(Poster 89) Comorbidities and Sexual Function Outcomes After Pelvic Organ Prolapse Repair

Objectives: Our primary aim was to assess sexual function in women before and after pelvic organ prolapse (POP) surgery using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) at 6-12 months. Our secondary aim was to evaluate the effects of cardiovascular and metabolic disease, Charlson Comorbidity Index (CCI) scores, and psychiatric disorders on sexual function scores, orgasm (question 2), and sexual pain (question 5).

Methods: This retrospective review included 395 patients enrolled in a surgical outcome database at a single institution from 2019-2022. Patients were excluded if they did not complete both pre- and postoperative PISQ-12 questionnaires, with postoperative responses collected at least 6 months post-surgery. Charlson Comorbidity Scores were grouped into 0-2 (no to mild) and 3-6 (moderate to severe) comorbidity burdens. Orgasm presence was based on a response of ‘usually’ or ‘always’ for PISQ-12 question 2 (Do you climax (have an orgasm) when having sexual intercourse with your partner?) Presence of sexual pain was based on a response of ‘sometimes,’ ‘usually’ or ‘always’ for PISQ-12 question 5 (Do you feel pain during sexual intercourse?). Continuous outcomes were compared using a two-sample t-test, and a generalized multivariate linear model controlled for comorbidities.

Results: Thirty-one patients had complete long term sexual function data, with a mean postoperative follow-up of 9.7 months and a mean age of 63 years. Of these, 81% were White, 61% had cardiovascular or metabolic disease, and 26% had psychiatric disorders. Twelve patients (39%) had a CCI lower score of 0-2, and 19 (61%) had a higher CCI score. Patients with cardiovascular disease were older (mean age = 67 vs. 57, p=0.03). Those with a better/lower CCI reported more baseline sexual pain (4 vs. 0, p=0.03).

Overall, mean PISQ-12 scores were16.26 preoperatively and 14.97 postoperatively. (p=0.3). Postoperatively, fewer patients reported orgasm (32.3% compared to 54.8% preop) and more reported dyspareunia (19.4% compared to 12.9% preop), but this was not statistically significant. The multivariate model showed no significant impact of comorbidities or CCI on sexual function or pain. However, patients with psychiatric disorders had higher postoperative orgasm scores compared to those without (mean = 2.6 vs. 1.6, Δβ = 1.01, 95% CI [0.04-1.98], p = 0.05), although the change in scores between the 2 groups were not statistically significant.

Conclusions: Overall sexual function based on PISQ-12 scores were similar after surgery, while fewer patients reported orgasm, and more reported sexual pain. These changes were not influenced by cardiovascular or metabolic disease or CCI scores. Having a psychiatric disorder had a marginally significant positive effect on orgasm scores postoperatively. Larger studies are needed to further explore this effect.

Table 1: Overall Summary of Outcomes
Table 2: Psychiatric Disorders and Postoperative Orgasm Scores, Multivariable Model