Sexual function in women with pelvic organ prolapse

Czech version

Authors: Samuel Tvarožek ^1,2 ; Martina Szypulová ^1,2 ; Anežka Šteflová ^1,2 ; Martin Huser ^1,2 ; Zdeněk Rušavý ³
Authors‘ workplace: Gynekologicko-porodnická klinika FN Brno ¹; Lékařská fakulta, MU, Brno ²; Gynekologicko-porodnická klinika LF UK a FN Plzeň ³
Published in: Ceska Gynekol 2025; 90(1): 64-70
Category:
doi: https://doi.org/10.48095/cccg202564

Overview

A woman's sexuality is a complex phenomenon involving several factors, among which age and health are the most important. However, other aspects are not negligible. The impact of pelvic organ prolapse on sexual function cannot be ignored, as the reported prevalence of pelvic organ prolapse in female population exceeds 50%. This article presents a systematic review of articles dealing with the impact of pelvic organ prolapse on female sexual function. Sexual dysfunction is common in women with pelvic organ prolapse, regardless of prolapse stage or the compartment affected. Estrogen therapy has no effect on sexuality in women with prolapse, while pelvic floor muscle training may provide some improvement. There is no evidence that conservative therapy using a pessary is associated with negative impact on sexual function. Native tissue repair tends to improve sexual function in general, except for posterior colporrhaphy, which was frequently associated with dyspareunia. No correlation between postoperative vaginal length and change in sexual function was identified. The impact of transvaginal mesh repair on sexuality remains unclear. In contrast, there is enough evidence proving that sacrocolpopexy significantly improves sexual function in women.

Keywords:

body image – pelvic organ prolapse – pelvic floor muscle training – sexual function – sacrocolpopexy – transvaginal mesh repair – native tissue repair

Sources

1. Lee DM, Nazroo J, O’Connor DB et al. Sexual health and well-being among older men and women in England: findings from the english longitudinal study of ageing. Arch Sex Behav 2016; 45 (1): 133–144. doi: 10.1007/s10508-014-0465-1.

2. Field N, Mercer CH, Sonnenberg P et al. Associations between health and sexual lifestyles in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet Lond Engl 2013; 382 (9907): 1830–1844. doi: 10.1016/S0140-6736 (13) 62222-9.

3. Rogers GR, Villarreal A, Kammerer-Doak D et al. Sexual function in women with and without urinary incontinence and/or pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2001; 12 (6): 361–365. doi: 10.1007/s0019201 70012.

4. Panman CM, Wiegersma M, Talsma MN et al. Sexual function in older women with pelvic floor symptoms: a cross-sectional study in general practice. Br J Gen Pract 2014; 64 (620): e144–e150. doi: 10.3399/bjgp14X677518.

5. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins – Gynecology. Female sexual dysfunction: ACOG practice bulletin clinical management guidelines for obstetrician-gynecologists, number 213. Obstet Gynecol 2019; 134 (1): e1–e18. doi: 10.1097/AOG.0000000000003324.

6. Apostolou M. Understanding the prevalence of sexual dysfunctions in women: an evolutionary perspective. Adapt Hum Behav Physiol 2016; 2: 26–43. doi: 10.1007/s40750-015-0029-1.

7. Avis NE. Sexual function and aging in men and women: community and population-based studies. J Gend Specif Med 2000; 3 (2): 37–41.

8. Brown HW, Hegde A, Huebner M et al. International urogynecology consultation chapter 1 committee 2: epidemiology of pelvic organ prolapse: prevalence, incidence, natural history, and service needs. Int Urogynecol J 2022; 33 (2): 173–187. doi: 10.1007/s00192-021-05018-z.

9. Burrows LJ, Meyn LA, Walters MD et al. Pelvic symptoms in women with pelvic organ prolapse. Obstet Gynecol 2004; 104 (5 Pt 1): 982–988. doi: 10.1097/01.AOG.0000142708.61298.be.

10. Mirskaya M, Isaksson A, Lindgren EC et al. Bearing the burden of spill-over effects: living with a woman affected by symptomatic pelvic organ prolapse after vaginal birth – from a partner’s perspective. Sex Reprod Healthc 2023; 37: 100894. doi: 10.1016/j.srhc.2023.100894.

11. Karabulut A, Ozkan S, Koçak N et al. Evaluation of confounding factors interfering with sexual function in women with minimal pelvic organ prolapse. Int J Gynaecol Obstet 2014; 127 (1): 73–76. doi: 10.1016/j.ijgo.2014.04.015.

