Female Sexual Dysfunction (FSD) is a multifaceted biopsychosocial condition that affects 40-50% of women in the general population1 and 25-50% of those with Pelvic Floor Disorders (PFDs)2, such as Pelvic Organ Prolapse (POP) and Stress Urinary Incontinence (SUI). FSD can manifest as hypoactive sexual desire, arousal difficulties, lubrication problems, pain during intercourse, and orgasmic disorders, often leading to anxiety, depression, and feelings of inadequacy. The development of sexual arousal is influenced by both biological and psychological factors. Approximately 12% of women will undergo surgery for POP or Urinary Incontinence (UI) by age 80, with reconstructive surgery aiming to restore pelvic anatomy and improve quality of life, particularly sexual function.
However, the success of these surgeries in terms of sexual function is variable. Sexual dysfunction after vaginal surgery can be attributed to organic, emotional, and psychological factors.  Vaginal narrowing, especially after procedures like colpoperineorrhaphy, can lead to sexual dysfunction in some women, though it may not be the sole cause. Overall, evaluating sexual health through tools like the Female Sexual Function Index (FSFI) is essential to track the effects of surgery and guide treatment strategies.

A retrospective questionnaire based study of 157 women aged 18-65 years, presenting with various urogynecological complaints like Prolapse , SUI , CPT , RVF, VVF , Vaginal Cyst, vaginal septum etc who underwent surgery from July 2023 to June 2024.The various surgeries done is summarised in Table 1. POP surgery was performed only in patients with symptomatic POP ≥ stage 2 according to POP-Q (quantification). Sexual functions were assessed using Female Sexual Function Index (FSFI) questionnaire, among sexually active women at baseline and 3-6 months after surgery.The data were analyzed using SPSS version 21. p value<0.05 was considered significant.

The mean (SD) age of the patients in this study was 42.32 +15.41 years, with ages ranging from 18 to 65 years. Most of the patients had delivered vaginally, with their parity ranging from 1 to 9. Among the 157 patients included in the study, 53 patients were not sexually active ( due to loss of interest,lack of partner intimacy, lack of private space or religious belief)or declined to engage in sexual intercourse (SI) after surgery(sexual activity could jeopardize the healing process or lead to complications) . Vaginal length on and average was in between 5-8cm. There was a statistically significant difference in female sexual functions after surgery for POP and/or SUI (p<0.0001). This improvement was observed in both total and individual scores of each domain of FSFI except orgasm and satisfaction with an overall improvement in sexual function from a mean of 21.5+4.21 pre-surgery to 23.8 +4.34 post-surgery.

Almost all women in the study exhibited hypoactive sexual desire, as indicated by FSFI scores of less than 26. The average time for resumption of sexual activity post-surgery ranged between 97 and 118 days. The observed improvement in sexual function can primarily be attributed to the restoration of normal pelvic anatomy, along with improvements in urinary and anal incontinence, as well as a reduction in leakage incidents thereby alleviating the discomfort and distress associated with incontinence, which can significantly affect sexual health. Some women reported a deterioration in sexual function, mainly due to dyspareunia (pain during intercourse) and a persistent fear of causing damage to the surgical repair.

Preoperative sexual well-being is a key predictor of postoperative sexual satisfaction, making a thorough evaluation of sexual function essential before pelvic floor reconstruction. However, assessing sexual health remains complex and often insufficient. The challenge lies in conducting comprehensive research on Female Sexual Dysfunction (FSD) that considers all its aspects and explores preventative, diagnostic, and therapeutic approaches within a multidisciplinary framework.

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