Retrospective Analysis of Sexual Function After Transvaginal Mesh Surgery

Despite ample research regarding the impact of reconstructive surgery on anatomic/functional outcomes of pelvic organ prolapse (POP), including incidence of dyspareunia, evidence regarding sexual outcomes is equivocal.

To assess changes in sexual function in women followed up for at least 12 months after transvaginal mesh surgery for POP.

We conducted a retrospective review of women who underwent surgery for POP using different mesh products between 2008 and 2019. Baseline demographics were compiled along with intraoperative and postoperative information. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) was used to assess sexual function.

Women sexually active before and after surgery were assessed to determine changes in overall and question-specific PISQ-12 responses and potential factors to explain sexual function after surgery.

622 women underwent surgery using mesh at our center. 360 (58%) attended at least one visit at a median of 12 months (IQR 11-23 months), with 113 (31%) sexually active at baseline and 247 (69%) sexually inactive. 97 had complete PISQ-12 responses before and after surgery. There was an overall improvement in the median PISQ-12 scores of 2 points (P < .001); improvements persisted when scores were stratified by various factors. Specific improvements were noted in climax (P = .046) and orgasm intensity (P = .002), fear (P < .001) or actual incontinence during intercourse (P = .004), avoidance of intercourse due to prolapse (P < .001), and negative emotions (P < .001). There was a slight positive effect of the baseline PISQ-12 score on the postoperative PISQ-12 score (regression coefficient 0.24, 95% CI: 0.09-0.39), and a stronger negative effect of having a concomitant anal sphincteroplasty (-4.84, 95% CI: -8.42 to -1.25). Preoperative prolapse stage was not associated with postoperative sexual outcomes. There was a weak negative association between the postoperative PISQ-12 and Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) scores [r_s(95) = -0.27, P = .008] and a moderate negative association between postoperative PISQ-12 and total Pelvic Floor Distress Inventory short form [r_s(94) = -0.42, P < .001].

Transvaginal mesh surgery appears to positively impact sexual function, and improvements were independent of mesh or baseline prolapse severity. Khandwala S, Cruff J, Williams C. Retrospective Analysis of Sexual Function After Transvaginal Mesh Surgery. Sex Med 2021;9:100281.