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Female Sexual Functioning in Women With a Symptomatic Pelvic Organ Prolapse; A Multicenter Prospective Comparative Study Between Pessary and Surgery.
J Sex Med. 2022 02; 19(2):270-279.JS

Abstract

BACKGROUND

Female pelvic organ prolapse (POP) has a negative effect on female sexual functioning and with an increasing life expectancy female sexual dysfunction caused by POP will be an arising global issue.

AIM

Improvement in female sexual functioning, measured with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire IUGA-Revised (PISQ-IR), 24-months after pessary or surgery, for both sexually active (SA) and sexually inactive women (NSA) presenting with POP.

METHODS

A multicenter prospective comparative cohort study was conducted in 22 Dutch hospitals. Women referred with moderate to severe POP symptoms and POP stage ≥ 2 were included and chose either pessary therapy or surgical intervention. The PISQ-IR was filled in at baseline and 24-months, the delta of change was calculated and compared between both groups. Multivariate linear regression was performed to adjust for potential confounding factors in the association between the summary score of the PISQ-IR and therapy.

OUTCOMES

Change in PISQ-IR between pessary and surgical intervention.

RESULTS

The delta of change at 24-months was calculated for 198 women in the pessary group and 129 women in the surgery group. SA women in the surgery group reported statistically significant more improvement on the condition-specific (-0.19 95%CI -0.35; -0.03, P = .02), and condition-impact (-0.48 95%CI -0.69; -0.28, P < .001) domains as well as on the summary score (-0.15 95%CI -0.23; -0.08, P < .001) as compared to the pessary group. No significant differences between pessary and surgery were found on the domains for NSA women. After controlling for potential baseline confounders, surgery still had a statistically significant effect on the summary score (B = 0.08; 95%CI interval 0.007-0.15, P = .03). Women having surgery had 2.62 times higher odds of changing from NSA to SA than pessary therapy.

CLINICAL IMPLICATIONS

SA women who clearly express that POP-related symptoms limit their sexual functioning should be counseled that surgery results in a more remarkable improvement.

STRENGTHS & LIMITATIONS

Our strengths include the large sample size, long-term follow-up, the use of the PISQ-IR as a validated outcome tool evaluating both SA and NSA women, and this study reflects real-life clinical practice that enhances the external validity of the findings. A limitation of our study is the considerable proportion of non-responders at 24-months follow-up.

CONCLUSION

Sexual function in SA women with POP is superior in case surgery is performed as compared to pessary therapy. van der Vaart LR, Vollebregt A, Pruijssers B, et al. Female Sexual Functioning in Women With a Symptomatic Pelvic Organ Prolapse; A Multicenter Prospective Comparative Study Between Pessary and Surgery. J Sex Med 2022;19:270-279.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: l.r.vdvaart@gmail.com.Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Hoofddorp, the Netherlands.Department of Obstetrics and Gynaecology, UMCU, University of Utrecht, Utrecht, the Netherlands.Department of Obstetrics and Gynaecology, Reinier de Graaf Hospital, Delft, the Netherlands.Department of General Practice/ Women's Studies Medicine, University Medical Centre Radboud, Nijmegen, the Netherlands.Department of Obstetrics and Gynaecology, Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Gynaecology, Bergman Clinics, Amsterdam, the Netherlands.Department of Obstetrics and Gynaecology, UMCU, University of Utrecht, Utrecht, the Netherlands; Department of Gynaecology, Bergman Clinics, Hilversum, the Netherlands.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

