¹Radboudumc, Nijmegen, Netherlands
²Rijnstate, Arnhem, Netherlands
³Zuyderland, Heerlen, Netherlands
⁴Maxima MC, Veldhoven, Netherlands
⁵Isala, Zwolle, Netherlands

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Introduction: While sexual function generally improves after pelvic organ prolapse (POP) surgery, concerns remain de novo dyspareunia [1]. This study compares the effect of the modified Manchester procedure (MP) and the sacrospinous hysteropexy (SSH) on sexual function and dyspareunia.

Methods: Analysis of the data on sexual function from a multicentre randomized controlled trial evaluating MP versus SSH in treatment of primary uterine prolapse. The primary outcome was the change in the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR) score from baseline to 24 months. Secondary outcomes included dyspareunia incidence and de novo dyspareunia.

Results: A total of 393 (MP = 197, SSH=196) women completed the PISQ-IR questionnaire at baseline and after 24 months follow-up. In sexually active patients (MP=101, SSH=99), the mean PISQ-IR score improved within both groups: 0.27 (p= <.001; Cohen’s d= 0.59) points after MP and 0.20 (p= <.001; Cohen’s d= 0.40) points after SSH. There was no difference in PISQ-IR score between the groups at 24 months follow-up (MP 3.46, SSH 3.36; p=.062), nor in the change over time. The occurrence of de novo dyspareunia did not differ significantly (MP 5%, SSH 13%; p= .075).

Conclusion: Both MP and SSH lead to a similar improvement in sexual function in sexually active patients, without a difference between procedures. There is no difference in de novo dyspareunia rates after MP compared to SSH. In view of higher effectivity, the MP should be considered as a surgical option for POP, without concern for a negative impact on sexual function.

Literatur

[1] Fatton B, de Tayrac R, Letouzey V, Huberlant S. Pelvic organ prolapse and sexual function. Nat Rev Urol. 2020;17(7):373-90.