Women with complicated pelvic floor disorders combined or not with urinary incontinence (UI) appear to have decreased rates of sexual satisfaction. Lower urinary tract symptoms are an independent risk factor for decreased female sexual function [1]. The information regarding pelvic organ prolapse (POP) or overactive bladder symptoms (OAB) on women’s sexual function is often absent or inadequate. The sexual history in the clinical assessment is usually skipped both by the physicians and patients. The Female Sexual Function Index (FSFI) is considered the "gold-standard" tool widely used to assess and quantify sexual function in clinical practice and research. Sexual dysfunction usually motivates symptomatic women to ask for medical advice even within the context of POP management. 
The present study was designed to determine the effect of overactive bladder and pelvic organ prolapse on sexual activity and women's  quality of sexual life. As control groups were used healthy women and women who had benign gynecologic surgery other than for POP or UI.

This is a cross-sectional study performed in an Urogynecology unit of a Tertiary Academic Hospital. Consecutive women prolapse without OAB (POP group) and with OAB (POP-OAB group) symptoms who had undergone native tissue POP surgery were asked to participate in the study. Post-operatively, all women in the POP and the POP-OAB group filled in the Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), Sexual Quality of Life Questionnaire – Female (SQOL-F) and FSFI. In addition, all participants underwent clinical examination with POP-Q classification, standardized cough test, and full urodynamics investigation. For control, we enrolled a group of healthy asymptomatic women who did not have any intervention (Healthy group) and women who had undergone gynaecological surgery in the same department but not prolapse surgery or oncologic surgery (Gyn group). Any woman from the control groups with incontinence symptoms was excluded (ICIQ-UI SF ≠ 0). Informed oral consent was obtained as appropriately by all the participants, and the Hospital's Ethics Committee approved the study protocol . All data were stored and analysed in Microsoft EXCEL. Paired t-test χ2, and ANOVA were used to compare the results among the groups; p<0.05 was considered statistically significant.

A total of 82 subjects were included. The POP group and POP-OAB group comprised 19 and 21 participants, respectively. The Healthy  and Benign Gynae surgery groups were 22 and 20 subjects. Demographic data such as age and body mass index (BMI), parity, birth weight, instrumental birth, and smoking were collected from the study subjects (see Table 1). Table 2 shows the scores of the given questionnaires. The mean summary scores obtained from the ICIQ-SF, the FSFI, the SQOL-F, and the PISQ-12 questionnaires in each group of patients are described in Table 2. ANOVA was performed to show any difference among the groups. In all questionnaires, the ANOVA showed statistically significant differences between the groups. In the FSFI, the Healthy group and Gyn groups had significantly higher scores  than the POP group (p=0.015 and 0.049 respectively). In the SQOL-F, the Healthy group had a significantly higher score compared to the POP group (p=0.002). Women with POP-OAB had significantly higher ICIQ-UI scores (p<0.001), whereas no differences were found in these two groups regarding the PISQ-12 questionnaire.

Female sexual dysfunction is a common condition that immensely affects the quality of life. Sexual life has a fundamental role during the woman’s reproductive life, and pelvic floor disorders may deteriorate women's sexual activity and sexual quality of women. Unfortunately, there are scanty data about the post-operative sexual life of women who had POP surgery.
In the present study, several assumptions can be elicited from the comparisons of the four groups. First, even though the POP group women are older, both FSFI and SQOL-F scores are severely affected, an outcome indicating the effect of pelvic floor surgery on the sexual life of these patients. Further comparisons between the three non-healthy groups reveal that (a) the POP-OAB group scores similarly to the Gyn group in FSFI and the SQOL-F questionnaires, and (b) the POP-OAB group scores higher, although not statistically significant, in the PISQ-12. The last comparison appears to be severely affected by partner-related issues and marginally by behavioral-emotive issues. Finally, the consecutive enrollment of the subject in this study may create a bias regarding the presence and the performance of the partner in the POP group.

Even after surgical correction, pelvic organ prolapse appears to significantly affect the sexual activity and the quality of sexual life in women. However, the presence of OAB symptoms in this cohort of patients was not an aggravating factor for the deterioration in sexual life.

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Continence 2S2 (2022) 100381
DOI: 10.1016/j.cont.2022.100381