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Background: Female sexual dysfunction is common in the general population, with age emerging as a significant determinant of sexual activity and functioning. Aim: To establish age-specific reference scores for the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in the general Dutch female population. Methods: A retrospective, cross-sectional, questionnaire-based study was conducted in the Netherlands. The study population comprised 2518 Dutch-speaking women aged ≥18 years, representing a cross section of the general Dutch population. The PISQ-12 was used to assess sexual functioning in heterosexual women. The Groningen Defecation and Fecal Continence questionnaire was utilized to demonstrate demographic factors. Outcomes: We established age-specific reference scores for the PISQ-12 in the general Dutch population. Results: Of the 2518 women, 1592 (63.2%) were sexually active and 926 (36.8%) were not. Further analysis focused on the sexually active group: we found a decrease in mean total PISQ scores, ranging from 38.34 among 18- to 34-year-olds to 36.98 among ≥65-year-olds. Older women scored lower in the behavior domain, specifically pertaining to sexual desire (P < .001) and sexual excitement (P < .001). They also had lower scores in the partner-related domain regarding partner problems of erection (P < .001) and orgasm perception (P < .001). With increasing age, negative emotional reaction scores were higher (P < .001). In the physical domain, we observed significantly different scores for pain during sexual intercourse (P < .001) and restrictions in sexual activity due to fear of urinary leakage (P < .001), with the lowest scores in the youngest group. Clinical Implications: These age-specific references scores of the PISQ-12 provide an overview of sexual functioning of a general population, which enables caregivers to assess and interpret patients' individual scores more accurately. Strengths and Limitations: We included only sexually active women in our subanalyses, potentially introducing selection bias for older women with better physical conditions. The study's strength lies in its extensive sample size, representing a cross section of the general Dutch population. Furthermore, the self-administered questionnaire approach helped minimize embarrassment and obtain realistic responses. Conclusion: Our study demonstrated age-specific PISQ-12 reference scores and highlighted associations between aging and diminishing scores of sexual desire, sexual excitement, erection problems, and orgasm perception, while women aged 18 to 34 years reported the lowest scores for pain during intercourse and limited sexual activity due to fear of urinary leakage. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Although laparoscopic sacrocolpopexy is a recommended procedure for sexually active women, its full impact on sexual life remains underexplored. This study is aimed at comprehensively assessing changes in the quality of sexual life and the prevalence of dyspareunia in women 1 year after laparoscopic sacrocolpopexy. Methods: This prospective observational study enrolled women undergoing laparoscopic sacrocolpopexy for pelvic organ prolapse stage≥ 2. Included were women with a completed Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA Revised (PISQ-IR) questionnaire before and at 1 year after surgery. Individual domains of the PISQ-IR were compared separately. Dyspareunia, single summary PISQ-IR and PISQ-12 scores were additionally compared in sexually active women. Statistical analyses included paired signed rank, Wilcoxon, Median, Chi-squared, and Fisher tests (p < 0.05). Results: Between February 2015 and December 2019, a total of 333 women were included. Mean age was 61.0 ± 11.2 and 141 (42%) reported being sexually active at baseline. At 12 months postoperatively, sexual activity was preserved in 110 (78%) of these women and an additional 26 women (14%) became sexually active. Both single-summary PISQ-IR (3.4 vs 3.6, p < 0.01) and PISQ-12 (36.0 vs 38.1, p < 0.01) scores increased significantly. The only variable that was associated with deteriorated scores postoperatively was a higher BMI. Individual domain analyses revealed significant improvement in condition-specific and condition-impact domains, except for the desire domain, which deteriorated. Prevalence of dyspareunia decreased post-surgery from 21.8% to 16.4%, p < 0.05. Newly sexually active women were older, had shorter vaginal length preoperatively, but lower PISQ-IR scores postoperatively than sexually inactive women pre- and postoperatively. Women ceasing sexual activity were older and had lower preoperative PISQ-IR scores than sexually active women pre- and postoperatively. Conclusions: Although the overall rate of sexually active women and sexual desire declined 12 months after sacrocolpopexy, overall sexual function scores improved and the prevalence of dyspareunia decreased. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic sacral colpopexy (LSC) is the gold standard treatment for women with apical/anterior pelvic organ prolapse (POP). For isolated posterior vaginal prolapse, instead, the literature suggests fascial native tissue repair. This is a retrospective 2-year quality-of-life follow-up study after laparoscopic posterior plication (LPP) combined with LSC in patients with anterior/apical prolapse combined with severe posterior colpocele. The primary endpoint was to evaluate the subjective outcomes quality of life (QoL), sexual function, and patient satisfaction rate. The secondary endpoint was to evaluate perioperative and anatomical outcomes at the 2-year follow-up. Methods: A total of 139 consecutive patients with anterior and/or apical prolapse (POP-Q stage ≥ II) and severe posterior vaginal prolapse (posterior POP-Q stage ≥ III) were retrospectively selected from our database among women who underwent, from November 2018 to February 2021, a "two-meshes" LSC. The patients were classified into Group A (81 patients; LSC plus LPP) and Group B (67 patients; LSC alone). The primary endpoint was evaluated using the Patient Global Impression of Improvement (PGI-I), the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), the Female Sexual Distress Scale (FSDS), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and the EuroQol (EQ-5D). The secondary endpoint was studied using the POP-Q study and an intra-, peri-, and post-operative complications assessment. Two-year follow-up data were analyzed for the study. Results: At 2 years, all women showed a statistically significant amelioration of their symptoms on the QoL questionnaires. We found a statistical difference in favor of posterior plication in terms of the PGI-I successful outcome rate (Group A versus B: 85.3% versus 67.1%), FSDS (median 11 versus 21), and PISQ-12 (median 89 versus 62) (p < 0.05 for all comparisons). A significant improvement of all EQ-5D values was observed from baseline to 2-year follow-up, and only for the "pain/discomfort" domains did we observe a significant improvement in LSC plus LPP patients versus LSC alone (p < 0.05). LSC plus LPP women showed, at 2 years, a significant amelioration of their Ap and GH POP-Q points. We observed no statistical differences in terms of intra-post-operative complications or anatomic failure rate between groups. Conclusions: Our LPP approach to LSC appears to be a safe, feasible, and effective treatment for advanced pelvic organ prolapse with a significant impact on the patient's general health and sexual quality of life. Adding laparoscopic posterior vaginal plication to "two-meshes" sacral colpopexy is recommended in patients with apical/anterior prolapse and concomitant severe posterior colpocele. This surgical approach, in addition to improving the anatomical results of these patients, is associated with a significant improvement in sexual and quality of life indexes. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Pelvic organ prolapse (POP) is a common morbidity and 10–20% of the patients need surgical correction. Sacrocolpopexy or sacrohysteropexy procedures are satisfactory but still difficult. Lateral suspension (LS) as a safe and simple technique has become an alternative technique recently. Vaginal natural orifice transluminal endoscopic surgery (V-NOTES) is also a new modality and LS using V-NOTES has not been performed previously and should be promising. Methods: This prospective observational pilot study was conducted with a total of 38 women with stage 3 and 4 POP according to the Pelvic Organ Prolapse Quantification grading system (POP-Q). Lateral suspension via V-NOTES was performed with the Salman–Ketenci Gencer technique using a mesh for POP. The preoperative and postoperative 6-month POP-Q stages together with Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) scores were recorded and compared. Results: Comparison of the preoperative and postoperative 6-month POP-Q stages of the patients were statistically significant except for the total vaginal length (p<0.01). Compared with the preoperative total and subscale scores of PISQ-12, the postoperative values were considerably improved (p<0.001). Conclusions: With the Salman–Ketenci Gencer technique not only good anatomical but also good functional results were obtained with V-NOTES. Surgeons may focus on uterine sparing while using the Salman–Ketenci Gencer technique for apical prolapse owing to the higher rate of complications related to the colposuspension and better sexual results after the cervicosuspension. [ABSTRACT FROM AUTHOR]