34969614

Citation

van der Vaart, Lisa R., et al. "Female Sexual Functioning in Women With a Symptomatic Pelvic Organ Prolapse; a Multicenter Prospective Comparative Study Between Pessary and Surgery." The Journal of Sexual Medicine, vol. 19, no. 2, 2022, pp. 270-279.
van der Vaart LR, Vollebregt A, Pruijssers B, et al. Female Sexual Functioning in Women With a Symptomatic Pelvic Organ Prolapse; A Multicenter Prospective Comparative Study Between Pessary and Surgery. J Sex Med. 2022;19(2):270-279.
van der Vaart, L. R., Vollebregt, A., Pruijssers, B., Milani, A. L., Lagro-Janssen, A. L., Roovers, J. W. R., & van der Vaart, C. H. (2022). Female Sexual Functioning in Women With a Symptomatic Pelvic Organ Prolapse; A Multicenter Prospective Comparative Study Between Pessary and Surgery. The Journal of Sexual Medicine, 19(2), 270-279. https://doi.org/10.1016/j.jsxm.2021.11.008
van der Vaart LR, et al. Female Sexual Functioning in Women With a Symptomatic Pelvic Organ Prolapse; a Multicenter Prospective Comparative Study Between Pessary and Surgery. J Sex Med. 2022;19(2):270-279. PubMed PMID: 34969614.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Female Sexual Functioning in Women With a Symptomatic Pelvic Organ Prolapse; A Multicenter Prospective Comparative Study Between Pessary and Surgery. AU - van der Vaart,Lisa R, AU - Vollebregt,Astrid, AU - Pruijssers,Bente, AU - Milani,Alfredo L, AU - Lagro-Janssen,Antoine L, AU - Roovers,Jan-Paul W R, AU - van der Vaart,Carl H, Y1 - 2021/12/27/ PY - 2021/08/28/received PY - 2021/11/08/revised PY - 2021/11/16/accepted PY - 2022/1/1/pubmed PY - 2022/4/1/medline PY - 2021/12/31/entrez KW - Female KW - Pelvic Organ Prolapse KW - Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire IUGA-Revised (PISQ-IR) KW - Pessary KW - Prolapse Surgery KW - Sexual Dysfunction SP - 270 EP - 279 JF - The journal of sexual medicine JO - J Sex Med VL - 19 IS - 2 N2 - BACKGROUND: Female pelvic organ prolapse (POP) has a negative effect on female sexual functioning and with an increasing life expectancy female sexual dysfunction caused by POP will be an arising global issue. AIM: Improvement in female sexual functioning, measured with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire IUGA-Revised (PISQ-IR), 24-months after pessary or surgery, for both sexually active (SA) and sexually inactive women (NSA) presenting with POP. METHODS: A multicenter prospective comparative cohort study was conducted in 22 Dutch hospitals. Women referred with moderate to severe POP symptoms and POP stage ≥ 2 were included and chose either pessary therapy or surgical intervention. The PISQ-IR was filled in at baseline and 24-months, the delta of change was calculated and compared between both groups. Multivariate linear regression was performed to adjust for potential confounding factors in the association between the summary score of the PISQ-IR and therapy. OUTCOMES: Change in PISQ-IR between pessary and surgical intervention. RESULTS: The delta of change at 24-months was calculated for 198 women in the pessary group and 129 women in the surgery group. SA women in the surgery group reported statistically significant more improvement on the condition-specific (-0.19 95%CI -0.35; -0.03, P = .02), and condition-impact (-0.48 95%CI -0.69; -0.28, P < .001) domains as well as on the summary score (-0.15 95%CI -0.23; -0.08, P < .001) as compared to the pessary group. No significant differences between pessary and surgery were found on the domains for NSA women. After controlling for potential baseline confounders, surgery still had a statistically significant effect on the summary score (B = 0.08; 95%CI interval 0.007-0.15, P = .03). Women having surgery had 2.62 times higher odds of changing from NSA to SA than pessary therapy. CLINICAL IMPLICATIONS: SA women who clearly express that POP-related symptoms limit their sexual functioning should be counseled that surgery results in a more remarkable improvement. STRENGTHS & LIMITATIONS: Our strengths include the large sample size, long-term follow-up, the use of the PISQ-IR as a validated outcome tool evaluating both SA and NSA women, and this study reflects real-life clinical practice that enhances the external validity of the findings. A limitation of our study is the considerable proportion of non-responders at 24-months follow-up. CONCLUSION: Sexual function in SA women with POP is superior in case surgery is performed as compared to pessary therapy. van der Vaart LR, Vollebregt A, Pruijssers B, et al. Female Sexual Functioning in Women With a Symptomatic Pelvic Organ Prolapse; A Multicenter Prospective Comparative Study Between Pessary and Surgery. J Sex Med 2022;19:270-279. SN - 1743-6109 UR - https://www.unboundmedicine.com/medline/citation/34969614/Female_Sexual_Functioning_in_Women_With_a_Symptomatic_Pelvic_Organ_Prolapse L2 - https://linkinghub.elsevier.com/retrieve/pii/S1743-6095(21)00784-0 DB - PRIME DP - Unbound Medicine ER -