Gynaecological and sexual function related to anatomical changes in the female pelvis after restorative proctocolectomy

  • T. Öresland
  • S. Palmablad
  • M. Ellström
  • I. Berndtsson
  • N. Crona
  • L. Hultén
Original Articles

Abstract

Restorative proctocolectomy with an ileal pouch-anal anastomosis preserves anal sphincters, the normal route of defaecation and the normal body image and it has been suggested that the procedure might be associated with less gynaecological and sexual problems than conventional proctocolectomy. To shed further light on this subject 60 female patients were invited to participate in a study comprising a detailed interview, examination by a gynaecologist and investigation with hysterosalpingography and vaginography. Twenty-one women with a mean follow-up of 38 months after surgery agreed to participate. Their gynaecological state was considered normal although one woman complained of vaginal discharge. Five women experienced occasional dyspareunia and 2 patients had to take special precautions to avoid bowel leaks at intercourse. While the position of the vagina and uterus in the pelvis appeared normal, hysterosalpingography disclosed bilateral occlusion of the fallopian tubes in 2 and unilateral occlusion in another 9 patients with tubes adhering to the bottom of the lesser pelvis in 10 of the patients. Only one out of 14 patients succeeded in trying to conceive during the follow-up period. Among the remaining 39 women not specially studied 5 out of 14 had conceived after the operation.

Résumé

La proctocolectomie avec confection d'un réservoir iléoanal permet de conserver la fonction sphinctérienne, de maintenir les voies habituelles de la défécation et de maintenir le schéma corporel normal; cette intervention pourrait entraîner moins de problèmes gynécologiques et sexuels qu'une proctocolectomie conventionnelle. Afin de préciser ces éléments, 60 femmes ont été invitées à participer à une étude comportant un interview détaillé, un examen par un gynécologue et des investigations radiologiques avec une hystérosalpyngographie et une vaginographie. Vingt et une femmes avec un suivi moyen de 38 mois après chirurgie ont accepté d'être inclues dans l'étude. Le status gynécologique des ces patientes a été considéré comme normal bien qu'une patiente se plaigne d'un écoulement vaginal. Cinq patientes se plaignent occasionellement de dyspareunie et 2 doivent prendre des mesures de protection particulière pour éviter une incontinence au cours des rapports sexuels. Bien que la position du vagin et de l'utérus apparaissent comme normal dans le petit bassin, l'hystérosalpyngographie a montré une occlusion bilatérale des trompes chez 2 malades et une occlusion unilatérale chez 9 malades avec des adhérences tubaires dans le petit bassin chez 10 malades. Une seule patiente sur les 14 qui se sont efforcées de devenir enceintes y est parvenue. Parmi les 39 autres malades qui n'ont pas fait l'objet d'une étude particulière, 5 sont devenues enceintes après l'opération.

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Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • T. Öresland
    • 1
    • 4
  • S. Palmablad
    • 2
  • M. Ellström
    • 3
  • I. Berndtsson
    • 1
  • N. Crona
    • 3
  • L. Hultén
    • 1
  1. 1.Department of Surgery II, Sahlgrens' HospitalUniversity of GöteborgGöteborgSweden
  2. 2.Department of Radiology, Sahlgrens' HospitalUniversity of GöteborgGöteborgSweden
  3. 3.Department of Obstetrics and Gynaecology, Sahlgrens' HospitalUniversity of GöteborgGöteborgSweden
  4. 4.Department of SurgerySahlgrenska SjukhusetGöteborgSweden

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