Sexual Function and Clitoral Anatomy after Vaginal Surgery with and without Midurethral Sling
Year: 2026
Type: preprint
Abstract: STRUCTURED ABSTRACT Importance Sexual dysfunction can occur after midurethral sling (MUS) and transvaginal prolapse surgery. It remains unclear whether these procedures impact the clitoris, despite its role in sexual function and proximity to the MUS and vagina. Objectives To compare postoperative sexual function and clitoral features by MUS and vaginal surgery approach after transvaginal prolapse repair with/without concomitant MUS. Design Cross-sectional ancillary study of magnetic resonance imaging (MRI) and sexual function data from the Defining Mechanisms of Anterior Vaginal Wall Descent study. Setting Eight clinical sites in the US Pelvic Floor Disorders Network. Participants: 88 women with uterovaginal prolapse who underwent vaginal mesh hysteropexy or vaginal hysterectomy with uterosacral ligament suspension with/without MUS between 2013-2015. Data were analyzed between September 2021-June 2023. Exposures Between June 2014-May 2018, participants underwent pelvic MRI 30-42 months after surgery, or earlier if reoperation was desired. Sexual activity and function at baseline and 24-48-month follow-up were evaluated using the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Clitoral features were obtained from postoperative MRI-based 3-dimensional models. Main Outcomes and Measures PISQ-IR scores and clitoral features (size, position). Results Eighty-two women (median [range] age, 65 [47-79] years) were analyzed: 45 MUS (22 hysteropexy, 23 hysterectomy) and 37 No-MUS (19 hysteropexy, 18 hysterectomy). Postoperatively, 25 MUS, 12 No-MUS, 20 hysteropexy, and 17 hysterectomy patients were sexually active (SA). Overall, within the MUS and vaginal surgery groups, sexual function remained unchanged or improved (most PISQ-IR change from baseline scores were ≥0) among SA and NSA women. Among SA women after surgery, the MUS group (vs No-MUS) had a poorer PISQ-IR arousal/orgasm (SA-AO) score (median, 3.5 vs 4.3; P=.02). The hysteropexy group (vs hysterectomy) had less improvement in PISQ-IR SA-AO score (median, 0.0 vs 0.3; P=.01). Women with MUS (vs without) had a smaller clitoral glans thickness (median, 9.0 mm vs 10.0 mm; P=.008) and clitoral body volume (median, 2783.5 mm 3 vs 3587.4 mm 3 ; P=.01). Conclusions and Relevance SA women with MUS (vs without) or hysteropexy (vs hysterectomy) experienced poorer postoperative sexual function. MUS was linked to a smaller clitoris. Future studies should explore surgery-induced changes in clitoral anatomy and sexual function. KEY POINTS Question How do sexual function and clitoral anatomy differ by midurethral sling placement and vaginal surgery approach? Findings This cross-sectional study compared patient-reported sexual function outcomes and 30-42-month postoperative magnetic resonance imaging-based 3-dimensional clitoral models of 82 women after vaginal prolapse surgery with or without concomitant midurethral sling. Midurethral sling (vs no sling) and vaginal mesh hysteropexy (vs vaginal hysterectomy) were associated with poorer postoperative sexual function outcomes. Additionally, midurethral sling was associated with a smaller clitoral glans and body. Meaning Midurethral sling and vaginal mesh hysteropexy were associated with, and may adversely alter, postoperative sexual function and/or clitoral anatomy. VISUAL ABSTRACT/PROMOTIONAL IMAGE
Source: medRxiv
Institutions: Massachusetts Institute of Technology, Icahn School of Medicine at Mount Sinai, University of Pittsburgh, Magee-Womens Hospital, Albany Medical Center Hospital, The University of Texas Southwestern Medical Center, University of Pennsylvania, Brown University, University of California San Diego, Duke University, Duke Medical Center, University of Alabama at Birmingham, UAB Medicine, National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, RTI International
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: RCT of Hypnotherapy vs Tpolterodine for OAB: Voiding and Brain Activation Changes, G3635159340, Perioperative Pelvic Floor Rehab: A Rrandomized Trial, Pelvic Floor Disorders Network, Cleveland Clinic Clinical Site, Pelvic Floor Disorders Network Clinical Sites (U10), Pittsburgh Pelvic Floor Research Program, Brown/WIH Pelvic Floor Disorders Network Site, Pelvic Floor Disorders Network - Duke University Clinical Site, G9000118490, Impact of hyperglycemic memory on innate immune response to urogynecologic mesh, Mesh complications: The role of local mechanical stresses on tissue remodeling following mesh implantation, Overcoming complications of polypropylene prolapse meshes: Development of novel elastomeric membranes
OpenAlex ID: W7155057412