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FEMALE
UROLOGY
Sexual
function in women with pelvic organ prolapse compared to women without
pelvic organ prolapse
Novi JM, Jeronis S, Morgan MA, Arya LA
Division of Urogynecology and Reconstructive Pelvic Surgery, Temple University
School of Medicine, Philadelphia, Pennsylvania, USA
J Urol. 2005; 173: 1669-72
- Purpose:
We compared sexual function in women with pelvic organ prolapse to that
in women without prolapse.
- Materials
and Methods: We collected sexual function data using a standardized,
validated, condition specific questionnaire. The study group consisted
of 30 women with pelvic organ prolapse and it was compared with 30 unmatched
controls without evidence of prolapse.
- Results:
The 2 groups were similar in age, race, parity and postmenopausal
hormone use. Subjects in the study group were more likely to have undergone
previous pelvic surgery. Mean total Pelvic Organ Prolapse/Urinary Incontinence
Sexual Function Questionnaire scores +/- SD were lower in the study
group compared with controls (81.4 +/- 7.3 vs 106.4 +/- 15.5, p <
0.001). In the study group total questionnaire scores in women with
prior pelvic surgery were similar to those in women without prior pelvic
surgery (79.3 +/- 14.9 vs 82.9 +/- 10.2, p = 0.61).
-
Conclusions:
Pelvic organ prolapse appears to have a significant negative impact
on sexual function.
- Editorial
Comment
The authors report on a comparison of sexual function in women with
pelvic organ prolapse and women without pelvic organ prolapse. They
utilized an excellent statistical analysis involving a Likert scale
as well as the PISQ (a validated, condition-specific, self-administered
questionnaire that evaluates sexual function in women with pelvic organ
prolapse and/or urinary incontinence). Statistical planning was utilized
to identify the appropriate size study groups to detect a difference
if present between the controls and the patients with prolapse.
This is a noteworthy paper that covers an issue, which is not frequently
discussed in the medical office but is never far from the thoughts of
a large portion of the population. The study’s strength lies in
the use of a validated self administered questionnaire as well as excellent
statistical analysis. It did exclude women younger than 35 years perhaps
to obtain a greater degree of similarity between the two groups. It
addition, it only involved patients presenting for gynecological evaluation
or therapy and not the general population. Several key points on which
the paper may educate the reader include the findings that there was
no significant difference in dyspareunia rate between women with and
without previous hysterectomy as well as in women who have undergone
anti-incontinence surgery those who did not. This fact will allow the
urologic surgeon to clearly respond to patients who wonder about their
sexual function after their anti-incontinence operation. The publication
helps characterize the sexual habits and desires of patients with prolapse
compared to the general population including: observing that both groups
were able to find a man when needed; both groups felt their men were
sexually satisfied to the same degree; both groups wanted sex to the
same degree; and both groups attempted to self pleasure at that same
rate and had identical rates of anorgasmia. Differences between the
two groups that were highlighted did include that women with prolapse,
though masturbating at the same degree, were not able to achieve orgasm
with the same degree of efficacy and that though both groups desired
sexual activity to the same degree, women with prolapse were not able
to participate in coitus at the same level of desired frequency.
This is an excellent paper, which should be read and appropriately digested.
It would have been of extreme interest if the authors had been able
to comment if there was an increased rate for women with prolapse utilizing
different sexual techniques or acts of pleasure in order to allow their
partner to achieve the same rate of partner satisfaction as those without
prolapse in view of their altered vaginal anatomy. I recommend this
article for all physicians actively involved in prolapse surgery.
Dr.
Steven P. Petrou
Associate Professor of Urology
Mayo Clinic College of Medicine
Jacksonville, Florida, USA |