Aims:Urinary incontinence (UI) is a common condition in women and might affect women’s physical and psychological health in different aspects. This study evaluated the effects of UI on the quality of life (QoL) and sexual function in women of reproductive age.Methods:In this prospective case-control study, sexually active and premenopausal women who were admitted to the urogynecology outpatient clinic of our hospital with UI were included. Women without UI complaints were selected for the control group. All the women were asked to fill the Urogenital Distress Inventory-6 (UDI-6), the Incontinence Impact Questionnaire-7 (IIQ-7), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12).Results:There were 64 women [median age: 42 (12)] in the UI group and 58 women [median age: 40 (11)] in the control group. Although the median age was similar in the two groups, the UI group had significantly more gravidas [3 (1) vs. 2 (1); p

Objectives: This study aimed to investigate the long‐term sexual function of patients with cervical cancer who underwent treatment and to explore influential factors. Methods: This retrospective cross‐sectional study was conducted at Peking University First Hospital in (Beijing, China). A total of 207 patients, who were diagnosed with Stage IA‐IIA cervical cancer and had undergone surgical treatment (some patients had also been treated with adjuvant radiotherapy and chemotherapy) between January 2010 and August 2020, completed questionnaires via telephone. The median time since diagnosis was 54 (range, 13–138) months. Sexual function was assessed using the validated short form of Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12). The multivariate logistic regression analysis was performed to determine factors influencing sexual function after treatment. Results: The mean preoperative PISQ‐12 score was 39.42 ± 3.922, and the mean postoperative PISQ‐12 score was 32.60 ± 6.592, indicating a significant decrease in postoperative PISQ‐12 score compared with preoperation (p < 0.001). In total, 49.8% of the patients had sexual dysfunction after treatment. According to the results of the multivariate logistic regression analysis, longer follow‐up (months), ovariectomy, lack of hormone replacement therapy after ovariectomy and adjuvant radiotherapy were significantly associated with sexual dysfunction after treatment (p < 0.05). There was no significant correlation among surgical method, tumor stage, adjuvant chemotherapy, and sexual dysfunction after treatment. Conclusions: The sexual function of cervical cancer survivors significantly decreased after treatment, which was related to the length of follow‐up, ovariectomy, and adjuvant radiotherapy. Hormone replacement therapy after ovariectomy can help patients to improve their sexual function. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of this prospective study was to examine the impact of sociodemographic, pregnancy and obstetric characteristics on sexual function 12 months postpartum in primiparous women. We hypothesized that sexual function would decrease after childbirth. Methods: Between 1 October 2014 and 1 October 2017, all nulliparous women in early pregnancy registering for maternity health care in Region Örebro County, Sweden, were invited to participate in this prospective study. A total of 958 women were included. Sexual activity and function were measured at early pregnancy, 8 weeks postpartum and 12 months postpartum using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). The associations between sociodemographic, pregnancy and obstetric characteristics and sexual activity and function from early pregnancy to 12 months postpartum were examined using linear and logistic models based on generalized estimating equations. Results: We found that the prevalence of sexually active women decreased from 98.0% in early pregnancy to 66.7% at 8 weeks postpartum, but increased to 90.0% at 12 months postpartum. Age ≥ 35 years, second-degree perineal tear and current breastfeeding were statistically significant risk factors for sexual inactivity at 12 months postpartum. Poor self-reported health in early pregnancy was statistically significantly associated with decreased sexual function at 12 months postpartum. Conclusions: A majority of women resumed sexual activity at 8 weeks postpartum and most women at 12 months postpartum; the decrease in sexual function at 12 months postpartum was small and few risk factors were observed. [ABSTRACT FROM AUTHOR]

