PPelvic organ prolapse (POP) affects a large proportion of women. Apart from the clinical consequences of POP, quality of life (QoL), self-esteem and social life are significantly afflicted. Sexual life may be significantly impaired in women with POP. Surgery is commonly suggested as a first-line permanent treatment in the group of women with clinically significant POP. Sexual life after any surgery may be affected for a certain period of time, alas POP surgery, due to non-reversible anatomic changes in the genitalia, may affect sexual intercourse, orgasm, lubrication and therefore the impact on the sexual life may be extraordinary. The Sexual Quality of Life Questionnaire-Female (SQOL-F) is a short instrument that appraises the relationship between female sexual dysfunction and life quality. SQOL-F investigates the psychosexual feelings (7 items, score range 7-42), the sexual and relationship satisfaction (5 items, score range 5-30), the sexual self-esteem (3 items, score range 3-18), and the sexual repression (3 items, score range 3-18), with a score range between 18-108 points where the higher the better sexual life. The aim of this study is to present the preliminary results about the sexual life of women who underwent surgery for clinically significant prolapse using the SQOL-F questionnaire [1, 2, 3].

This is a prospective cohort study performed in a tertiary university urogynecologic unit. All patients who presented with POP from January 2018 to December 2020 were invited to participate in the study. Inclusion criteria were: (a) age > 18-years-old, (b) Greek speakers, (c) women with clinically significant POP grade ≥3. Exclusion criteria were: (a) previous POP or incontinence surgery, (b) operation with synthetic mesh augmentation. All patients had undergone clinical examination, standardized cough test and pad test. Symptoms were measured with the use of ICIQ-UI SF questionnaire, Patient Global Impression-Improvement (PGI-I), Patient Global Impression-Symptoms (PGI-S) and SQOL-F. All patients underwent full urodynamics investigation (uroflowmetry, filling cystometry, pressure-flow studies, and urethral profilometry). The patients underwent native tissue prolapse surgery depending on the prolapsing site: anterior prolapse was treated with anterior vaginal repair, posterior prolapse with posterior vaginal repair, uterine prolapse with vaginal hysterectomy with McCall culdoplasty or the Manchester-Fothergill procedure (amputation of the cervix). Wherever there was multiple site prolapse, a combination of procedures was performed. Αll patients were examined as a 3 months post-operatively follow-up with: (a) clinical exam and standardized stress test, (b) PGI-I, (c) PGI-S, and (d) SQOL-F. Statistical analysis was performed with JASP 0.11.1 (University of Amsterdam). Paired t-test was used to compare pre- and post-operative results. p<0.05 value was considered statistically significant.

64 patients were recruited. Mean age was 61.9 (±8.3), mean BMI score 29.3 (±4.1), and mean parity 2.4 (±0.8). All patients had native tissue POP surgery; the majority (39/52, 75%) had vaginal hysterectomy and McCall culdoplasty along with antero-posterior repair, and 11 of them had combined anti-incontinence procedures (17.2%). At 3-months post-operative follow-up, mean POP-Q (Ba) score was -2.0 (±0.9), mean POP-Q (C) score was -5.6 (±3.6), and mean POP-Q (Bp) score was -2.2 (±0.5). Mean PGI-S score was 1.5 (±0.8) (57.8% score=1, 12.5% score 2), and mean PGI-I score was 1.7 (±1.2) (46.8% score 1, 21.9% score 2). Total SQOL-F score was 65.2 (±35.7). Post-operative USI, DO, and UUI rates were 32.3%, 11.7%, and 14,7%, respectively. Pre-operative presence of OAB and post-operative UUI did not affect SQOL-F score. However, post-operative PGI-S and PGI-I score was related with lower total SQOL-F score and in all the SQOL-F sub-domains. ANOVA indicated that lower POP-Q C (p=0.042) and smaller POP-Q PB (p=0.006) were significantly related with lower score in the Sexual Repression domain.

The quality of sexual life after POP surgery is largely under-investigated and the important parameters are largely unknown. It is true that many women with POP are less sexually active for a variety of reasons, the prolapse only being a non-detrimental factor. The fact that post-operative POP is not related significantly with the total SQOL-F score but only with one out of the four sub-groups of the questionnaire, indicates that a healthy sexual life relies on anatomical parameters up to a certain point.

SQOL-F score after POP surgery appears to be reduced. Anatomical post-operative outcome seems to be related with lower SQOL-F score only in the domain of sexual repression.

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