Do alterations in vaginal dimensions after reconstructive pelvic surgeries affect the risk for dyspareunia? (original) (raw)
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Vaginal length after a laparoscopic sacropexy
Urogynaecologia
Vaginal shortening after surgical treatment of pelvic organ prolapse is associated with dyspareunia, which negatively affects women’s sexual life as well as their psychosocial well-being. The aim of the study is to determine the vaginal length in women with high-grade pelvic organ prolapse treated with laparoscopic sacropexy. In the prospective study we included 22 women with high-grade prolapse of the uterus or vagina that were treated. They underwent a gynaecological examination with a measurement of the vaginal length, as well as the evaluation of the degree of prolapse prior to the procedure (laparoscopic sacropexy). The second measurement and evaluation of the vaginal length during the follow-up examination between 6 to 12 weeks after surgery was done. The control group included 23 healthy women, without genital prolapse. There was no statistically significant difference in the mean vaginal length before and after surgery in the group of treated women.
The role of vaginal apex excision in the management of persistent posthysterectomy dyspareunia
American Journal of Obstetrics and Gynecology, 2000
The purpose of this study was to evaluate the effectiveness of vaginal apex excision in the treatment of patients with posthysterectomy dyspareunia. STUDY DESIGN: This was a case series with an independent third-party survey of patients with posthysterectomy dyspareunia managed at the University of Utah Pelvic Pain Clinic. Thirteen patients were first treated with local injections of anesthetics into localized vaginal pain foci. Further evaluation included formal psychometric testing and a diagnostic spinal block. Nine patients underwent surgical excision of the vaginal apex. An independent interviewer who did not know the patients assessed the effects of this procedure on dyspareunia and coital frequency at a mean of 36.4 ± 3.7 months after the operation. RESULTS: The mean coital verbal analog pain score (1-10 scale) decreased from 9.22 ± 0.27 before excision of the vaginal apex to 3.11 ± 0.84 after the operation (P < .001), and coital frequency improved from 5.22 ± 2.02 episodes per month before surgery to 11.11 ± 1.82 episodes per month after surgery (P = .02). Of the 9 patients, 5 essentially had the dyspareunia cured. Dyspareunia was decreased and coital frequency was markedly increased in all but 1 of the other 4 cases. CONCLUSION: Excision of the vaginal apex is an effective treatment for carefully selected patients with posthysterectomy dyspareunia. (Am J Obstet Gynecol 2000;183:1385-9.)
The effect of vaginal pelvic organ prolapse surgery on sexual function
Neurourology and Urodynamics, 2014
Aims: Data on female sexual function after prolapse surgery are conflicting. The aim of the study was to evaluate the change in sexual function and vaginal symptoms using patient reported outcomes following prolapse surgery in addition to the anatomical stage. Methods: Prospective observational study of women undergoing pelvic organ prolapse (POP) surgery. The validated International Consultation on Incontinence modular Questionnaire-Vaginal Symptoms (ICIQ-VS) questionnaire was completed preoperatively, 6 and 12 months postoperatively. Results: Ninety-three women participated in the study with 83 (89%) returning the 6 months questionnaire and 80 (86%) the 12 months questionnaire. Twenty-four healthy women without prolapse were included as a control group. The mean vaginal-and sexual-symptom score both improved with a significant decrease at 6 months and 12 months after surgery (P < 0.001, P < 0.05, respectively). The POP-Q scores of each compartment also improved significantly after 6 and 12 months (P < 0.001) with 75% reaching anatomical success. There was no correlation between anatomical success and subjective ICIQ-VS outcomes. The vaginal and sexual matters score had a lesser reduction in women who had additional levator plication sutures during posterior vaginal repair compared to those without. Women with levator plication also showed a significant increase in postoperative dyspareunia. Conclusions: Surgical intervention for POP improved the vaginal and sexual matters scores at 6 and 12 months postoperatively. Levator plication additionally to posterior vaginal repair is associated with an increase in postoperative dyspareunia rates and with decreased sexual function. Neurourol. Urodynam. 9999:1-6, 2014. # 2014 Wiley Periodicals, Inc.