Aims: Urinary incontinence (UI) is a common condition in women and might affect women's physical and psychological health in different aspects. This study evaluated the effects of UI on the quality of life (QoL) and sexual function in women of reproductive age. Methods: In this prospective case-control study, sexually active and premenopausal women who were admitted to the urogynecology outpatient clinic of our hospital with UI were included. Women without UI complaints were selected for the control group. All the women were asked to fill the Urogenital Distress Inventory-6 (UDI-6), the Incontinence Impact Questionnaire-7 (IIQ-7), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12). Results: There were 64 women [median age: 42 (12)] in the UI group and 58 women [median age: 40 (11)] in the control group. Although the median age was similar in the two groups, the UI group had significantly more gravidas [3 (1) vs. 2 (1); p<0.00] and parity [2.5 (1) vs. 2 (1); p<0.001], body mass index [27.9 (7.2) vs. 24.9 (5.1); p=0.002], and Pelvic Organ Prolapse-Quantification [0 (0) vs. 0 (0); p=0.03] levels. The most common UI type was mixed UI (64.1%) followed by the stress (20.3%) and urge UI (15.6%). The UI group had significantly higher scores in both the subscale and total scores in IIQ-7 and UDI-6 questionnaires (p<0.001). For the PSIQ-12 questionnaire, the behavioral-emotive subscale did not differ between the two groups, while physical and partner subscales and the total score were significantly lower in the UI group (p<0.001). Conclusions: This study showed that UI had a negative impact on QoL and sexual function in women of reproductive age. Sexual dysfunction occurs mainly on physical and partner-related issues. [ABSTRACT FROM AUTHOR]

Évaluer l'impact de l'incontinence urinaire sur la fonction sexuelle des femmes marocaines en utilisant le questionnaire Pelvic Organ Prolapse and/or Urinary Incontinence Sexual Questionnaire (PISQ-12) validé en arabe. Nous avons réalisé une enquête, sur une période de 6 mois, entre septembre 2018 et mars 2019, auprès de 50 femmes souffrant d'incontinence urinaire. Nous avons comparé les caractéristiques socio-démographiques entre les femmes avec et sans activité sexuelle puis on a comparé le score PISQ-12 entre les différents types d'incontinence urinaire. Une valeur p inférieure à 0,05 a été considérée comme significative. Notre population d'étude se caractérisait par une moyenne d'âge de 53 ans, une nette prédominance de femmes mariées et en période d'activité génitale, très souvent multipares. L'incontinence urinaire la plus fréquente chez nos patientes est de type urgenturie IUU, suivie de celle à l'effort IUE et de l'incontinence urinaire mixte IUM. Les prolapsus des organes pelviens étaient présents chez 52 % de nos patientes. L'impact négatif de l'incontinence urinaire sur la fonction sexuelle a été mis en évidence par le bas score moyen PISQ-12 de 28,45. Le score moyen était plus bas chez les patientes présentant un prolapsus des organes pelviens (p < 0,05). Les femmes ménopausées avec une IUU avaient une meilleure fonction sexuelle que celles avec une IUE ou IUM (p = 0,038). La qualité de vie sexuelle est altérée chez les femmes présentant une incontinence urinaire. Il n'existe pas de corrélation entre les différents types d'incontinence urinaire et le score total PISQ-12. L'association prolapsus et incontinence urinaire était plus délétère sur la sexualité. Assess the impact of urinary incontinence on the sexual function of Moroccan women using the Pelvic Organ Prolapse and/or Urinary Incontinence Sexual Questionnaire (PISQ-12) validated in Arabic. We conducted a survey, on a 6 months period, between September 2018 and March 2019, with 50 women suffering from urinary incontinence. First, we compared socio-demographic characteristics between women with and without sexual activity. Afterwards, we compared the PISQ-12 score between the different types of urinary incontinence. A P -value less than 0.05 was considered significant. Our study population was characterized by an average age of 53 years, a clear predominance of married women, in their genitally active period, very often multiparous. The most common urinary incontinence in our patients is urge urinary incontinence UUI followed by stress urinary incontinence SUI and mixed urinary incontinence MUI. Pelvic organ prolapse was found in 52% of our patients. The negative impact of urinary incontinence on sexual function was brought to light by the low mean PISQ-12 score of 28.45 of our patients. The PISQ-12 score was lower in patients with pelvic organ prolapse (P < 0.05). Postmenopausal women with UUI had a better sexual function than women with SUI or MUI (P = 0.038). The quality of sexual life is impaired in women with urinary incontinence. There is no correlation between the different types of urinary incontinence and the total PISQ-12 score. The association prolapse and urinary incontinence was more deleterious on sexuality. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: This was a planned secondary analysis of a systematic review that described sexual function outcomes following pelvic organ prolapse (POP) surgery. We aimed to describe the relationship of pre- and postoperative vaginal anatomic measures with sexual function outcomes. Data Sources included the Medline, Embase, and clinicaltrials.gov databases from inception to April 2018. Methods: The original systematic review included prospective, comparative studies that reported sexual function outcomes before and following POP surgery. Studies were extracted for population characteristics, sexual function outcomes, and vaginal anatomy, including total vaginal length (TVL) and genital hiatus. By meta-regression, we analyzed associations across studies between vaginal anatomic measurements and sexual function using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12) and dyspareunia outcomes. Results: We screened 3124 abstracts and identified 74 papers representing 67 original studies. Among these, 14 studies reported TVL and PISQ-12 outcomes. Nine studies reported TVL and dyspareunia outcomes, eight studies reported GH and PISQ-12 outcomes, and seven studies reported GH and dyspareunia outcomes. We found no associations between anatomic measures and PISQ-12 or dyspareunia, although, we found a statistically significant association found between preoperative TVL and change in PISQ-12. Conclusion: Across studies, the evidence does not support an association between vaginal anatomy and either validated, condition-specific sexual function questionnaires or dyspareunia. However, no study has directly analyzed these associations in the setting of pelvic floor reconstructive surgery. [ABSTRACT FROM AUTHOR]

