgical interventions for prolapse. More women will resume sexual function and, of those women who are sexually active prior to surgery, their sexual function should improve. It also appears that neither hysterectomy nor uterine preservation has an effect on sexual function, although the secondary analysis was not powered for these specific outcomes.”