Sexual function after rectocele repair

Pelvic organ prolapse is a common condition among women with a prevalence of 11% and may affect the anterior, posterior, or apical compartment with a negative impact on sexual function.

Aim of the current study was to evaluate sexual function before and after surgical rectocele fascial repair in sexually active patients who suffer from symptomatic rectoceles.

Female Sexual Function Index (FSFI) and anatomical outcome after rectocele repair.

Between December 2000 and December 2009, we asked sexually active female patients who were to undergo rectocele fascial repair for symptomatic rectoceles to participate in this study. The patients were gynecologically examined before and after surgery and prolapse staging was performed using the ICS-Pelvic Organ Prolapse Staging. Patients were asked to fill in the FSFI before surgery and at 6 months follow-up. For statistical analysis, Graph Pad Prism version 5.0 for Windows was used (Graph Pad, La Jolla, CA, USA). Student's t-test was used after normality tests to compare groups and α was set 0.05.

Sixty-eight patients were included in this study. Median age was 72 years (range 47-91), median parity of 2 (range 0-3) and median body mass index was 29 kg/m2 (range 23-31). Main complaints preoperatively were painful prolapse feeling (n=52), dyspareunia (n=59), and a feeling of vaginal heaviness (n=39). One patient who had suffered from postoperative infection that resulted in excessive scar tissue of the posterior wall suffered from de novo dyspareunia. Statistical analyses (paired t-test) showed significant improvement for desire (P<0.001), satisfaction (P<0.0001), and pain (P<0.0001) and no significant changes for arousal (P=0.0897), lubrication (P=1), and orgasm (P=0.0893).

Posterior fascial repair improves some domains of sexual function but not all in sexually active patients with symptomatic rectoceles, and local oestrogene treatment may contribute to this finding.