Changes in vaginal anatomy and sexual function after vaginal surgery

  • John A. Occhino
  • Emanuel C. Trabuco
  • Christine A. Heisler
  • Christopher J. Klingele
  • John B. Gebhart
Original Article


Introduction and hypothesis

The study’s objectives were to determine changes in vaginal length and caliber after vaginal surgery and to correlate changes with sexual function.


This prospective study measured vaginal length and caliber before and immediately after vaginal surgery and at 5- to 8-week follow-up. A sexual function questionnaire was administered preoperatively and 6 months postoperatively.


Ninety-two women were enrolled (mean age, 64 years); 44 (47.8%) were sexually active. The most common procedure was Mayo-McCall culdoplasty in 85 women (92.4%). Fourteen (15.2%) had intentional vaginal shortening and narrowing (coning). Mean vaginal length changed from 10.4 cm preoperatively to 8.7 cm at 5- to 8-week follow-up in women not having coning. Mean vaginal caliber changed from 3.2 to 2.8 cm. Preoperative and postoperative sexual function questionnaire scores did not correlate with vaginal measurements.


Vaginal shortening and narrowing occurred after vaginal surgery; sexual function was unchanged.


Gynecologic surgical procedures Pelvic organ prolapse Sexual dysfunction, physiological Urinary incontinence Vagina 



Body mass index


Female sexual dysfunction


Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12


  1. 1.
    Samuelsson EC, Victor FT, Tibblin G, Svardsudd KF (1999) Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol 180:299–305PubMedCrossRefGoogle Scholar
  2. 2.
    Boyles SH, Weber AM, Meyn L (2003) Procedures for pelvic organ prolapse in the United States, 1979–1997. Am J Obstet Gynecol 188:108–115PubMedCrossRefGoogle Scholar
  3. 3.
    Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89:501–506PubMedCrossRefGoogle Scholar
  4. 4.
    Subak LL, Waetjen LE, van den Eeden S, Thom DH, Vittinghoff E, Brown JS (2001) Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol 98:646–651PubMedCrossRefGoogle Scholar
  5. 5.
    Karram MM (2009) “Evidence-based medicine” to support the surgical procedures we perform on patients with pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 20:763–764PubMedCrossRefGoogle Scholar
  6. 6.
    Basson R, Berman J, Burnett A, Derogatis L, Ferguson D, Fourcroy J et al (2000) Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. J Urol 163:888–893PubMedCrossRefGoogle Scholar
  7. 7.
    Laumann EO, Paik A, Rosen RC (1999) Sexual dysfunction in the United States: prevalence and predictors. JAMA 281:537–544, Erratum in: (1999) JAMA 281:1174PubMedCrossRefGoogle Scholar
  8. 8.
    Nicolosi A, Laumann EO, Glasser DB, Moreira ED Jr, Paik A, Gingell C, Global Study of Sexual Attitudes and Behaviors Investigators’ Group (2004) Sexual behavior and sexual dysfunctions after age 40: the global study of sexual attitudes and behaviors. Urology 64(5):991–997CrossRefGoogle Scholar
  9. 9.
    Barber MD, Visco AG, Wyman JF, Fantl JA, Bump RC, Continence Program for Women Research Group (2002) Sexual function in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol 99:281–289PubMedCrossRefGoogle Scholar
  10. 10.
    Pauls RN, Silva WA, Rooney CM, Siddighi S, Kleeman SD, Dryfhout V et al (2007) Sexual function after vaginal surgery for pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 197(622):e1–e7Google Scholar
  11. 11.
    Katz VL, Lentz GM, Lobo RA, Gershenson DM (2007) Comprehensive gynecology, 5th edn. Mosby Elsevier, PhiladelphiaGoogle Scholar
  12. 12.
    Vassallo BJ, Karram MM (2003) Management of iatrogenic vaginal constriction. Obstet Gynecol 102:512–520PubMedCrossRefGoogle Scholar
  13. 13.
    Tan JS, Lukacz ES, Menefee SA, Luber KM, Albo ME, Nager CW (2006) Determinants of vaginal length. Am J Obstet Gynecol 195:1846–1850PubMedCrossRefGoogle Scholar
  14. 14.
    Given FT Jr, Muhlendorf IK, Browning GM (1993) Vaginal length and sexual function after colpopexy for complete uterovaginal eversion. Am J Obstet Gynecol 169(2 Pt 1):284–287PubMedGoogle Scholar
  15. 15.
    Weber AM, Walters MD, Schover LR, Mitchinson A (1995) Vaginal anatomy and sexual function. Obstet Gynecol 86:946–949PubMedCrossRefGoogle Scholar
  16. 16.
    Schimpf MO, Harvie HS, Omotosho TB, Epstein LB, Jean-Michel M, Olivera CK, Society of Gynecologic Surgeons Fellows’ Pelvic Research Network et al (2010) Does vaginal size impact sexual activity and function? Int Urogynecol J Pelvic Floor Dysfunct 21:447–452PubMedGoogle Scholar
  17. 17.
    Lee RA (1992) Atlas of gynecologic surgery. Saunders, PhiladelphiaGoogle Scholar

Copyright information

© The International Urogynecological Association 2011

Authors and Affiliations

  • John A. Occhino
    • 1
  • Emanuel C. Trabuco
    • 1
  • Christine A. Heisler
    • 1
  • Christopher J. Klingele
    • 1
  • John B. Gebhart
    • 1
  1. 1.Division of Gynecologic SurgeryMayo ClinicRochesterUSA

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