Determinants of vaginal length
American Journal of Obstetrics and Gynecology, 2006
Objective: The purpose of this study was to describe quantitatively the associations between total vaginal length and demographic, historic, and physical characteristics. Study design: At 2 clinical sites, patients completed a standardized questionnaire and physical examination. Bivariate correlations explored relationships between total vaginal length and demographic, historic, and examination variables. Significant variables were evaluated with a multivariate linear regression model.
Does Surgical Approach in Pelvic Floor Repair Impact Sexual Function in Women?
Sexual Medicine, 2019
Introduction Surgical routes used to correct complex pelvic floor disorders (CPFDs) may have a negative impact on women’s sexual function. Currently, there is no evidence concerning the impact of a specific surgical procedure on postoperative sexual function in women. Aim The aim of this study was to compare an abdominal approach with rectopexy and sacrocolpopexy to a perineal procedure with abdominal rectopexy, regarding female sexual function in cases of CPFDs. Methods Women who were operated for CPFDs between January 2003 and June 2010 were retrospectively asked to answer the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12, the Miller Score of Incontinence, and a urinary incontinence frequency score. We also questioned them about their sexual function and satisfaction before and after the operation using visual analogic scores. Main Outcome Measure We compared the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 before and after the surgery in...
The long and short of it: anterior vaginal wall length before and after anterior repair
International urogynecology journal, 2015
Anterior vaginal wall length (AVL) is on average 6.1 ± 1.3 cm in women with normal support and lengthened in women with cystocele. We hypothesize that AVL is reduced after anterior repair and that women with larger cystoceles will have greater reduction in AVL. Demographic, clinical, and surgical data were collected for women undergoing hysterectomy and anterior repair in whom intraoperative vaginal wall measurements had been made between November 2009 and April 2014. In the operating room, AVL was defined preoperatively as the distance from the hymenal ring to the anterior cervicovaginal junction at the hysterectomy incision site, and postoperatively, from the hymenal ring to the same location on the anterior cuff. During the anterior repair the fibromuscular tissues were plicated using an interrupted technique. Measurements were available for 40 women. Average age was 61.7 ± 10 years, median parity was 2.5 and median preoperative Pelvic Organ Prolapse Quantification System (POP-Q)...
Clinical and Experimental Obstetrics & Gynecology, 2021
Background: The cesarean delivery rate has been increasing all over the world over the last few years. There is a change in mindset due to the change in women's role, let alone the perception stating that cesarean delivery can decrease the risk of having pelvic floor dysfunction and maintain the sexual functions. Therefore, women think that cesarean delivery is a good choice for delivery, even it has no indications. This study aimed at analyzing and providing quantitative data by comparing the dyspareunia based on FSFI scores between cesarean section and vaginal delivery. Method: The systematic data search was done in the Medical Database (PUBMED, Google Scholar, Cochrane) and the archives of RSUD Dr. Soetomo. The inclusion criteria consisted of (1) observational study with the following keywords ''cesarean section'', ''cesarean delivery'', ''vaginal birth'', ''vaginal delivery'', ''dyspareunia'', ''FSFI'', (2) all included papers could be accessed completely, and the data that had been obtained could be analyzed accurately. Result: Twelve observational studies toward 2144 patients had been analyzed. The dyspareunia score after 3-month of delivery between cesarean section and vaginal delivery had a Mean Difference (MD) of 0.18 and 95% CI of-0.19 to 0.54 (p-value of 0.35). The dyspareunia score after 6-month of delivery between cesarean section and vaginal delivery had a Mean Difference (MD) of 0.43 and 95% CI of-0.28 to 1.14 (p-value of 0.23). Meanwhile, the dyspareunia score after 12-month of delivery between cesarean section and vaginal delivery had a Mean Difference (MD) of 0.12 and 95% CI of-0.23 to 0.48 (p-value of 0.50). From those three forest plots, all diamonds were tangent to the vertical line (no effect) and had a p > 0.05, so it could be inferred that no significant statistical difference was found between the experimental group (cesarean section) and the control group (vaginal delivery). Those three studies were heterogeneous since I 2 was more than 50%. Conclusion: This meta-analysis concludes that there is a tendency for 3-month, 6-month, and 12-month of post delivery dypareunia rate to be lower in cesarean section than vaginal delivery, but it's not staistically significant.
