International Urogynecology Journal

, Volume 24, Issue 9, pp 1481–1487

Changes in female sexual function after pelvic organ prolapse repair: role of hysterectomy

  • Elisabetta Costantini
  • Massimo Porena
  • Massimo Lazzeri
  • Luigi Mearini
  • Vittorio Bini
  • Alessandro Zucchi
Original Article

Abstract

Introduction and hypothesis

Incontinence and pelvic organ prolapse (POP) have an impact on sexuality. Few studies evaluate the impact of hysterectomy on sexual function. We designed the present observational prospective longitudinal cohort study in order to evaluate the impact of uterus preservation after POP repair on sexual function.

Methods

Between January 2006 and January 2011, 107 patients with POP, mean age 58 ± 8.9 years, underwent colposacropexy with or without hysterectomy. All the women without uterine disease were offered the chance to preserve the uterus. All patients gave written informed consent and completed the Female Sexual Function Index (FSFI) questionnaire, before and after surgery, provided detailed case history, underwent urogynaecological examination and urodynamic assessment and completed the Urogenital Distress Inventory short form (UDI-6) and Incontinence Impact on Quality of Life short form (IIQ-7) questionnaires, and the satisfaction Visual Analogue Scale (VAS). One year after surgery patients repeated the FSFI questionnaire and underwent a clinical check-up. The primary end-point was post-operative sexual function as evaluated by the FSFI, the secondary end-points were objective anatomical and subjective success, defined respectively as no prolapse and no incontinence-related symptoms.

Results

Sixty-eight patients were included: 32 underwent uterus-sparing surgery and 36 hysterectomy plus colposacropexy. After surgery both groups had significant improvements in the total FSFI score and in the domains of desire, arousal and orgasm. The median post-operative scores of desire, arousal, and orgasm domains showed significant improvements in the uterus-sparing group compared with the hysterectomy group. None of the women had a uterine or vault prolapse recurrence.

Conclusions

Our data demonstrate that POP plays a role in female sexual dysfunction and uterus sparing surgery is associated with a greater improvement in sexual function.

Keywords

POP surgery Female sexual dysfunction FSFI Hysterocolposacropexy Uterus preservation 

