Postoperative impact of pelvic organ prolapse and urinary incontinence surgeries on female sexual function measured by validated instruments: a systematic review and meta-analysis.

INTRODUCTION

Female sexual dysfunction (FSD) is frequently observed in women with urinary incontinence (UI) and pelvic organ prolapse (POP). Although surgical management of POP and SUI is widely performed, evidence regarding postoperative changes in female sexual function remains inconsistent and sometimes contradictory.

OBJECTIVE

To compare the postoperative effect of POP and UI surgeries on female sexual function and to explore the differential responsiveness of validated assessment tools.

METHODS

A literature search was conducted in PubMed, Web of Science, the Cochrane Library, and EMbase from database inception to 2025. The studies assessing sexual function using Female Sexual Function Index (FSFI) and PISQ-12, or reporting dyspareunia outcomes were included. Meta-analysis was analyzed by RevMan 5.4.

RESULTS

No statistically change was observed between preoperative and postoperative FSFI scores in women undergoing surgery for POP (P = .19), whereas patients treated surgically for SUI demonstrated statistically significant improvement in FSFI scores (P = .02). Among POP procedures, Laparoscopic repair was associated with higher postoperative FSFI scores compared with vaginal surgery (P < .00001). In contrast, no difference in FSFI outcomes was identified between traditional and minimally invasive sling procedures for SUI (P = .11). Assessment using the PISQ-12 revealed significant postoperative improvement in POP and SUI patients (POP:P < .00001; SUI:P = .002), with no difference between surgical approaches or combined procedures. Postoperative dyspareunia rates differed among SUI techniques (P = .04), but not among POP surgeries (P = .29); however, dyspareunia occurred more frequently after POP surgery compared with baseline (P = .002).

CONCLUSIONS

Surgical management of POP and UI shows a general correlation with improved sexual function scores, the extreme heterogeneity suggests that these pooled estimates should be viewed as broad trends rather than precise clinical benchmarks. The observed differences in FSFI and PISQ-12 scores may reflect differential patterns in detecting functional changes in specific patient groups, though the high variability precludes a definitive hierarchy of instrument sensitivity.