(Poster 134) Patient Reflections on Decision-Making Post Colpocleisis: A Qualitative Analysis

Objectives: There is a lack of data around patients’ decision-making when pursuing surgery for pelvic organ prolapse (POP). The decision to undergo obliterative vaginal repair resulting in the loss of coital function implies the risk of regret. We sought to understand patients’ perspectives around decision-making and satisfaction with colpocleisis retrospectively.

Methods: This study employed a qualitative, inductive thematic analysis approach to explore the experiences of patients who underwent obliterative vaginal procedures for POP. Semi-structured interviews, guided by a protocol developed with clinical and methodological expertise, were conducted with 17 purposively sampled patients from a single rural tertiary center between 2022 and 2024. Interviews explored prolapse experience, surgical team interaction, counseling, sexual activity, and post-operative regret. Interviews were recorded, transcribed, de-identified, and coded line-by-line to facilitate theme development through iterative review until thematic saturation was reached.

Results: Seventeen women who had undergone obliterative vaginal repairs in the prior two years participated in one-on-one virtual interviews with a single interviewer and thematic saturation was reached. The average age of participants was 78 years-old, all were White and English-speaking, and nine had partners, although none were sexually active.
Five themes emerged related to the decision to undergo obliterative repair: 1) Practical approach, 2) Patient autonomy, 3) Patient goals, 4) Strong influence of surgeon counseling and previous experiences with POP treatments and 5) Positive outcomes without regret.
Practical approach means patients choosing the least invasive, most durable surgery to improve their quality of life, which outweighed their loss of coital function. Patients felt this decision was their own choice and they felt well-informed about their other options, exercising their autonomy. Patient goals refer to the valued activities and/or function that motivated them to have this surgery over other treatment options. The strong influence of surgeon counseling was consistently described, and patients' previous experiences with POP treatment shaped their surgical expectations and decision. Finally, patients were happy with their surgical outcomes and free from regret from loss of coital function, although some expressed unease about the changes in their anatomy post vaginal closure.

Conclusions: The decision to undergo vaginal closure is unique to each patient, but with common themes. Among a group of patients who were not sexually active at the time of their surgical decision, colpocleisis was associated with high satisfaction without regret. Surgeon counseling is highly influential on patient evaluation of their options and anticipated outcomes. Surgeons should screen patients for a sense of loss or unease with the anatomic changes of an obliterative repair and set clear expectations about post-operative outcomes related to other pelvic floor disorders.
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Table. Themes which emerged from interviewing women around their decision-making process when choosing to undergo obliterative repairs with supporting quotations.