Pelvic Organ Prolapse and Sexual Dysfunction

Abstract

Introduction: This narrative review aims to investigate the intricacy of human sexuality, the prevalence and effect of pelvic organ prolapse (POP) repair on overall sexual function and dyspareunia, and the subsequent repercussions on body image self-perception and quality of life. Methods: A MEDLINE and PUBMED search was conducted for studies evaluating the effect of POP surgery on sexual function and dyspareunia in sexually active women as well as its impact on body image self-perception and QoL. We included both observational and randomized controlled studies evaluating this subject. We evaluated patients who underwent anterior and/or posterior compartment repair eventually including vaginal hysterectomy. We excluded studies including women with concomitant anti-incontinence surgical correction and/or any vaginal reconstruction with synthetic materials. Results: Women with POP are more likely to diminish sexual activity due to a perceived impact on body image and attractiveness as well as worry of incontinence. Conservative management (such as pelvic floor muscle physiotherapy or pessary use) or surgical intervention via transabdominal or transvaginal routes have been used to treat POP, but concerns remain regarding sexual consequences. Despite a post-surgical positive sexual outcome, there is an inherent risk of de novo dyspareunia regardless of the surgical technique employed with slightly higher risk for the transvaginal approach. Patient counselling prior to surgery has proved to be an important element of POP treatment. Only studies on complications of POP surgery, specifically its impact on female sexuality, dyspareunia, global quality of life, and self-perceived body image, were included and analyzed for this review. We limited our search to the international English language literature published over the last three decades and excluded all studies involving the use of synthetic material in transvaginal POP repair. Discussion and Conclusions: Although no consistent evidence was found that disorders of the pelvic floor in women have a clear adverse effect on sexuality, their anatomical correction using the patient’s native tissues is recommended. Dyspareunia reduced significantly after repair, but the rate remains higher after the transvaginal approach versus the minimally invasive (robot-assisted and laparoscopic) approach used for sacrocolpopexy.