12. Novi JM, Jeronis S, Morgan MA et al. Sexual function in women with pelvic organ prolapse compared to women without pelvic organ prolapse. J Urol 2005; 173 (5): 1669–1672. doi: 10.1097/01.ju.0000154618.40300.c8.

13. Tok EC, Yasa O, Ertunc D et al. The effect of pelvic organ prolapse on sexual function in a general cohort of women. J Sex Med 2010; 7 (12): 3957–3962. doi: 10.1111/j.1743- 6109.2010.01940.x.

14. Özel B, White T, Urwitz-Lane R et al. The impact of pelvic organ prolapse on sexual function in women with urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17 (1): 14–17. doi: 10.1007/s00192-005-1327-0.

15. Weber AM, Walters MD, Schover LR et al. Sexual function in women with uterovaginal prolapse and urinary incontinence. Obstet Gynecol 1995; 85 (4): 483–487. doi: 10.1016/00 29-7844 (94) 00434-F.

16. Barber MD, Visco AG, Wyman JF et al. Sexual function in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol 2002; 99 (2): 281–289. doi: 10.1016/s0029-7844 (01) 01727-6.

17. Lowenstein L, Gamble T, Deniseiko Sanses TV et al. Sexual function is related to body image perception in women with pelvic organ prolapse. J Sex Med 2009; 6 (8): 2286–2291. doi: 10.1111/j.1743-6109.2009.01329.x.

18. Özengin N, Çankaya H, Duygu E et al. The effect of pelvic organ prolapse type on sexual function, muscle strength, and pelvic floor symptoms in women: a retrospective study. Turk J Obstet Gynecol 2017; 14 (1): 121–127. doi: 10.4274/tjod.45722.

19. Li J, Zhao X, Li J et al. Pelvic organ prolapse after delivery: effects on sexual function, quality of life, and psychological health. J Sex Med 2023; 20 (12): 1384–1390. doi: 10.1093/jsxmed/qdad120.

20. Afshari P, Houshyar Z, Javadifar N et al. The relationship between body image and sexual function in middle-aged women. Electron Physician 2016; 8 (11): 3302–3308. doi: 10.19082/3302.

21. Nazarpour S, Simbar M, Khorrami M et al. The association between sexual function and body image among postmenopausal women: a cross--sectional study. BMC Womens Health 2021; 21 (1): 403. doi: 10.1186/s12905-021-01549-1.

22. Moroni RM, Alves da Silva Lara L, Ferreira CH et al. Assessment of body image, sexual function, and attractiveness in women with genital prolapse: a cross-sectional study with validation of the Body Image in the Pelvic Organ Prolapse (BIPOP) questionnaire. J Sex Med 2019; 16 (1): 126–136. doi: 10.1016/j.jsxm.2018.11.005.

23. Handelzalts JE, Yaakobi T, Levy S et al. The impact of genital self-image on sexual function in women with pelvic floor disorders. Eur J Obstet Gynecol Reprod Biol 2017; 211: 164–168. doi: 10.1016/j.ejogrb.2017.02.028.

24. Jelovsek JE, Barber MD. Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life. Am J Obstet Gynecol 2006; 194 (5): 1455–1461. doi: 10.1016/j.ajog.2006.01.060.

25. Marschalek ML, Bodner K, Kimberger O et al. Sexual function in postmenopausal women with symptomatic pelvic organ prolapse treated either with locally applied estrogen or placebo: results of a double-masked, placebo-controlled, multicenter trial. J Sex Med 2022; 19 (7): 1124–1130. doi: 10.1016/j.jsxm.2022.04.007.

26. Celik H, Gurates B, Yavuz A et al. The effect of hysterectomy and bilaterally salpingo-oophorectomy on sexual function in post-menopausal women. Maturitas 2008; 61 (4): 358–363. doi: 10.1016/j.maturitas.2008.09.015.

27. Hagen S, Stark D, Glazener C et al. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. Lancet 2014; 383 (9919): 796–806. doi: 10.1016/S0140-6736 (13) 61977-7.

28. Braekken IH, Majida M, Ellström Engh M et al. Can pelvic floor muscle training improve sexual function in women with pelvic organ prolapse? A randomized controlled trial. J Sex Med 2015; 12 (2): 470–480. doi: 10.1111/jsm.12746.

