Sexual and Psychological Outcomes After Vaginal Surgery for Pelvic Organ Prolpase and Stress Urinary Incontinence.

INTRODUCTION AND HYPOTHESIS: The objective was to evaluate changes in sexual function, anxiety and depression after vaginal reconstructive surgery for pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI) and to examine the relationship between sexual function and psychological outcomes.

METHODS

This prospective observational study included 97 sexually active women aged 25-80 years. Patients were assigned to POP surgery alone or POP surgery with transobturator tape. Sexual function (Female Sexual Function Index, FSFI), anxiety (Beck Anxiety Inventory, BAI) and depression (Beck Depression Inventory-II, BDI-II) were assessed preoperatively and 6 months postoperatively. Paired analyses compared scores and mixed-design repeated-measures analysis of variance was used to evaluate group-by-time effects. Multivariate regression revealed factors associated with score changes and clinically meaningful improvements in FSFI, BAI and BDI-II were assessed using the minimal clinically important difference (MCID).

RESULTS

Six months postoperatively, sexual function, anxiety and depression improved significantly (all p < 0.001), with no significant differences between groups. The mean FSFI score increased from 16.54 ± 7.90 to 21.90 ± 7.36; sexual dysfunction resolved in 24% of patients and 60% of patients achieved clinically meaningful improvements (MCID > 3.34). The mean BAI decreased from 20.14 ± 11.80 to 13.99 ± 8.86 and the mean BDI-II decreased from 16.68 ± 10.11 to 11.84 ± 8.55. Postoperative FSFI scores correlated negatively with psychological scores. Multivariate analysis revealed that a higher POP stage limited FSFI improvement and that menopause adversely affected psychological outcomes.

CONCLUSIONS

Vaginal reconstructive surgery for POP and/or SUI was associated with significant improvements in sexual function, anxiety and depression. A substantial proportion of patients achieved clinically meaningful improvements in sexual function, highlighting the potential psychosocial benefits of surgery. These findings underscore the value of a holistic, biopsychosocial approach and emphasise the importance of the concurrent evaluation of sexual and psychological health.