Patients’ Decisions to Undergo Colpocleisis: A Qualitative Study

Importance Shared decision making is important in the pathway to urogynecologic surgery, especially when counseling about colpocleisis, as the loss of vaginal patency carries the risk of regret. Objectives We sought to understand the perspective of patients who chose to undergo colpocleisis. Study Design A qualitative, inductive thematic analysis approach was used to explore the experiences of patients who underwent colpocleisis. Semi-structured interviews were conducted with 17 purposively sampled patients from a rural tertiary center who had surgery between 2022 and 2024. Interviews explored prolapse experience, surgeon counseling, patient activity and goals, and postoperative regret. Interviews were recorded, transcribed, de-identified, and coded to facilitate theme development through iterative review until thematic saturation was reached. Results Seventeen women who had undergone obliterative vaginal repairs participated in one-on-one interviews. The mean age was 78 years, all were White and English-speaking, and 9 had partners; none recalled being sexually active at the time of their decision for surgery. They shared common features such as their acceptance of rural conditions, their active lifestyles, and their analytic approach to pelvic floor disorders. Four themes emerged: (1) patient autonomy, (2) patient expectations, (3) influence of surgeon counseling, and (4) patient satisfaction without regret. Conclusions The decision to undergo vaginal closure is unique to each patient, but with common themes. Surgeon counseling is highly influential on patient evaluation of their options and anticipated outcomes. The risk of regret appears minimal, suggesting that thorough counseling and appropriate patient selection are highly effective.