Pelvic organ prolapse (POP) is known to negatively affect women's quality of life, including sexual function and psychological well-being. While robot-assisted sacrocolpopexy (RASC) has demonstrated efficacy in anatomical correction of POP, its impact on sexual function — particularly in older populations — remains insufficiently characterized. The aim of this study was to evaluate changes in sexual function and sexual health-related quality of life following RASC at our institution, using a validated, condition-specific questionnaire.

This was a single-center prospective observational study. A total of 63 patients who underwent RASC at our institution between August 2021 and August 2025 were enrolled. Sexual function was assessed using the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire – IUGA Revised (PISQ-IR) at three time points: preoperatively, and at 3 and 6 months postoperatively. The PISQ-IR captures both activity-related and non-activity-related domains, enabling comprehensive evaluation regardless of sexual activity status. Statistical comparisons between time points were performed using paired t-tests, with significance set at p < 0.05.

The median patient age was 72.0 years (range 49–84), and the median console time was 184 minutes (range 147–285). Regarding sexual activity (PISQ-IR item 1), only 2 patients (3.2%) reported being sexually active preoperatively, increasing slightly to 4 patients (6.3%) at both 3 and 6 months postoperatively.
Among the non-activity-related domain items, significant improvements were observed across multiple psychological subscales. Fear related to POP (item 3) decreased significantly from preoperative to 6-month postoperative assessment (3.3 ± 1.1 vs. 2.1 ± 1.3, p < 0.001), as well as from 3 to 6 months postoperatively (2.8 ± 1.4 vs. 2.0 ± 1.2, p = 0.016). Feelings of sexual inadequacy due to POP (item 5b) improved significantly between the preoperative and 6-month postoperative time points (2.2 ± 1.2 vs. 3.1 ± 1.2, p = 0.007). Similarly, anger related to the impact of POP on sexual life (item 5c) showed significant improvement from preoperative to 6 months (3.2 ± 0.9 vs. 3.7 ± 0.8, p = 0.021) and from 3 to 6 months postoperatively (3.6 ± 0.5 vs. 3.9 ± 0.3, p = 0.030).

Although the proportion of sexually active patients was low — consistent with the predominantly elderly cohort — the PISQ-IR non-activity-related domain revealed meaningful and statistically significant improvements in POP-related psychological burden. Specifically, fear of prolapse, feelings of sexual inferiority, and prolapse-related anger all diminished progressively over the 6-month postoperative period. These findings suggest that successful anatomical restoration through RASC alleviates the psychological distress associated with POP, even in patients who are not currently sexually active. The continued improvement observed between 3 and 6 months implies that psychological recovery follows a delayed trajectory relative to anatomical outcomes.

RASC contributes to improvement in sexual health-related quality of life even in elderly patients, primarily through reduction of POP-associated psychological burden. While the rate of sexual activity remained low in this cohort, significant amelioration of fear, sexual inadequacy, and anger related to POP was demonstrated. These results underscore the importance of incorporating patient-reported sexual well-being outcomes into the evaluation of surgical success following RASC.