Sexual and Psychological Outcomes After Vaginal Surgery for Pelvic Organ Prolpase and Stress Urinary Incontinence

The objective was to evaluate changes in sexual function, anxiety and depression after vaginal reconstructive surgery for pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI) and to examine the relationship between sexual function and psychological outcomes.

This prospective observational study included 97 sexually active women aged 25-80 years. Patients were assigned to POP surgery alone or POP surgery with transobturator tape. Sexual function (Female Sexual Function Index, FSFI), anxiety (Beck Anxiety Inventory, BAI) and depression (Beck Depression Inventory-II, BDI-II) were assessed preoperatively and 6 months postoperatively. Paired analyses compared scores and mixed-design repeated-measures analysis of variance was used to evaluate group-by-time effects. Multivariate regression revealed factors associated with score changes and clinically meaningful improvements in FSFI, BAI and BDI-II were assessed using the minimal clinically important difference (MCID).

Six months postoperatively, sexual function, anxiety and depression improved significantly (all p < 0.001), with no significant differences between groups. The mean FSFI score increased from 16.54 ± 7.90 to 21.90 ± 7.36; sexual dysfunction resolved in 24% of patients and 60% of patients achieved clinically meaningful improvements (MCID > 3.34). The mean BAI decreased from 20.14 ± 11.80 to 13.99 ± 8.86 and the mean BDI-II decreased from 16.68 ± 10.11 to 11.84 ± 8.55. Postoperative FSFI scores correlated negatively with psychological scores. Multivariate analysis revealed that a higher POP stage limited FSFI improvement and that menopause adversely affected psychological outcomes.

Vaginal reconstructive surgery for POP and/or SUI was associated with significant improvements in sexual function, anxiety and depression. A substantial proportion of patients achieved clinically meaningful improvements in sexual function, highlighting the potential psychosocial benefits of surgery. These findings underscore the value of a holistic, biopsychosocial approach and emphasise the importance of the concurrent evaluation of sexual and psychological health.