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Improvement in dyspareunia after vaginal mesh removal measured by a validated questionnaire

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Abstract

Introduction and hypothesis

The objective was to examine the effect of the surgical removal of vaginally placed prolapse and incontinence mesh on sexual function. We hypothesize that patients with painful complications of mesh will experience improvement in dyspareunia and sexual function after mesh removal.

Methods

The eligible cohort consisted of 133 women who presented with a new onset of pain attributed to mesh-augmented incontinence or prolapse surgery and who elected to undergo mesh removal between 1 August 2012 and 1 July 2013. Sexual function symptoms were assessed before and after mesh removal surgery using the Pelvic Organ Prolapse and Urinary Incontinence Sexual Function Questionnaire short form (PISQ-12). Multivariate analysis was performed to identify predictors of improvement in dyspareunia.

Results

Ninety-four patients undergoing mesh removal completed a pre-operative questionnaire, 63 of whom also completed a post-operative questionnaire. After mesh removal, there was a nearly 50% reduction in the proportion of women reporting always experiencing post-operative pain with intercourse among those experiencing pre-operative pain. There was a statistically significant quantitative improvement in pain with intercourse after mesh removal based on mean change score of PISQ-12 question 5 “How often do you experience pain with intercourse?”. In multivariate analysis, only history of vaginal delivery was associated with symptom improvement.

Conclusion

Removal of transvaginal prolapse mesh is associated with improvement in self-reported dyspareunia based on a standardized question on a validated instrument in a small cohort of women. Although larger studies are needed to confirm the relationship between mesh-augmented surgeries and post-procedural dyspareunia, these data suggest that consideration of mesh removal is a reasonable step for patients with painful intercourse attributed to mesh-augmented prolapse and incontinence surgeries.

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Abbreviations

FDA:

Federal Drug Administration

LUTS:

Lower urinary tract symptoms

PISQ-12:

Prolapse and Urinary Incontinence Sexual Function Questionnaire short form

POP:

Pelvic organ prolapse

TVM:

Transvaginal mesh

UCLA:

University of California, Los Angeles

UTIs:

Urinary tract infections

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Authors and Affiliations

  1. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, 200 Medical Plaza, Suite 140, Los Angeles, CA, 90095, USA

    T. Grisales

  2. Division of Pelvic Medicine and Reconstructive Surgery, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    A. L. Ackerman & S. Raz

  3. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, CA, USA

    L. J. Rogo-Gupta & L. Kwan

  4. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, Keck School of Medicine of USC, Los Angeles, CA, USA

    L. V. Rodriguez

Authors
  1. T. Grisales
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  3. L. J. Rogo-Gupta
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  4. L. Kwan
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  5. S. Raz
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Contributions

T. Grisales: project development, manuscript writing and editing, data collection, data analysis, and final approval; A.L. Ackerman: manuscript editing, data analysis and visualization, and final approval of the manuscript; L.J. Rogo-Gupta: project development, manuscript editing and final approval of the manuscript; L. Herbert: data analysis and visualization; S. Raz: project development and final approval of the manuscript; L.V. Rodriguez: project development, manuscript editing, and final approval of the manuscript.

Corresponding author

Correspondence to T. Grisales.

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Conflicts of interest

A.L. Ackerman is consultant for Watershed Medical and Cynosure. The remaining authors declare that they have no conflicts of interest.

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Supplementary Information

192_2021_4923_MOESM1_ESM.tif

Dyspareunia after mesh removal. a For all patients who underwent mesh removal, post-operative pain varied by the amount of pre-operative dyspareunia. Almost half of patients complaining usually or always of dyspareunia pre-operatively exhibited substantial improvement, with no subjects worsening after surgery. For patients with less frequent pre-operative dyspareunia, most were unchanged, with only one subject exhibiting worsening pain. b Among the 51 patients reporting always or usually experiencing dyspareunia pre-operatively, the relative improvement is indicated by the post-operative scores on Pelvic Organ Prolapse and Urinary Incontinence Sexual Function Questionnaire short form 12 question 5 (TIF 1.41 mb)

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Grisales, T., Ackerman, A.L., Rogo-Gupta, L.J. et al. Improvement in dyspareunia after vaginal mesh removal measured by a validated questionnaire. Int Urogynecol J 32, 2937–2946 (2021). https://doi.org/10.1007/s00192-021-04923-7

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  • DOI: https://doi.org/10.1007/s00192-021-04923-7

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