Pelvic organ prolapse burden on sexual health and body image: a cross-sectional study

Pelvic organ prolapse (POP) is common and can affect sexual health and body image. Sexual concerns of non-sexually active (NSA) females with POP have been poorly described.

To describe the burden of POP and explore associations between sexual function and body image in all patients seeking surgery.

Secondary analysis of a baseline patient cohort, randomized controlled trial (RCT) of 2 POP reconstructive surgeries at 5 urogynecology tertiary centers. We present baseline sexual activity, function, and sex-related affect and body image. Patients scheduled for POP surgery completed validated condition-specific questionnaires of sexual function, body image, demographics, POP burden, and medical comorbidities. We used descriptive statistics and appropriate tests of significance.

Differences between sexually active (SA) and NSA patients in POP-specific sexual function and body image; associations between body image and impaired sexual function.

Of 181 patients, 86 (47.5%) were SA, with a mean (SD) of age 62 (11.1). SA patients were younger, with fewer comorbidities. 30/86 (35%) had clinically significant sexual function impairment. Reasons for being NSA included pelvic symptoms (69.1%), lack of interest (53.8%), and lack of partner (40.5%). Frustration, sexual inferiority, and anger were similar between NSA and SA patients. NSA patients have 5 times the odds of avoiding sexual activity because of fear of pelvic symptoms; twice the odds of being more dissatisfied and twice the odds of feeling more inadequate in their sex life than SA patients. (P < .05, unadjusted and adjusted analyses). A total of 171 patients (80% partnered) had similar body image scores between SA and NSA patients. Partnered NSA patients were more likely than SA to avoid sexual intimacy because of POP, aOR 2.35 (95% CI, 1.03-5.33). Patients who had clinically significant POP-related impairment of sexual function had significantly worse body image (P < .001).

Patients with clinically bothersome POP have significant sexual concerns. Body image was similarly affected regardless of sexual activity. Perceived partner avoidance of intimacy was a common barrier. This is an opportunity for tailored sexual health individual and couples counseling.

Our findings apply to many surgical POP patients regardless of partner or sexual activity status. Limitations include missing data, no validated measure of sexual distress, and no evaluation of partner sexual function.

The burden of POP-related sexual dysfunction and corresponding poor body image is substantial in both SA and NSA patients awaiting POP surgery. In the preoperative assessment of POP, sexual health and body image questions should be routinely included.