29. Meriwether KV, Komesu YM, Craig E et al. Sexual function and pessary management among women using a pessary for pelvic floor disorders. J Sex Med 2015; 12 (12): 2339–2349. doi: 10.1111/jsm.13060.

30. Weber AM, Walters MD, Piedmonte MR. Sexual function and vaginal anatomy in women before and after surgery for pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 2000; 182 (6): 1610–1615. doi: 10.1067/mob.2000.107436.

31. Celik DB, Kizilkaya Beji N, Yalcin O. Sexual function in women after urinary incontinence and/or pelvic organ prolapse surgery. J Clin Nurs 2014; 23 (17–18): 2637–2648. doi: 10.1111/jocn.12496.

32. Glavind K, Larsen T, Lindquist AS. Sexual function in women before and after surgery for pelvic organ prolapse. Acta Obstet Gynecol Scand 2015; 94 (1): 80–85. doi: 10.1111/aogs.12524.

33. Jha S, Gray T. A systematic review and meta-analysis of the impact of native tissue repair for pelvic organ prolapse on sexual function. Int Urogynecology J 2015; 26 (3): 321–327. doi: 10.1007/s00192-014-2518-3.

34. Ulrich D, Dwyer P, Rosamilia A et al. The effect of vaginal pelvic organ prolapse surgery on sexual function. Neurourol Urodyn 2015; 34 (4): 316–321. doi: 10.1002/nau.22569.

35. Azar M, Noohi S, Radfar S et al. Sexual function in women after surgery for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19 (1): 53–57. doi: 10.1007/ s00192-007-0399-4.

36. Dua A, Jha S, Farkas A et al. The effect of prolapse repair on sexual function in women. J Sex Med 2012; 9 (5): 1459–1465. doi: 10.1111/ j.1743-6109.2012.02660.x.

37. Haase P, Skibsted L. Influence of operations for stress incontinence and/or genital descensus on sexual life. Acta Obstet Gynecol Scand 1988; 67 (7): 659–661. doi: 10.3109/00016348809004283.

38. Kahn MA, Stanton SL. Posterior colporrhaphy: its effects on bowel and sexual function. Br J Obstet Gynaecol 1997; 104 (1): 82–86. doi: 10.1111/j.1471-0528.1997.tb10654.x.

39. Wang CL, Long CY, Juan YS et al. Impact of total vaginal mesh surgery for pelvic organ prolapse on female sexual function. Int J Gynaecol Obstet 2011; 115 (2): 167–170. doi: 10.1016/j.ijgo.2011.05.019.

40. Long CY, Hsu CS, Wu MP et al. Comparison of the changes in sexual function of premenopausal and postmenopausal women following transvaginal mesh surgery. J Sex Med 2011; 8 (7): 2009–2016. doi: 10.1111/j.1743-6109.2011.02295.x.

41. Liang CC, Lo TS, Tseng LH et al. Sexual function in women following transvaginal mesh procedures for the treatment of pelvic organ prolapse. Int Urogynecology J 2012; 23 (10): 1455–1460. doi: 10.1007/s00192-012-1713-3.

42. Shen T, Song LJ, Xu YM et al. Sexual function and health-related quality of life following anterior vaginal wall surgery for stress urinary incontinence and pelvic organ prolapse. Int J Impot Res 2011; 23 (4): 151–157. doi: 10.1038/ijir.2011.22.

43. Sentilhes L, Berthier A, Sergent F et al. Sexual function in women before and after transvaginal mesh repair for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19 (6): 763–772. doi: 10.1007/s00192-007-0521-7.

44. Bartuzi A, Futyma K, Kulik-Rechberger B et al. Transvaginal Prolift (®) mesh surgery due to advanced pelvic organ prolapse does not impair female sexual function: a prospective study. Eur J Obstet Gynecol Reprod Biol 2012; 165 (2): 295–298. doi: 10.1016/j.ejogrb.2012.07.011.

45. Hoda MR, Wagner S, Greco F et al. Prospective follow-up of female sexual function after vaginal surgery for pelvic organ prolapse using transobturator mesh implants. J Sex Med 2011; 8 (3): 914–922. doi: 10.1111/j.17 43-6109.2010.01959.x.

