Surgery outperforms pessary for sexually active women in pelvic organ prolapse

Among sexually active women with pelvic organ prolapse (POP), surgery leads to better sexual function outcomes than pessary therapy, a recent study has found.

Researchers conducted a multicentre prospective comparative cohort study of 539 women enrolled from 22 Dutch hospitals. Nearly two-thirds (n=335; 62.2 percent) were treated with pessary, while the rest (n=204; 37.8 percent) underwent surgery. In the respective groups, 64.2 percent (n=203) and 65.8 percent (n=127) were sexually active.

The study primary outcome was improvement in female sexual function over 24 months, as measured using the Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Scores were compared between treatment arms.

Sexually active women in the surgery group saw a significant improvement in the overall PISQ-IR score relative to comparators in the pessary group (mean difference, –0.15, 95 percent confidence interval [CI], –0.23 to –0.08; p<0.001). This effect was driven mostly by better scores in the condition-specific (mean difference, –0.19, 95 percent CI, –0.35 to –0.03; p=0.02) and condition-impact (mean difference, –0.48, 95 percent CI, –0.69 to –0.28; p<0.001) domains in the surgery arm.

In contrast, pessary and surgery performed statistically comparably in sexually inactive women.

“Sexual function in sexually active women with POP is superior if surgery is performed compared to pessary therapy. The improvement mainly depends on the decreased impact of POP symptoms on sexual functioning,” the researchers said.

“Sexually active women who clearly express that their sexual functioning is bothered by POP-related symptoms should be counselled that surgery results in more remarkable improvement,” they added.