Introduction: Despite ample research regarding the impact of reconstructive surgery on anatomic/functional outcomes of pelvic organ prolapse (POP), including incidence of dyspareunia, evidence regarding sexual outcomes is equivocal. Aim: To assess changes in sexual function in women followed up for at least 12 months after transvaginal mesh surgery for POP. Methods: We conducted a retrospective review of women who underwent surgery for POP using different mesh products between 2008 and 2019. Baseline demographics were compiled along with intraoperative and postoperative information. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) was used to assess sexual function. Main Outcome Measures: Women sexually active before and after surgery were assessed to determine changes in overall and question-specific PISQ-12 responses and potential factors to explain sexual function after surgery. Results: 622 women underwent surgery using mesh at our center. 360 (58%) attended at least one visit at a median of 12 months (IQR 11–23 months), with 113 (31%) sexually active at baseline and 247 (69%) sexually inactive. 97 had complete PISQ-12 responses before and after surgery. There was an overall improvement in the median PISQ-12 scores of 2 points (P

Introduction and hypothesis: Female pelvic organ prolapse (POP) can severely influence sexual function. Robot-assisted surgery is increasingly used to treat POP, but studies describing its effect on sexual function are limited. The objective of this study was to evaluate sexual function after robot-assisted POP surgery.Methods: This prospective cohort study included all patients who underwent a robot-assisted sacrocolpopexy (RASC) or supracervical hysterectomy with sacrocervicopexy (RSHS). Exclusion criteria were unknown preoperative sexual activity status or concomitant surgery. In sexually active women, sexual function was measured with the translated validated version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Changes in sexual activity were scored. Prolapse stages were described using the simplified Pelvic Organ Prolapse Quantification (S-POP) system.Results: A total of 107 women were included (median follow-up 15.3 months). No difference was found in the total number of sexually active women before and after surgery [63 (58.9%) vs. 61 (63.5%), p = 0.999]. Significantly fewer women avoided sexual intercourse postoperatively compared with preoperatively. Preoperatively, sexual intercourse was avoided due to vaginal bulging (2% vs. 24%, respectively, p = 0.021). Total mean PISQ-12 scores improved significantly 1 year after prolapse correction (33.5 vs. 37.1; p = 0.004), mainly due to improved scores on the physical and behavioral-emotive domain. No significant difference in pre- and postoperative complains of dyspareunia was found.Conclusion: Robot-assisted middle-compartment surgery improved sexual function 1 year after surgery according to enhanced physical and emotional scores. The total number of sexually active women and complains of dyspareunia before and after surgery did not differ. [ABSTRACT FROM AUTHOR]

Purpose: Female patients with pelvic floor diseases may suffer from several sexual disorders and sexual life impairments. The aim of this manuscript was to evaluate sexual dysfunction in female patients presenting with faecal incontinence (FI) and defecation disorder (DD). Methods: A retrospective review was performed of a prospectively collected database of sexually active women referred to the pelvic floor clinic, who completed the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-12 (PISQ-12) at first visit. Statistical analysis was performed to evaluate and compare sexual dysfunction between patients with FI and DD and with published data on the general population. Regression analysis was used to identify predictors of sexual dysfunction and surgery. Results: Three hundred thirteen patients were included, 192 (61%) with FI and 121 (39%) with DD. The patients with DD received more non-gynaecological surgical procedures ( p = 0.023). More patients with DD received surgery for their current pelvic floor disease ( p < 0.001). Major sexual impairment (PISQ-12 < 30) was found in 100 patients (31.9%). The mean PISQ-12 (33.2 ± 7.2) score was by 5 points lower than those reported in the general population from PISQ-validating studies. Prior anorectal surgery (odds ratio (OR) = 15.4), partner ejaculation problems (PISQ item 11, OR = 2.5), reduced sexual arousal (item 2, OR = 2.1), and orgasm perception (item 13, OR = 2.1) were the strongest predictors of worse sexual function in patients with FI. Patients with DD were almost 15 times more likely to receive subsequent surgery (OR = 14.6, p < 0.001), whereas fear of urine leakage almost doubled the risk. Conclusions: Sexual dysfunction is prevalent among patients suffering from FI and DD, and questionnaires are useful in recognizing these patients. Subsequent surgery is more common for patients with DD compared to those with FI. [ABSTRACT FROM AUTHOR]