Persistent Site-Specific Defects after Reconstructive Pelvic Surgery
International Urogynecology Journal, 2001
Our objective was to determine the persistence rates of site-specific defects after reconstructive pelvic surgery. We conducted a retrospective analysis of the post-operative outcome for 77 patients with pelvic support defects. Forty-five patients in the abdominal group underwent a Burch procedure, paravaginal repair and sacral colpopexy when indicated; 32 patients in the vaginal group had a sacrospinous vault fixation with or without colporrhaphy. A w 2 test, Wilcoxon's two-sample test, Wilcoxon's signed-rank test and multivariate logistic regression model were used for data analysis. The two groups were similar in age, weight, parity and menopausal status. There was significant improvement of all defects except in the vaginal group, which showed a higher rate of persistent paravaginal defects (68.7 vs. 13.3%, P = 0.001). After adjusting for potential confounders, there was no difference in the rates of apical and anterior wall defects between the two groups. The odds ratio for persistent paravaginal defects in the vaginal group was 8.9 (95% CI: 2.3-34). The choice of surgical procedure is the most important factor determining the rate of persistent pelvic support defects. Lateral wall defects must be addressed at the time of reconstructive surgery.
Prevalence of perioperative complications among women undergoing reconstructive pelvic surgery
American Journal of Obstetrics and Gynecology, 2000
The primary aim of this study was to report on the prevalence of perioperative complications associated with reconstructive pelvic surgery. A secondary aim was to identify risk factors predictive of perioperative complications in this population. STUDY DESIGN: A retrospective chart review was performed of 100 consecutive cases of reconstructive pelvic surgery. Statistical analysis included descriptive statistics and logistic regression. RESULTS: The prevalence of perioperative complications was 46%, including 13 intraoperative complications and 33 postoperative complications. The readmission rate for complications was 15%. The number of procedures per patient was an independent risk factor for intraoperative blood loss (P < .0038). Intraoperative estimated blood loss in turn was an independent risk factor for perioperative complications (P < .0001). CONCLUSIONS: Perioperative complications associated with reconstructive pelvic surgery were increased relative to those associated with general gynecologic surgery. The number of procedures per patient and associated blood loss appeared to contribute to the increase in perioperative complications. (Am J Obstet Gynecol 2000;183:1355-60.)
Assessment of the Effects of Perineoplasty on Female Sexual Function
Balkan Medical Journal, 2015
Background: The scar tissue formed by episiotomy during vaginal delivery, and the related pain, is very frequent. The change in the normal anatomy can cause cosmetic and physiologic problems. It can affect and cause deterioration in sexual functions. Therefore, making the right diagnosis and applying the right surgical procedures are very important. Aims: Our aim was to examine the effect of the perineoplasty operation on the sexual dysfunctions that present due to vaginal delivery. Study Design: Self-controlled study. Methods: Forty patients, who attended our clinic between April 2012 and May 2013, and who were between the ages of 20 and 50 years, were included in the study. The patients had complaints of scar tissue in the perineum and various sexual dysfunctions after vaginal delivery, and they were suitable for perineoplasty. The Female Sexual Function Index (FSFI) questionnaire was applied to the patients before and 6 months after the operation, and the results were compared. Results: After the perineoplasty operation, there was a statistically significant improvement in the patients in the domains of sexual desire, arousal, lubrication, orgasm, and sexual satisfaction (p<0.005). However, there was no significant improvement in the feeling of pain during sexual intercourse (p=0.184). The mean±SD total FSFI score increased significantly after the operation (p<0.005). Conclusion: The sexual dysfunctions that develop due to perineal damage during vaginal delivery can benefit significantly from the perineoplasty operation if the indications are correct. However, vaginal perineoplasty did not provide an improvement in dyspareunia.