Surgery outperforms pessary in sexually active women with pelvic organ prolapse

Among sexually active women suffering from pelvic organ prolapse (POP), surgical interventions appear to yield better sexual function outcomes than pessary therapy, a recent study has found.

Researchers conducted a multicentre prospective comparative cohort study of 539 women with symptomatic POP, of whom 335 (mean age 62.8 years) were treated with pessary while 204 (mean age 59.3 years; p<0.001) underwent surgery. In the respective treatment groups, 64.2 percent (n=203) and 65.8 percent (n=127) said they were sexually active.

The primary study outcome of improvement in sexual function, as measured by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire IUGA-Revised (PISQ-IR), was assessed after 24 months of follow-up.

Among sexually active women, summary PISQ-IR scores significantly improved by a mean of 0.18 points from baseline (p<0.001). Such an effect was driven by improvements in the following domains: global quality rating (p=0.04), condition specific (p<0.001), and condition impact (p<0.001).

In comparison, no overall PISQ-IR improvements were reported in the pessary subgroup (p=0.33), though significant improvements were logged for the domains of global quality rating (p=0.009) and condition impact (p<0.001).

Comparing subgroups, surgery was found to be superior for sexually active women with POP, yielding significantly greater benefit overall (mean difference, –0.15; p<0.001) and in the domains of condition specific (mean difference, –0.19; p=0.02) and condition impact (mean difference, –0.48; p<0.001).

In contrast, pessary and surgery yielded comparable sexual function outcomes in POP women who were sexually inactive.