Hypothesis / aims of study
Human sexuality is a fundamental aspect of individual well-being and quality of life. A number of components of sexual function, such as vaginal lubrication, pain perception, and orgasmic response, can be impacted by the menopause. However, because the topic is delicate, the study of elderly women's sexuality can present challenges, especially in conservative cultures. There is a growing body of evidence suggesting an increased prevalence of sexual dissatisfaction among women with pelvic organ prolapse, specifically apical prolapse. Sacrospinous ligament suspension surgery (SLSS), an autologous tissue repair technique, has emerged as a solution for restoring vaginal apical support. This procedure involves anchoring the vaginal vault to the sacrospinous ligament, a robust pelvic structure, to provide enhanced support.
However, there are still questions about how SLSS can affect patients' sexual function and happiness because of the particular surgical methods used. We suggest SLS surgery could help patients with vaginal prolapse have better sexual experiences.
Study design, materials and methods
The study was conducted among women undergoing ligament suspension surgery at two teaching Hospitals between 2022 and 2024. Exclusion criteria include lack of consent to participate in the study and the presence of congenital, structural, or anatomical abnormalities of the genital tract. To assess sexual satisfaction, the study employed the Female Sexual Function Index (FSFI), developed by R. Rosen [1] and validated in Persian [2]. This multidimensional, self-reported questionnaire consists of 19 items that evaluate female sexual dysfunction across six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain.
Results
This study encompassed 115 participants ranging in age from 29 to 76 years, with a mean age of 52.74 years. Their reproductive history varied, with an average of 4.40 gravida and 3.69 parity. Body Mass Index (BMI) among participants ranged from 18.36 to 35.15. Our analysis of Pelvic Organ Prolapse (POP) stages revealed distinct patterns across compartments: In the anterior compartment, stage 2 prolapse was most prevalent, affecting 63.3% of participants. Apical prolapse presented a distribution across stages: 15.9% at stage 1, 58.4% at stage 2, 21.2% at stage 3, and 4.4% at stage 4. Notably, our results demonstrated a significant improvement in postoperative outcomes, with 69% of participants exhibiting higher postoperative scores. The average score increased from 19.1451 preoperatively to 21.8381 postoperatively, representing a substantial improvement in pelvic organ function.
The mean difference between preoperative and postoperative FSFI scores was -2.69292, with weak and non-significant correlations between age and postoperative FSFI scores.
Interpretation of results
Overall, the results indicate that surgical interventions, such as sacrospinous ligament suspension (SSLS), generally have a positive impact on sexual function, with most participants experiencing improvements. The primary factor influencing these outcomes appears to be the surgical intervention itself, as there are no significant correlations with age or BMI, and the differences between groups are inconsistent. However, for a more nuanced understanding, additional details about the groups being compared would be beneficial. While SSLS often leads to improved or unchanged sexual function for most women, there is a risk of developing de novo dyspareunia, ranging from 0% to 9%.