Sex After Surgery: Changes in Sexual Function After Surgery for Pelvic Organ Prolapse

INTRODUCTION: Women with pelvic organ prolapse commonly suffer from sexual dysfunction, which can greatly impact quality of life. For women seeking surgical correction of their prolapse, it is critical to understand its impact on sexual function postoperatively. Prior studies have primarily shown improvement in sexual function following prolapse surgery. However, few studies prospectively explore how prolapse surgery impacts specific domains of sexual function, such as desire, arousal, lubrication, orgasm, and satisfaction. OBJECTIVE: To compare changes between pre- and postoperative overall sexual function and domains of desire, arousal, lubrication, orgasm, satisfaction, and pain in patients undergoing surgery for pelvic organ prolapse (POP). METHODS: Patients undergoing POP surgery were prospectively enrolled between September 2020 and July 2024. All types of pelvic organ prolapse surgeries were included (excluding obliterative repairs), as well as those undergoing concomitant hysterectomy and urinary incontinence procedures. All patients were sexually active, or intended to be postoperatively. Sexual function was evaluated using Female Sexual Function Index (FSFI) and Pelvic Organ Prolapse/Incontinence Sexual Questionnaire short form (PISQ-12) at baseline, 6 months, and 1 year postoperatively. Higher scores indicate better sexual function. Paired t-tests were used for continuous outcomes, and chi-squared tests for categorical outcomes, comparing baseline to 6-month and 1-year follow-ups. For continuous outcomes, generalized estimating equations (GEE) models were applied, and GEE logistic regression was used for binary outcomes (dyspareunia and sexual dysfunction). Results include mean differences, coefficient estimate differences (Δβ), odds ratios (OR), and 95% confidence intervals (CI). RESULTS: Our study included 59 sexually active patients with a mean age of 56 years. Baseline and operative data are listed in Table 1. Response rates were 54% at 6 months, and 81% at 1 year. Sexual dysfunction (FSFI score < 26.55) was present at baseline in 65% of patients. Multivariate models (Table 2) showed significantly higher sexual arousal (P=0.01) and sexual desire (p=0.02) after surgery, while lubrication, orgasm, satisfaction, and pain domains remained similar after surgery. Overall sexual function improved at 6 months with total FSFI (24.81 vs 21.23; Δβ=3.52; CI 0.38–6.66; P=0.03) and total PISQ-12 scores (35.54 vs 31.79; Δβ=3.5; CI 0.47–6.53; P=0.02) compared to baseline. At 1 year, there was an increase/improvement in PISQ-12 score (35.92 vs 31.79; Δβ=3.93; CI 1.69–6.17; p<0.001), while other domains and total FSFI were similar to baseline. Additionally, there were no significant differences in dyspareunia (6 month OR = 0.76; CI 0.27–2.19, 1 year OR = 1.23; CI 0.45–3.34) or sexual dysfunction (6 month OR = 0.83; CI 0.28–2.41, 1 year OR = 0.50; CI 0.19–1.34) at either time point. CONCLUSIONS: Overall sexual function improved postoperatively as demonstrated by a statistically significant increase in total FSFI and PISQ-12 scores at 6 months and an increase in PISQ-12 1 year postoperatively. The sexual function domains of arousal and desire also improved significantly after prolapse surgery. While all sexual domains (lubrication, orgasm, satisfaction, pain) trended towards improvement at both time points, this was not significant.Table 1Table 2