Introduction: Studies on pelvic organ prolapse (POP) surgery show conflicting evidence regarding the impact of uterus preservation and hysterectomy on sexual function and no large randomized trials with long-term follow-up have been published on this topic. Aims: The aim of this secondary analysis was to evaluate and compare sexual function after sacrospinous hysteropexy and vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse. Methods: This is a secondary analysis of the SAVE U trial data, a multicenter trial in 4 nonuniversity hospitals in the Netherlands comparing sacrospinous hysteropexy and vaginal hysterectomy with suspension of the uterosacral ligaments in primary surgery of uterine prolapse stage II or higher. Primary outcome of the original study was recurrent prolapse stage II or higher of the uterus or vaginal vault (apical compartment) evaluated by POP-Q examination in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse at 12 months follow-up. Secondary outcomes were overall anatomical recurrences, functional outcome, complications, hospital stay, postoperative recovery, and sexual functioning. Data from patients who had completed the POP/urinary incontinence sexual questionnaire (PISQ-12) at baseline and 24months after surgery were used in the present trial. Total, subscale, and individual question analyses were performed. The SAVE U trial is registered in the Dutch trial registry, number NTR1866. Main Outcome Measures: Differences and changes in sexual function 24 months after surgery, measured by the PISQ-12 questionnaire. Results: Between November 2009 and March 2012, 208 women were randomized between sacrospinous hysteropexy (n = 103) and vaginal hysterectomy with suspension of the uterosacral ligaments (n = 105). Of these, 99 women completed questionnaires at baseline and after 24 months follow-up and were included in the present study. During a follow-up period of 24 months, no significant differences in total PISQ-12 scores were observed between the groups. After both interventions the item "avoidance of intercourse due to prolapse" significantly improved, as did the physical subscale of the PISQ-12 questionnaire. Conclusion: There was no statistically significant difference in overall sexual functioning (total PISQ-12 scores) between uterus-preserving sacrospinous hysteropexy and vaginal hysterectomy with suspension of the uterosacral ligaments after a follow-up period of 24 months. [ABSTRACT FROM AUTHOR]

Objective: To provide data on the anatomical dimensions of adult female genitalia and to investigate the possible association of vulvar morphology and sexual function.Study Design: This cross-sectional prospective cohort study, using measurements of the external genitalia was performed in a day-care unit of a tertiary, university-affiliated medical center from 2013 to 2014. Thirty-two premenopausal women aged 20-51 years, undergoing gynecological procedures under general anesthesia (not involving the external genitalia) were asked to respond to both a local general data questionnaire and a validated sexual function questionnaire (PISQ-12). Based on reported orgasmic performance during sexual intercourse, patients were divided into two groups, and the measured genital features were compared.Results: Age, body mass index, parity and sexual activity history were recorded. A wide range of values was noted for each measurement. There was no statistically significant association between external genitalia measurements and age, parity or sexual activity. There was no statistically significant difference in any of the external genitalia measurements between the groups.Conclusion: Wide variability exists in the appearance of female external genitalia. Sexual function does not appear to be associated with genital dimensions. This information is important for both women and surgeons when considering cosmetic vulvar surgery. [ABSTRACT FROM AUTHOR]

Background. To evaluate the impact of the different types of genital prolapse and associated factors, on sexual quality of life in women presenting a genital prolapse. Design and methods. Forty-four women were included in this prospective observational study. We collected clinical data. Genital prolapse was quantified according to the Pelvic Organ Prolapse Quantification scale (POP-Q). Sexual function was evaluated using a validated questionnaire (PISQ-12). Statistical analysis between POP-Q stages, clinical characteristics and PISQ-12 scores was undertaken. Results. A history of abdominal surgery significantly decreases the sexual quality of life (P=0.03). PISQ-12 scores were poorly affected by the type and the severity of genital prolapse. Conclusions. The only factor influencing sexual quality of life was a history of previous abdominal surgery. The type and severity of genital prolapse did not influence sexual function. These results must be confirmed further studies with a higher sample size.

