Rachel Pope1, Prakash Ganesh2, Chisomo Chalamanda3, William Nundwe3, Jeffrey Wilkinson4. 1. Baylor College of Medicine, Department of Obstetrics and Gynecology, Division of Global Women's Health, Houston, TX, USA. Electronic address: rachel.pope@bcm.edu. 2. International Training and Education Center for Health (I-TECH), University of Washington, Seattle, WA, USA. 3. Fistula Care Center, Lilongwe, Malawi. 4. Baylor College of Medicine, Department of Obstetrics and Gynecology, Division of Global Women's Health, Houston, TX, USA.
Abstract
INTRODUCTION: Women with vesicovaginal fistulas often experience a disruption in their normal lives, including sexual relationships, because of urinary incontinence. AIM: Although surgery repairs the urinary leakage, it is not known how surgery might affect sexual function positively or negatively. METHODS: 119 women were enrolled before surgery and interviewed including a revised Female Sexual Distress Scale (FSDS-R) score and examined for vaginal length, caliber, and pelvic floor strength. MAIN OUTCOME MEASURES: Approximately one third of women return to normal sexual function after repair, although a minority experience de novo dysfunction. RESULTS: 115 women completed follow-up 6 to 12 months after surgery. Approximately one third (35.6%, n = 41) stated that intercourse had returned to the way it was before a fistula. Forty-four women (40%) report sexual problems after the fistula developed; 15% due to incontinence and 23.5% due to pain. Fourteen women (12.2%) stated that they experienced problems with intercourse since surgery; 50% due to incontinence during intercourse and 50% due to pain. Nineteen of the participants (16.5%) scored in the range of dysfunction as assessed by the FSDS-R tool after surgery. Fibrosis did not significantly change and was not found to be associated with sexual function. Vaginal length was found to decrease on average by 5 mm. Of the variables examined, the factors statistically significantly associated with dysfunction included a larger-size fistula as determined by the Goh classification (> 3 cm diameter) and decreased vaginal caliber. FSDS-R scores drastically decreased from before to after surgery and the reason for problems with intercourse changed from leaking urine before surgery to lack of partner and concern for HIV infection. CLINICAL IMPLICATIONS: Women with large fistulas and decreased vaginal calibers are at high risk for sexual dysfunction and should be counseled appropriately preoperatively and offered surgical and medical interventions. STRENGTHS & LIMITATIONS: Physical parameters were combined with qualitative interviews and FSDS-R scores to contextualize sexual health before and after surgery. Limitation is the brief follow-up of 6-12 months after surgery as many women were still abstaining from sexual activity. CONCLUSION: Sexual dysfunction is a complex issue for women with obstetric fistulas; although many women do not continue to experience problems, several need ongoing counseling and treatment. Pope R, Ganesh P, Chalamanda C, et al. Sexual Function Before and After Vesicovaginal Fistula Repair. J Sex Med 2018;15:1125-1132.
INTRODUCTION:Women with vesicovaginal fistulas often experience a disruption in their normal lives, including sexual relationships, because of urinary incontinence. AIM: Although surgery repairs the urinary leakage, it is not known how surgery might affect sexual function positively or negatively. METHODS: 119 women were enrolled before surgery and interviewed including a revised Female Sexual Distress Scale (FSDS-R) score and examined for vaginal length, caliber, and pelvic floor strength. MAIN OUTCOME MEASURES: Approximately one third of women return to normal sexual function after repair, although a minority experience de novo dysfunction. RESULTS: 115 women completed follow-up 6 to 12 months after surgery. Approximately one third (35.6%, n = 41) stated that intercourse had returned to the way it was before a fistula. Forty-four women (40%) report sexual problems after the fistula developed; 15% due to incontinence and 23.5% due to pain. Fourteen women (12.2%) stated that they experienced problems with intercourse since surgery; 50% due to incontinence during intercourse and 50% due to pain. Nineteen of the participants (16.5%) scored in the range of dysfunction as assessed by the FSDS-R tool after surgery. Fibrosis did not significantly change and was not found to be associated with sexual function. Vaginal length was found to decrease on average by 5 mm. Of the variables examined, the factors statistically significantly associated with dysfunction included a larger-size fistula as determined by the Goh classification (> 3 cm diameter) and decreased vaginal caliber. FSDS-R scores drastically decreased from before to after surgery and the reason for problems with intercourse changed from leaking urine before surgery to lack of partner and concern for HIV infection. CLINICAL IMPLICATIONS: Women with large fistulas and decreased vaginal calibers are at high risk for sexual dysfunction and should be counseled appropriately preoperatively and offered surgical and medical interventions. STRENGTHS & LIMITATIONS: Physical parameters were combined with qualitative interviews and FSDS-R scores to contextualize sexual health before and after surgery. Limitation is the brief follow-up of 6-12 months after surgery as many women were still abstaining from sexual activity. CONCLUSION:Sexual dysfunction is a complex issue for women with obstetric fistulas; although many women do not continue to experience problems, several need ongoing counseling and treatment. Pope R, Ganesh P, Chalamanda C, et al. Sexual Function Before and After Vesicovaginal Fistula Repair. J Sex Med 2018;15:1125-1132.