International Urogynecology Journal

, Volume 24, Issue 11, pp 1853–1857

Pelvic organ prolapse and sexual function

POP Surgery Review


Introduction and hypothesis

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


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.


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).


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.


Dyspareunia Transvaginal mesh Sexual function 


  1. 1.
    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):888–893PubMedCrossRefGoogle Scholar
  2. 2.
    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):576–580PubMedCrossRefGoogle Scholar
  3. 3.
    Baessler K, O’Neill SM, Maher CF et al (2010) A validated self-administered female pelvic floor questionnaire. Int Urogynecol J 21(2):163–172PubMedCrossRefGoogle Scholar
  4. 4.
    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):552–558PubMedCrossRefGoogle Scholar
  5. 5.
    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
  6. 6.
    Ghielmetti T, Kuhn P, Dreher EF, Kuhn A (2006) Gynaecological operations: do they improve sexual life? Eur J Obstet Gynecol Reprod Biol 129(2):104–110PubMedCrossRefGoogle Scholar
  7. 7.
    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–e4PubMedCrossRefGoogle Scholar
  8. 8.
    Komesu YM, Rogers RG, Kammerer-Doak DN, Barber MD, Olsen AL (2007) Posterior repair and sexual function. Am J Obstet Gynecol 197(1):101e1–101e6CrossRefGoogle Scholar
  9. 9.
    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):669–674PubMedGoogle Scholar
  10. 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):209–216PubMedCrossRefGoogle Scholar
  11. 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):1518–1527PubMedCrossRefGoogle Scholar
  12. 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):1380–1386PubMedCrossRefGoogle Scholar
  13. 13.
    Nguyen JN, Burchette RJ (2008) Outcome after anterior vaginal prolapse repair: a randomized controlled trial. Obstet Gynecol 111(4):891–898PubMedCrossRefGoogle Scholar
  14. 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):467–471PubMedCrossRefGoogle Scholar
  15. 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):1826–1836PubMedCrossRefGoogle Scholar
  16. 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):235e1–235e8CrossRefGoogle Scholar
  17. 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):2944–2953PubMedCrossRefGoogle Scholar
  18. 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):75–81PubMedCrossRefGoogle Scholar
  19. 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):1762–1771PubMedCrossRefGoogle Scholar
  20. 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):242–250PubMedCrossRefGoogle Scholar
  21. 21.
    Iglesia CB, Sokol AI, Sokol ER et al (2010) Vaginal mesh for prolapse: a randomized controlled trial. Obstet Gynecol 116(2 Pt 1):293–303PubMedCrossRefGoogle Scholar
  22. 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):629–636PubMedCrossRefGoogle Scholar
  23. 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):360e1–7Google Scholar
  24. 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):1418–1421PubMedCrossRefGoogle Scholar
  25. 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:CD004014PubMedGoogle Scholar
  26. 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):157–163CrossRefGoogle Scholar
  27. 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):107–111PubMedCrossRefGoogle Scholar
  28. 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):127–133PubMedGoogle Scholar
  29. 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):3201–3207PubMedCrossRefGoogle Scholar
  30. 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):1307–1312PubMedCrossRefGoogle Scholar
  31. 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):545–52CrossRefGoogle Scholar
  32. 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):487–493PubMedCrossRefGoogle Scholar
  33. 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):108–113PubMedCrossRefGoogle Scholar
  34. 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):587e1–587e8CrossRefGoogle Scholar
  35. 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):74e1–74e8CrossRefGoogle Scholar
  36. 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):251–256PubMedCrossRefGoogle Scholar
  37. 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):1455–1462PubMedCrossRefGoogle Scholar
  38. 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):203–208PubMedCrossRefGoogle Scholar
  39. 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):1203–1211PubMedCrossRefGoogle Scholar
  40. 40.
    Lowman JK, Jones LA, Woodman PJ, Hale DS (2008)Does the Prolift system cause dyspareunia?Am J Obstet Gynecol 199(6):707e1–707e6CrossRefGoogle Scholar
  41. 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):615–620PubMedCrossRefGoogle Scholar
  42. 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):2009–2016Google Scholar
  43. 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):384–389Google Scholar

Copyright information

© ICUD-EAU 2013

Authors and Affiliations

  1. 1.Catharina Medical CenterEindhovenThe Netherlands
  2. 2.University of QueenslandRoyal Brisbane and Wesley UrogynaecologyBrisbaneAustralia

Personalised recommendations