Objective To evaluate the impact of laparoscopic sacrocolpopexy on symptoms, health-related quality of life ( HRQL) and sexuality among women with symptomatic urogenital prolapse ( UGP)., Patients and Methods A prospective analysis was carried out including 148 women with symptomatic UGP., Baseline characteristics, medical and obstetric history were recorded., The Pelvic Organ Prolapse Quantification ( POP-Q) classification was used to stage the UGP. Validated tools were used to evaluate symptoms (Pelvic Floor Distress Inventory, PFDI-20) and HRQL (Pelvic Floor Impact Questionnaire, PFIQ-7). Sexual function was evaluated using the Pelvic organ prolapse urinary Incontinence Sexual Questionnaire ( PISQ-12)., Measurements were recorded at the preoperative examination, then at 3 and 12 months after surgery. We compared the follow-up results with preoperative data., Results The anatomical results at 3 months showed a significant correction ( P < 0.05) relative to the preoperative values, on the three pelvic floor parameters measured, with a clinical relapse rate of 6.3%. This improvement remained significant after 12 months ( P < 0.05). There was no difference between the results obtained at 3 months and those at 12 months., At 3 months compared with the preoperative data, there was a significant improvement in PFDI-20 total mean score (32.24 vs 94.31, P < 0.05). At 12 months, the improvement remained significant (38.06 vs 94.31, P < 0.05) for all scores compared with the preoperative scores. Again, there was no difference between results at 3 months, and those at 12 months., The results showed a significant improvement in the PFIQ-7 score at 3 (16.61 vs 64.04, P < 0.05) and 12 months (18.21 vs 64.04, P < 0.05). There was no significant difference between the scores at 3 months and those at 12months., The total PISQ-12 score was linked significantly to urinary symptoms ( P < 0.05), pelvic symptoms ( P < 0.05) but not with ano-rectal ones., At 3 months, the total mean PISQ-12 score had improved significantly compared with the preoperative score (35.42 vs 32.07, P < 0.05). At this time, only two items of the PISQ-12 questionnaire were significantly increased: 'existence of negative emotions during sexual activity' ( P < 0.05) and 'the avoidance of sexual activity because of prolapse' ( P < 0.05). The total mean score remained significantly improved at 12 months (36.56 vs 32.07, P < 0.05) and there was no statistical difference compared with the results at 3 months., Conclusions Laparoscopic sacrocolpopexy resulted in the early improvement (primarily during the first 3 months) of all symptoms, HRQL and sexual function. This improvement was persistent in the medium term., Symptoms linked with UGP had different effects on sexuality fields., Anatomical improvement was not related to an improvement in all sexual fields. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Current evidence about the impact of pelvic floor surgery on sexual function is conflicting. Only a few studies have reported with validated questionnaires on sexual function after transvaginal mesh repair, with a discrepancy in reported outcomes. The aim of this study was to prospectively explore the impact of anterior repair (AR) with mesh insertion on sexual function, quality of life and dyspareunia. Study design: 69 women with symptomatic stage II or greater prolapse exclusively of the anterior compartment participated in a prospective study on safety and efficacy of two mesh implantation techniques for anterior vaginal wall prolapse repair between September 2007 and May 2009. They were invited to complete the validated condition-specific short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and quality of life (QoL) questionnaires (Pelvic Organ Prolapse (POP) Distress Inventory (POPDI), Urinary Distress Inventory (UDI), POP Impact Questionnaire (POPIQ), and Urinary Impact Questionnaire (UIQ)) pre-operatively and 6 months post-operatively. All data were processed and analyzed in Statistical Computing Environment R, version 2.9.1. Results: A significant decrease of Qol scores and a significant increase of PISQ-12 scores occurred after surgery. All sexually active women resumed sexual activity postoperatively. The majority of non-sexually active women remained sexually inactive. Postoperatively the frequency of pain during intercourse increased in 31% of cases and decreased or stayed unchanged in 69% of cases. The incidence of de novo dyspareunia after mesh repair was 4% while the incidence of dyspareunia slightly increased from 25% to 29% postoperatively. Conclusions: The results of this study suggest no deterioration in sexual function, a significant improvement in quality of life and a low incidence of de novo dyspareunia six months after AR with mesh insertion. Despite these findings, the majority of non-sexually active women remain sexually inactive postoperatively. These conclusions should be confirmed in a longer follow-up. [Copyright &y& Elsevier]

Introduction and hypothesis: We studied a web-based version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12). Methods: A randomized crossover study in which subjects completed both a web-based and paper-based version of the PISQ-12, with a 2-week separation between the completion of the two versions. Demographic data and questionnaire preferences were also assessed. Group 1 completed the web version first, and group 2 completed the paper version first. Results: We recruited 52 women and 50 (96.2%) completed the study. Demographic data were similar for the two groups. There was no difference in total PISQ-12 score ( P = 0.41) and a high degree of correlation between versions ( r = 0.88). Women preferred the web-based PISQ-12 (77.6%) over the paper-based version. Conclusion: The web-based version of the PISQ-12 is a reliable alternative to the standard paper-based version and was preferred by women in this study regardless of age, race, and education. [ABSTRACT FROM AUTHOR]

Sexual dysfunction is prevalent in women with pelvic organ prolapse and/or urinary incontinence. An instrument is needed to assess sexual function in urogynecologic patients who speak Chinese. To evaluate the reliability and validity of a Chinese translation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in urogynecologic patients in Taiwan. After a pilot study showing good test-retest reliability and internal consistency of the Chinese PISQ-12, 120 urogynecological patients and 63 normal women were recruited. All participants underwent the Pelvic Organ Prolapse Quantification (POP-Q) system and urodynamic assessment. They each completed the Chinese PISQ-12 and the short form of Incontinence Impact Questionnaire (IIQ-7). PISQ-12, POP-Q system and IIQ-7 scores were compared between the urogynecologic patients and normal controls. The test-retest reliability and internal consistency of the Chinese PISQ-12 total score (Pearson correlation coefficient r = 0.939, Cronbach's alpha = 0.892, respectively) and of each of its three domains were excellent. The mean total PISQ-12 score and mean scores in each domain indicated significantly worse sexual dysfunction in the urogynecologic group as compared with the control group were correlated with the severity of prolapse and distress caused by incontinence. This Chinese translation of the PISQ-12 is a reliable, consistent and valid instrument to evaluate sexual function in Taiwanese women with pelvic organ prolapse and/or urinary incontinence. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Some new urogynecology patients who are given the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) complete it despite stating that they are not sexually active. This study compared sexually active (SA) and non-sexually active (NSA) women who complete the PISQ-12, hypothesizing that these groups differ substantially. Methods: New patients during the study period were given the PISQ-12 and two other validated questionnaires. Medical and demographic data were collected and analyzed for univariate differences between SA and NSA PISQ-12 completers. Logistical regression identified factors predicting PISQ-12 completion. Results: Of the 655 new patients during the study period, 399 completed the PISQ-12. Of these, 16.8% were NSA. These women were older, less likely married, and had higher BMI than their SA counterpart. Being sexually active, younger, and married are predictors of PISQ-12 completion. Conclusions: Some NSA women complete the PISQ-12. Instructions should specify that only SA women complete this questionnaire. [ABSTRACT FROM AUTHOR]

