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Sexual Function After Pelvic Organ Prolapse Surgery: A Systematic Review Comparing Different Approaches to Pelvic Floor Repair. [Review]

MedStar author(s):

Citation: American Journal of Obstetrics & Gynecology. 225(5):475.e1-475.e19, 2021 11.PMID: 34087227Institution: MedStar Washington Hospital CenterDepartment: Obstetrics and GynecologyForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *Dyspareunia/et [Etiology] | *Gynecologic Surgical Procedures | *Pelvic Organ Prolapse/su [Surgery] | Female | Gynecologic Surgical Procedures/ae [Adverse Effects] | Humans | Postoperative Complications | Surgical MeshYear: 2021 Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:

0002-9378

Name of journal: American journal of obstetrics and gynecologyAbstract: CONCLUSIONS: Sexual function comparisons are most robust between TVM and NT repairs and show similar prevalence of sexual activity, de novo dyspareunia, and sexual function scores. Total dyspareunia is higher after TVM compared to SCP. Although sexual function data are sparse in the other comparisons, no other differences in sexual activity, dyspareunia, and sexual function score change were found. Copyright (c) 2021. Published by Elsevier Inc.DATA SOURCES: MEDLINE, Embase, and clinicaltrials.gov databases from inception to March 2021.OBJECTIVE: Women consider preservation of sexual activity and improvement of sexual function as important goals following pelvic organ prolapse (POP) surgery. The aim of this systematic review is to compare sexual activity and function before and after prolapse surgery between specific approaches to POP surgery including native tissue (NT) repairs, transvaginal synthetic mesh (TVM), biologic grafts (BG), and sacrocolpopexy (SCP).RESULTS: Screening of 3651 abstracts was performed and identified 77 original studies. The overall quality of evidence was moderate to high. There were 26 studies comparing TVM vs. NT, 5 comparing SCP vs. NT, 5 comparing TVM vs. SCP, and 7 comparing BG vs. NT. For TVM vs NT, no statistical differences were found in baseline or post-operative sexual activity, baseline or postoperative total dyspareunia, persistent dyspareunia, and de novo dyspareunia. PISQ-12 change scores were not different between TVM vs. NT (net difference -0.3; 95% CI -1.4 to 0.8). For SCP vs. NT, baseline or postoperative sexual activity, baseline or postoperative total dyspareunia, de novo dyspareunia, and PISQ-12 score differences were not different. For BG vs. NT, baseline or postoperative sexual activity, baseline or postoperative total dyspareunia, and PISQ-12 changes were also not different. For TVM vs. SCP, there was no difference in sexual activity and sexual function score change. Based on two studies, post-operative total dyspareunia was more common in TVM than SCP (27.5% vs. 12.2%, OR 2.72, 95% CI 1.33 to 5.58). Prevalence of post-operative dyspareunia was lower than pre-operative dyspareunia after all surgery types.STUDY APPRAISAL AND SYNTHESIS METHODS: Studies were double screened for inclusion and extracted for population characteristics, sexual function outcomes, and methodological quality. Evidence profiles were generated for each surgery comparison by grading quality of evidence for each outcome across studies using a modified GRADE system.STUDY ELIGIBILITY CRITERIA: Prospective comparative cohort and randomized studies of POP surgeries were included that reported specific sexual function outcomes: baseline and post-operative sexual activity, dyspareunia, and validated sexual function questionnaire scores. Four comparisons were made: TVM vs. NT, SCP vs. NT, TVM vs. SCP, and BG vs. NT.All authors: Alas A, Antosh DD, Balk EM, Dieter AA, Foda MA, Good MM, Kanter G, Kim-Fine S, Mamik MM, Meriwether KV, Rahn DD, Rogers RG, Singh ROriginally published: American Journal of Obstetrics & Gynecology. 2021 Jun 01Fiscal year: FY2021 Fiscal year of original publication: FY2021Digital Object Identifier:

https://dx.doi.org/10.1016/j.ajog.2021.05.042

Date added to catalog: 2021-07-19

Holdings ( 1 )
Title notes ( 8 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	34087227	Available		34087227

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

CONCLUSIONS: Sexual function comparisons are most robust between TVM and NT repairs and show similar prevalence of sexual activity, de novo dyspareunia, and sexual function scores. Total dyspareunia is higher after TVM compared to SCP. Although sexual function data are sparse in the other comparisons, no other differences in sexual activity, dyspareunia, and sexual function score change were found. Copyright (c) 2021. Published by Elsevier Inc.

DATA SOURCES: MEDLINE, Embase, and clinicaltrials.gov databases from inception to March 2021.

OBJECTIVE: Women consider preservation of sexual activity and improvement of sexual function as important goals following pelvic organ prolapse (POP) surgery. The aim of this systematic review is to compare sexual activity and function before and after prolapse surgery between specific approaches to POP surgery including native tissue (NT) repairs, transvaginal synthetic mesh (TVM), biologic grafts (BG), and sacrocolpopexy (SCP).

RESULTS: Screening of 3651 abstracts was performed and identified 77 original studies. The overall quality of evidence was moderate to high. There were 26 studies comparing TVM vs. NT, 5 comparing SCP vs. NT, 5 comparing TVM vs. SCP, and 7 comparing BG vs. NT. For TVM vs NT, no statistical differences were found in baseline or post-operative sexual activity, baseline or postoperative total dyspareunia, persistent dyspareunia, and de novo dyspareunia. PISQ-12 change scores were not different between TVM vs. NT (net difference -0.3; 95% CI -1.4 to 0.8). For SCP vs. NT, baseline or postoperative sexual activity, baseline or postoperative total dyspareunia, de novo dyspareunia, and PISQ-12 score differences were not different. For BG vs. NT, baseline or postoperative sexual activity, baseline or postoperative total dyspareunia, and PISQ-12 changes were also not different. For TVM vs. SCP, there was no difference in sexual activity and sexual function score change. Based on two studies, post-operative total dyspareunia was more common in TVM than SCP (27.5% vs. 12.2%, OR 2.72, 95% CI 1.33 to 5.58). Prevalence of post-operative dyspareunia was lower than pre-operative dyspareunia after all surgery types.

STUDY APPRAISAL AND SYNTHESIS METHODS: Studies were double screened for inclusion and extracted for population characteristics, sexual function outcomes, and methodological quality. Evidence profiles were generated for each surgery comparison by grading quality of evidence for each outcome across studies using a modified GRADE system.

STUDY ELIGIBILITY CRITERIA: Prospective comparative cohort and randomized studies of POP surgeries were included that reported specific sexual function outcomes: baseline and post-operative sexual activity, dyspareunia, and validated sexual function questionnaire scores. Four comparisons were made: TVM vs. NT, SCP vs. NT, TVM vs. SCP, and BG vs. NT.

English