Abbreviations

FSD

Female sexual dysfunction

FSFI

Female Sexual Function Index

HSP

Hysterocolposacropexy

HY + CSP

Hysterectomy and colposacropexy

IIQ-7

Incontinence Impact on Quality of Life

POP

Pelvic organ prolapse

UDI-6

Urogenital Distress Inventory

VAS

Visual Analogue Scale

References

  1. 1.
    Lindau ST, Schumm LP, Laumann EO et al (2007) A study of sexuality and health among older adults in the United States. N Engl J Med 357:762–774PubMedCrossRefGoogle Scholar
  2. 2.
    Filocamo MT, Serati M, Frumenzio E et al (2011) The impact of mid-urethral slings for the treatment of urodynamic stress incontinence on female sexual function: a multicentre prospective study. J Sex Med 8(7):2002–2008PubMedCrossRefGoogle Scholar
  3. 3.
    Pauls RN, Berman JR (2002) Impact of pelvic floor disorders and prolapse on female sexual function and response. Urol Clin North Am 29:677–683PubMedCrossRefGoogle Scholar
  4. 4.
    Zucchi A, Lazzeri M, Porena M et al (2010) Uterus preservation in pelvic organ prolapse surgery. Nat Rev Urol 7(11):626–633, ReviewPubMedCrossRefGoogle Scholar
  5. 5.
    Pauls RN (2010) Impact of gynecological surgery on female sexual function. Int J Imp Res 22(2):105–114, ReviewCrossRefGoogle Scholar
  6. 6.
    Lowenstein L, Gamble T, Sanses TV et al (2010) Fellow's Pelvic Research Network. Changes in sexual function after treatment for prolapse are related to the improvement in body image perception. J Sex Med 7(2 Pt 2):1023–1028PubMedCrossRefGoogle Scholar
  7. 7.
    Lowenstein L, Gamble T, Sanses TV, Fellow's Pelvic Research Network (2009) Sexual function is related to body image perception in women with pelvic organ prolapse. J Sex Med 6(8):2286–2291PubMedCrossRefGoogle Scholar
  8. 8.
    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):191–208PubMedCrossRefGoogle Scholar
  9. 9.
    Nappi RE, Albani F, Vaccaro P et al (2008) Use of the Italian translation of the Female Sexual Function Index (FSFI) in routine gynecological practice. Gynecol Endocrinol 24(4):214–219PubMedCrossRefGoogle Scholar
  10. 10.
    Costantini E, Lazzeri M, Zucchi A et al (2011) Five-year outcome of uterus sparing surgery for pelvic organ prolapse repair: a single-center experience. Int Urogynecol J Pelvic Floor Dysfunct 22(3):287–292CrossRefGoogle Scholar
  11. 11.
    Fatton B (2006) Use of POPQ in the management of pelvic prolapse. Gynecol Obstet Fertil 34:533ECrossRefGoogle Scholar
  12. 12.
    Abrams P, Cardozo L, Fall M et al (2002) Standardisation Sub-committee of the International Continence Society. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21:167–178PubMedCrossRefGoogle Scholar
  13. 13.
    Costantini E, Mearini L, Bini V et al (2005) Uterus preservation in surgical correction of urogenital prolapse. Eur Urol 48(4):642PubMedCrossRefGoogle Scholar
  14. 14.
    Paraiso MF, Barber MD, Muir TW et al (2006) Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. Am J Obstet Gynecol 195:1762–1771PubMedCrossRefGoogle Scholar
  15. 15.
    Silva WA, Pauls RN, Segal JL et al (2006) Uterosacral ligament vault suspension: five-year outcomes. Obstet Gynecol 108:255–263PubMedCrossRefGoogle Scholar
  16. 16.
    Shah SM, Bukkapatnam R, Rodriguez LV (2005) Impact of vaginal surgery for stress urinary incontinence on female sexual function: is the use of polypropylene mesh detrimental? Urology 65:270–274PubMedCrossRefGoogle Scholar
  17. 17.
    Glavind K, Tetsche MS (2004) Sexual function in women before and after suburethral sling operation for stress urinary incontinence: a retrospective questionnaire study. Acta Obstet Gynecol Scand 83:965–968PubMedGoogle Scholar
  18. 18.
    Hasson HM (1993) Cervical removal at hysterectomy for benign disease. J Rep Med 38:781–790Google Scholar
  19. 19.
    Thakar R, Sultan AH (2005) Hysterectomy and pelvic organ dysfunction. Best Pract Res Clin Obstet Gynaecol 19:403–418PubMedCrossRefGoogle Scholar
  20. 20.
    Achtari C, Dwyer PL (2005) Sexual function and pelvic floor disorders. Best Pract Res Clin Obstet Gynaecol 19:993–1008PubMedCrossRefGoogle Scholar
  21. 21.
    Handa VL, Zyczynski HM, Brubaker L et al (2007) Sexual function before and after sacrocolpopexy for pelvic organ prolapse. Am J Obstet Gynecol 197:629.e1–629.e6CrossRefGoogle Scholar
  22. 22.
    Roovers JP, van der BA, van Leeuwen JS et al (2006) Effects of genital prolapse surgery on sexuality. J Psychosom Obstet Gynaecol 27:43–48PubMedCrossRefGoogle Scholar
  23. 23.
    Rogers GR, Villareal A, Kammerer-Doak D et al (2001) Sexual function in women with and without urinary incontinence and/or pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 12:361–5PubMedCrossRefGoogle Scholar
  24. 24.
    Pauls RN, Silva WA, Rooney CM et al (2007) Sexual function after vaginal surgery for pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 197:622.e1–622.e7CrossRefGoogle Scholar
  25. 25.
    Azar M, Noohi S, Radfar S, Radfar MH (2008) Sexual function in women after surgery for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 19:53–57PubMedGoogle Scholar
  26. 26.
    Kuhn A, Brunnmayr G, Stadlmayr W et al (2009) Male and female sexual function after surgical repair of female organ prolapse. J Sex Med 6:1324–1334PubMedCrossRefGoogle Scholar
  27. 27.
    Zucchi A, Costantini E, Mearini L et al (2008) Female sexual dysfunction in urogenital prolapse surgery: colposacropexy vs. hysterocolposacropexy. J Sex Med 5(1):139–145PubMedGoogle Scholar
  28. 28.
    Gutl P, Greimel ER, Roth R, Winter R (2002) Women’s sexual behavior, body image and satisfaction with surgical outcomes after hysterectomy: a comparison of vaginal and abdominal surgery. J Psychosom Obstet Gynaecol 23:51–59PubMedCrossRefGoogle Scholar
  29. 29.
    Rhodes JC, Kjerulff KH, Langenberg PW et al (1999) Hysterectomy and sexual functioning. JAMA 282:1934–1941PubMedCrossRefGoogle Scholar
  30. 30.
    Goetsch MF (2005) The effect of total hysterectomy on specific sexual sensations. Am J Obstet Gynecol 192:1922–1927PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2013

Authors and Affiliations

  • Elisabetta Costantini
    • 1
  • Massimo Porena
    • 1
  • Massimo Lazzeri
    • 1
  • Luigi Mearini
    • 1
  • Vittorio Bini
    • 2
  • Alessandro Zucchi
    • 1
  1. 1.Department of Urology and AndrologyUniversity of Perugia, S.M. Misericordia Hospital, S. Andrea delle FrattePerugiaItaly
  2. 2.Department of Internal MedicineUniversity of PerugiaPerugiaItaly

Personalised recommendations