Comparison of the Changes in Sexual Function of Premenopausal and Postmenopausal Women Following Transvaginal Mesh Surgery

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Abstract
Introduction: The effect of transvaginal mesh (TVM) surgery on sexual function between premenopausal and postmenopausal women remains controversial. Aim: To compare the changes in sexual function of premenopausal and postmenopausal women following TVM repair. Methods: One hundred and fifty-two consecutive women with symptomatic pelvic organ prolapse (POP) stages II to IV were referred for TVM procedures at our hospitals. Sixty-eight women were included because they were sexually active and had complete follow-up. All subjects were divided into the premenopausal (N = 36) and postmenopausal (N = 32) groups. Preoperative and postoperative assessments included pelvic examination using the POP quantification (POP-Q) system and a personal interview with the Female Sexual Function Index (FSFI), Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7). Main Outcome Measures: The FSFI, UDI-6, and IIQ-7 questionnaires. Results: The mean age, rates of hypertension, and previous hysterectomy were significantly higher in the postmenopausal group (P < 0.05) compared with the premenopausal group. As for the POP-Q analysis, there was a significant improvement at points Aa, Ba, C, Ap, and Bp (P < 0.001) in both groups except for total vaginal length (P > 0.05). Similarly, the UDI-6 and IIQ-7 scores significantly decreased postoperatively (P < 0.01). After POP surgery, the score of the dyspareunia domain decreased significantly in the premenopausal group (P < 0.01) but was not the case for the postmenopausal group (P > 0.05). There were no significant changes in other domains and total scores in both groups (P > 0.05). However, higher rates of worsening dyspareunia and total scores were noted in the premenopausal group (P = 0.03 vs. 0.033). Conclusion: TVM procedure is effective for the anatomical restoration of POP. However, individual domain of FSFI such as dyspareunia may worsen in the premenopausal women. Additionally, our results revealed that over one third of premenopausal women could have a worsening sexuality domain postoperatively, with significantly higher rate of deteriorated dyspareunia and total FSFI scores than postmenopausal women.

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