46. Čadková I, Huvar I. Vaginální rekonstrukce prolapsu pánevních orgánů: efekt, komplikace, vliv na močové a pohlavní funkce a kvalitu života ve dvouletém follow-up. Část III – komplikace gastrointestinální, muskuloskeletální, celkové, sexuální funkce a kvalita života. Ceska Gynekol 2018; 83 (2): 250–256.

47. El Haddad R, Svabik K, Masata J et al. Women’s quality of life and sexual function after transvaginal anterior repair with mesh insertion. Eur J Obstet Gynecol Reprod Biol 2013; 167 (1): 110–113. doi: 10.1016/j.ejogrb.2012. 11.005.

48. Tvarozek S, Huser M, Dostalova M et al. Evaluating sexual function among women after recurrent pelvic organ prolapse transvaginal mesh repair. J Obstet Gynaecol 2022; 42 (8): 3666–3671. doi: 10.1080/01443615.2022.2153023.

49. Antosh DD, Dieter AA, Balk EM et al. Sexual function after pelvic organ prolapse surgery: a systematic review comparing different approaches to pelvic floor repair. Am J Obstet Gynecol 2021; 225 (5): 475.e1–475.e19. doi: 10.1016/j.ajog.2021.05.042.

50. Yeung E, Baessler K, Christmann-Schmid C et al. Transvaginal mesh or grafts or native tissue repair for vaginal prolapse. Cochrane Database Syst Rev 2024; 3 (3): CD012079. doi: 10.1002/14651858.CD012079.pub2.

51. Rusavy Z, Kovarova V, Tvarozek S et al. A comprehensive evaluation of sexual life in women after laparoscopic sacrocolpopexy using PISQ-IR. Int Urogynecology J 2024; 35 (4): 873–880. doi: 10.1007/s00192-024-05765-9.

52. Handa VL, Zyczynski HM, Brubaker L et al. Sexual function before and after sacrocolpopexy for pelvic organ prolapse. Am J Obstet Gynecol 2007; 197 (6): 629.e1–629.e6. doi: 10.1016/j.ajog.2007.08.016.

53. Najib B, Rusavy Z, Abdallah W et al. Impact of laparoscopic sacrocolpopexy (LSC) on sexual function in women with advanced stages of pelvic organ prolapse (POP): a five-year prospective study. Eur J Obstet Gynecol Reprod Biol 2023; 284: 12–15. doi: 10.1016/j.ejogrb.2023.02.016.

54. Gupta P, Payne J, Killinger KA et al. Analysis of changes in sexual function in women undergoing pelvic organ prolapse repair with abdominal or vaginal approaches. Int Urogynecol J 2016; 27 (12): 1919–1924. doi: 10.1007/s00192-016-3066-9.

55. Anglès-Acedo S, Ros-Cerro C, Escura-Sancho S et al. Sexual activity and function in women with advanced stages of pelvic organ prolapse, before and after laparoscopic or vaginal mesh surgery. Int Urogynecol J 2021; 32 (5): 1157–1168. doi: 10.1007/s00192-020-04406-1.

56. Koroglu N, Aslan Cetin B, Akca A et al. A comparison of pelvic organ prolapse and sexual function after abdominal and laparoscopic hysterectomy. Ginekol Pol 2018; 89 (10): 553–557. doi: 10.5603/GP.a2018.0094.

57. Kokanalı MK, Cavkaytar S, Aksakal O et al. McCall Culdoplasty vs. Sacrospinous Ligament Fixation after vaginal hysterectomy: comparison of postoperative vaginal length and sexual function in postmenopausal women. Eur J Obstet Gynecol Reprod Biol 2015; 194: 218–222. doi: 10.1016/j.ejogrb.2015.09.023.

58. Anglès-Acedo S, Ros-Cerro C, Escura-Sancho S et al. Female sexuality before and after sacrocolpopexy or vaginal mesh: is vaginal length one of the key factors? Int Urogynecol J 2022; 33 (1): 143–152. doi: 10.1007/s00192-021- 04697-y.

ORCID autorů

S. Tvarožek 0000-0003-1047-6742

M. Szypulová 0000-0001-5458-2139

A. Šteflová 0000-0001-7902-423X

M. Huser 0000-0002-2482-4819

Z. Rušavý 0000-0001-7125-9819

Doručeno/Submitted: 6. 10. 2024

Přijato/Accepted: 19. 11. 2024

MUDr. Samuel Tvarožek

Gynekologicko-porodnická klinika

LF MU a FN Brno

Jihlavská 20