There are still controversies around reconstructive surgeries used in POP treatment. The aim of this study was to compare the QoSL after VNTR vs. TVM surgery due to POP via the use of PISQ-12 and FSFI questionnaires. The study included a group of 121 sexually active patients qualified for reconstructive surgery due to symptomatic POP, and 50 control. The average results of PISQ-12 before and after surgery were compared using the t-test. The significance of the mean differences in demographic groups was measured using the t-test for independent samples and one-way ANOVA. The results in the demographic groups were compared using the Mann–Whitney U test and the Kruskal–Wallis test. Fifty-eight women had VNTR, while 63 had TVM. Results of PISQ-12 revealed significant improvement in the sexual life after reconstructive surgery (27.24 vs. 32.43; p < 0.001, t = 8.48) both after VNTR and TVM. There were no significant differences in the assessment of the QoSL according to PISQ-12 and FSFI results between both analyzed groups of patients (PISQ-12: VNTR vs. TVM; t-test p = 0.19 and FSFI: VNTR vs. TVM; Mann–Whitney U test p = 0.54). VNTR is the treatment of choice in the case of uncomplicated primary POP. [ABSTRACT FROM AUTHOR]

Objective: Women consider preservation of sexual activity and improvement of sexual function as important goals after pelvic organ prolapse surgery. This systematic review aimed to compare sexual activity and function before and after prolapse surgery among specific approaches to pelvic organ prolapse surgery including native tissue repairs, transvaginal synthetic mesh, biologic grafts, and sacrocolpopexy.Data Sources: MEDLINE, Embase, and ClinicalTrials.gov databases were searched from inception to March 2021.Study Eligibility Criteria: Prospective comparative cohort and randomized studies of pelvic organ prolapse surgeries were included that reported the following specific sexual function outcomes: baseline and postoperative sexual activity, dyspareunia, and validated sexual function questionnaire scores. Notably, the following 4 comparisons were made: transvaginal synthetic mesh vs native tissue repairs, sacrocolpopexy vs native tissue repairs, transvaginal synthetic mesh vs sacrocolpopexy, and biologic graft vs native tissue repairs.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 Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.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 transvaginal synthetic mesh with native tissue repairs, 5 comparing sacrocolpopexy with native tissue repairs, 5 comparing transvaginal synthetic mesh with sacrocolpopexy, and 7 comparing biologic graft with native tissue repairs. For transvaginal synthetic mesh vs native tissue repairs, no statistical differences were found in baseline or postoperative sexual activity, baseline or postoperative total dyspareunia, persistent dyspareunia, and de novo dyspareunia. Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form change scores were not different between transvaginal synthetic mesh and native tissue repairs (net difference, -0.3; 95% confidence interval, -1.4 to 0.8). For sacrocolpopexy vs native tissue repairs, baseline or postoperative sexual activity, baseline or postoperative total dyspareunia, de novo dyspareunia, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form score differences were not different. For biologic graft vs native tissue repairs, baseline or postoperative sexual activity, baseline or postoperative total dyspareunia, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form changes were also not different. For transvaginal synthetic mesh vs sacrocolpopexy, there was no difference in sexual activity and sexual function score change. Based on 2 studies, postoperative total dyspareunia was more common in transvaginal synthetic mesh than sacrocolpopexy (27.5% vs 12.2%; odds ratio, 2.72; 95% confidence interval, 1.33-5.58). The prevalence of postoperative dyspareunia was lower than preoperative dyspareunia after all surgery types.Conclusion: Sexual function comparisons are most robust between transvaginal synthetic mesh and native tissue repairs and show similar prevalence of sexual activity, de novo dyspareunia, and sexual function scores. Total dyspareunia is higher after transvaginal synthetic mesh than sacrocolpopexy. Although sexual function data are sparse in the other comparisons, no other differences in sexual activity, dyspareunia, and sexual function score change were found. [ABSTRACT FROM AUTHOR]

