Urogynaecology
Sexual Function Following Urogenital Prolapse Sushma Srikrishna1
and Linda Cardozo2
1. Locum Consultant Obstetrician, and Urogynaecologist, Department of Urogynaecology, King’s College Hospital; 2. Professor of Urogynaecology, Department of Urogynaecology, King’s College Hospital
Abstract
Urogenital prolapse is a common distressing condition with a significant impact on quality of life. Sexual dysfunction is also frequent in women attending urogynaecological outpatient clinics. About one-third of sexually active women with pelvic organ prolapse report that their condition interferes with sexual function. In addition, possible confounding variables such as older age and post-menopausal status may alter the association between prolapse and sexual function. Although female sexual dysfunction is a common problem, especially in patients with urogenital prolapse, it has been poorly studied in the literature. Consequently, data on the prevalence, aetiology of sexual dysfunction and effects of different therapeutic interventions are limited. The aim of this article is to consider the pathophysiology of sexual dysfunction in association with urogenital prolapse and the impact of conservative as well as surgical intervention strategies.
Keywords Urogenital prolapse, sexual function, quality of life, aetiology, pathophysiology
Disclosure: The authors have no conflicts of interest to declare. Received: 17 January 2011 Accepted: 2 March 2011 Citation: European Urological Review, 2011;6(1):60–4 Correspondence: Sushma Srikrishna, Department of Urogynaecology, King’s College Hospital, Denmark Hill, London SE5 9RS, UK. E:
sushmasrikrishna@hotmail.com
Urogenital prolapse is a common distressing condition with a significant adverse impact on quality of life (QoL).1,2
As there is no standard
Women with advanced pelvic organ prolapse are more likely to feel self-conscious and less physically and sexually attractive than women without this condition.6
Sexual dysfunction is also
validated definition of urogenital prolapse, it is difficult to determine prevalence in the female population. However, three large population studies suggest that the prevalence of stage 3–4 prolapse is in the range of 2–11%.3–5
About one-third of
sexually active women with pelvic organ prolapse report that their condition interferes with sexual function.7,8
common in women attending urogynaecology clinics, with up to 64% of sexually active women reporting dissatisfaction with their sex life.9 Sexual function in this population of women has been shown to be adversely affected in a number of studies8,10–12
although data are limited
and conflicting. Some studies suggest that women with co-existent lower urinary tract symptoms are significantly more likely than those without urinary symptoms to report decreased libido and dyspareunia.11 In addition, possible confounding variables such as older age and post-menopausal status may alter the association between prolapse and sexual function.13
Finally, a significant proportion of women with
urogenital prolapse may not be sexually active and therefore sexual function in this group is very difficult to assess.
The aim of this article is to consider the pathophysiology of sexual dysfunction in association with urogenital prolapse and the impact of conservative as well as surgical intervention strategies.
Pathophysiology of Sexual Dysfunction in Women with Urogenital Prolapse
A literature review reveals conflicting views in terms of the impact of urogenital prolapse on female sexual function. A number of
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pathophysiological mechanisms have been proposed to explain female sexual dysfunction in association with urogenital prolapse. These include urogenital atrophy, obstruction caused by physical presence of the prolapse, a short or narrow vagina or a tense contracted pelvic floor. Lack of physical sexual response may lead to discomfort and pain, aggravated by lack of lubrication and genital swelling. Psychological factors such as a lack of libido or negative emotional reactions associated with sex, embarrassment or fear of urinary or faecal leakage, leading to avoidance of sex could also play a part. Severe prolapse can be associated with urinary or faecal incontinence, which in turn has an added negative impact on sexual function.14
Physical Presence of Prolapse
The actual presence of an obstructive bulge in the vagina or a sense of vaginal laxity may itself lead to sexual dysfunction, particularly in more severe degrees of prolapse. During coitus, vaginal dimensions and compliance increase and decreased vaginal length, width or elasticity caused by prolapsed vaginal tissue, scarring from previous surgery or mesh insertion can cause dyspareunia; however, even patients with moderate prolapse may remain asymptomatic for sexual problems.
Some studies have shown a relationship between increasing degrees of prolapse and interference with sexual activity,7,14,15
sexual pleasure or frequency of sexual intercourse. Interestingly, although there is evidence to suggest a correlation between impairment of sexual function and worsening prolapse,14 correction may not necessarily improve sexual function.16
Associated Local Pathology
Long-standing prolapse may be associated with skin excoriation, keratinisation or even ulceration in severe cases. In association with
© TOUCH BRIEFINGS 2011 although not with surgical
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