Sexual Function after Pelvic Surgery

Pelvic surgery to correct prolapse may affect sexual function for a number of reasons including narrowed vaginal canal, poor lubrication, and fear of urinary incontinence. Some studies suggest that sexual dysfunction can occur up to 20% of the time after surgery for prolapse or incontinence. It is thought that the vaginal dissection may lead to pelvic floor neuropathy affecting the pudendal nerve, which subsequently affects vaginal sensation and orgasm. Hysterectomy has been associated with sexual dysfunction. It is thought that removal of the cervix alters the upper portion of the vaginal canal and causes a neuropathy, which is the source for dyspareunia as well as anor-gasmia. However, studies in the literature are conflicting as to the exact cause of sexual dysfunction after hysterec-tomy.22 Another possible cause for dyspareunia is poor estrogenization of the vaginal mucosa in those women who undergo surgical menopause at the time of a hysterectomy. Techniques used to repair the rectocele have been implicated in the cause of postoperative dyspareunia. Posterior colporrhaphy using levator plication has been implicated as a cause for postoperative dyspareunia. Kahn and Stanton23 evaluated 209 women who underwent a posterior colporrhaphy. They reported an increase in sexual dysfunction in up to 27% of the women included in the study. Site-specific repair of rectoceles has been reported to result in less dyspareunia. In a retrospective study, 73 women who underwent a site-specific rectocele repair were followed 6 months postoperatively to evaluate quality of life, sexual function, and bowel function. It was demonstrated that sexual function was not affected, but dyspareunia was significantly improved or cured after operation in 73% of patients and only worsened in 19% of patients.24 Kenton and colleagues25 also reported a significant reduction in dyspareunia, 92% after site-specific repair of rectoceles at 1 year. However, to date, there are no prospective randomized controlled trials evaluating the two techniques and their impact on sexual dysfunction.

New-onset dyspareunia after sacrospinous fixation has been reported in up to 50% of women. This was attributed to vaginal dryness, vaginal constriction, or a shortened vaginal length.26

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