It is estimated that 31–44% of all patients with symptomatic POP and/or UI suffer from sexual dysfunction. We aimed to validate the PISQ-12 in pre-and postmenopausal women and to assess the sexual function before and after POP reconstructive surgery. One hundred and forty sexually active patients were hospitalized due to symptomatic POP and 50 healthy controls were enrolled into the study. The patients were asked to complete PISQ-12, the FSFI and Beck's depression scale questionnaires twice. The Cronbach's alpha (α) was used to estimate the internal consistency. The scores were compared using the Intraclass Correlation Coefficient (ICC). Improvement in the QoSL (quality of sexual life) was observed in each age group of women. Pre-menopausal patients' QoSL was much better, both before and after surgery (29.62 and 34.64 points, respectively). The correlation between questionnaires before surgery was 0.63, and after was −0.76. The α value for the PISQ-12 was 0.83 before the procedure and 0.80 afterwards. In all the groups, the test–retest reliability was good—ICC = 0.72. Vaginal reconstructive surgeries improve the QoSL. The only demographic factor influencing the QoSL was the menopausal status. The Polish version of the PISQ-12 is a reliable and responsive instrument for assessing the sexual function in patients with diagnosed POP and/or UI. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to determine the percentage of sexually active women with a higher degree of descent in the anterior and middle compartment (in one compartment at least ≥ III degree) and how the surgical solution affects the quality of sexual life and overall quality of life in women who underwent surgery., Methods: Patients who underwent prolapse surgery were included in the study. Before the operation, a complete urogynecological examination was performed, including ultrasound examination, history and POP-Q (pelvic organ prolapse quantification system) evaluation, and quality of life questionnaires were completed. We compared the quality of sexual life in sexually active women before and after surgery to ascertain the effect of surgery in this respect., Results: The study included 128 patients who underwent pelvic organ descent surgery from January 2018 to April 2019. Depending on the type of operation, they were divided into three groups: reconstruction with anterior vaginal implant fixed to the sacrospinous ligament, laparoscopic sacrocolpopexy and sacrospinous vaginofixation according to Amreich-Richter. The differences between the groups in the results of the surgical solution were not statistically significant due to the size of the monitored group. Sexual activity of the patients even in the advanced stage of pelvic organ setup was reported preoperatively by 45.9% of women and postoperatively – after 1 year – by 44.8% of women. Comparing the quality of life preoperatively and postoperatively, there was a very significant improvement in 58.0% of respondents, a significant improvement in 36.0% and a slight improvement in 2.0%: only in 3.0% of women, there was a deterioration (ranging from mild to very significant). Surgical treatment of the descent slightly worsened the quality of sexual life in 20.8% of women, did not change it in 33.3% and significantly improved it in 45.8% of them., Conclusion: A high percentage of patients are sexually active even at an advanced stage of descent. Comparing the quality of life preoperatively and postoperatively, there was a significant improvement or even complete resolution of the problems associated with descent in most women. For some women, the surgical treatment of the descent may slightly worsen the quality of sexual life; in others, its quality remains at the same level, but the largest section of the studied group feels a significant improvement in the perception of sexual activities.

Introduction and Hypothesis: Treatment of anterior vaginal and/or apical prolapse by sacrocolpopexy is most often performed by systematic placement of two non-resorbable meshes, anterior and posterior, whether or not there is an associated posterior vaginal prolapse. We believe that isolated correction of an anterior vaginal and/or apical prolapse in the absence of posterior vaginal prolapse is not associated with a higher rate of de novo posterior vaginal prolapse., Method: A prospective, observational, monocenter study performed in the Gynecology unit of the Conception UHC in Marseille from May 2011 to October 2014. Patients over 18 years of age exhibiting an anterior vaginal and/or apical prolapse of stage ≥ 2 of the POP-Q classification resulting in functional impairment with alteration of the quality of life, without an associated posterior vaginal prolapse were included and underwent a laparoscopic anterior sacrocolpopexy (ASP). They were seen again in consultation one year from the intervention. Validated quality of life questionnaires were completed pre- and one year postoperatively., Results: 50 patients were included. The rate of de novo posterior vaginal prolapse was 8/50 (16 %). At one year, there was a significant improvement in terms of the SPDI-20 and SPIQ-7 (p < 0.0001) questionnaire, without significant improvement in the quality of sexual function (PISQ-12 questionnaire) (p = 0.073)., Conclusion: The risk of de novo posterior vaginal prolapse at one year is low when an ASP is carried out., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Objectives: To evaluate the impact of laparoscopic sacrocolpopexy on symptoms, health-related quality of life and sexuality after a 36 month-follow-up. We also reported anatomical outcomes and reoperation rate., Patients and Methods: A prospective monocentric study was carried out including 82 women with symptomatic Pelvic Organ Prolapse (POP) stage≥2 according to Pelvic Organ Prolapse Quantification classification. Symptoms were evaluated using the Pelvic Floor Distress Inventory (PFDI-20) and health-related quality of life by the Pelvic Floor Impact Questionnaire (PFIQ-7). Sexual function was evaluated using the Pelvic Incontinence Sexual Questionnaire (PISQ-12). Measurements were recorded at the preoperative examination, then at 3, 12 and 36 months after surgery., Results: PFDI-20 scores were significantly improved at 3 months (91.9 vs. 31.8, P<0.05) and PFIQ-7 scores also (60.8 vs. 16, P<0.05). This scores improvement remained significant at 12 months. There was no significant difference between results obtained at 12 and 36 months for PFDI-20 (36.8 vs. 42.2, P>0.05) and for PFIQ-7 (18.4 vs. 24.7, P>0.05). PISQ-12 score remained significantly improved at 3, 12 and 36 months compared to baseline (34.8, 35.3, 38.5 and 38.5, respectively). Ten patients (12.8%) had anatomical recurrence at 36 months for posterior compartment, 4 (5.1%) for anterior compartment and 1 (1.2%) for medium compartment. Four patients (4.9%) required reintervention., Conclusion: Laparoscopic sacrocolpopexy improved early functional outcome that remained significant after at least a 36 months follow up., Level of Evidence: 4., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)