Body image and sexual function improve following prolapse repair

Abstract

OBJECTIVE: Body image (a woman's perceptions and attitudes about her body) likely plays a role in pelvic organ prolapse treatment satisfaction and post-operative sexual function. The primary aim of this study was to describe changes in body image after surgical repair of vaginal vault prolapse. The secondary aim was to evaluate whether changes in sexual function are correlated with changes in body image.

METHODS: This was a planned secondary analysis of a randomized three-arm trial comparing surgical approaches for vaginal vault prolapse. Women with symptomatic post-hysterectomy vault prolapse were randomized to: transvaginal native tissue repair (NTR), mesh placed abdominally (Sacrocolpopexy; SC), or mesh placed transvaginally (TVM). Body image was measured using the validated Body Image in Pelvic Organ Prolapse (BIPOP) questionnaire at baseline, 6-, 12-, 24- and 36-months. Sexual activity and function were measured using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA revised (PISQ-IR) at similar time points. Longitudinal analysis for changes from baseline in mean BIPOP score and the proportion of women who met a distribution-based estimate of the minimally important difference (MID) was performed using general mixed models for repeated measures. The same method was used as a model to predict change in sexual function based on body image.

RESULTS: A total of 335 women were included in the analysis: NTR =123, SC=107, TVM = 105. Mean age was 66.1±8.5 years and a majority (242, 72%) had Stage 3 prolapse. Baseline total and subscale BIPOP scores were not significantly different by treatment arm. All arms improved by 6-months, and this improvement was sustained to 36-months with no significant differences between the groups for change in BIPOP score nor MID-equivalent improvement. 99(30%) women reported being sexually active at all visits, 131(39%) reported they were not sexually active at all visits, and the remainder changed sexual activity status throughout the study. Amongst sexually active participants, there were no baseline differences in PISQ-IR scores between groups (NTR, 54 women, 3.2+0.7; SC, 43 women, 3.3+0.7; TVM, 46 women, 3.1+0.6). In sexually active women, change in BIPOP and PISQ-IR scores were correlated at each visit and a significant association between these measures (p<0.001) remained after adjustment for baseline sexual function, site, age, surgical treatment arm, and baseline dyspareunia.

CONCLUSIONS: Body image improves following repair of vaginal vault prolapse, regardless of the surgical approach. Improvements in body image and sexual function are positively correlated among sexually active women.