title: Women's sexual dysfunction: a review of the "surgical landscape".
abstract: OBJECTIVE
  To assess the impact of urogynaecologic surgery for stress urinary incontinence, oncologic pelvic surgery, and hysterectomy on women's overall sexual health.
  
  
  METHODS
  We used Ovid and PubMed (updated January 2006) to conduct a literature electronic search on MEDLINE that included peer-reviewed English-language articles. We analysed all studies identified that provided any functional outcome data about urogynaecologic surgery for the treatment of stress urinary incontinence, radical cystectomy for bladder cancer, surgery for rectal cancer, and hysterectomy. Because of the substantial heterogeneity of outcome measures and follow-up intervals in case studies, we did not apply meta-analytic techniques to the data.
  
  
  RESULTS
  Most studies showed that either urogynaecologic or oncologic pelvic surgery may have a significant impact on women's sexual health. Epidemiology varied widely among the studies and reported either improvement or impairment of postoperative sexual functioning, due to different definitions, study designs, and small cohorts of patients. An increasing number of studies have prospectively examined this issue and have found often controversial findings about the role of pelvic and perineal surgery in women's sexual health.
  
  
  CONCLUSIONS
  Although numerous controversies exist, data demonstrate an overall positive impact of the surgical repair for stress urinary incontinence on resolution of coital incontinence, coupled with an improvement of overall sexual life. In contrast, genitourinary and rectal cancers are commonly associated with treatment-related sexual dysfunction, but few studies rigorously assessed women's postoperative sexual function after major oncologic pelvic surgery. Data about the functional outcome after hysterectomy are often contradictory. Adequately powered prospective clinical trials are needed.
authors.affiliation: Department of Urology, Scientific Institute H. San Raffaele, Milan, Italy. salonia.andrea@hsr.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Federico
authors.initials: F
authors.lastname: Dehò
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Zanni
authors.forename: Patrizo
authors.initials: P
authors.lastname: Rigatti
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
mesh_terms: D005260:Female; D005836:Genitalia, Female / Q000503:physiopathology*; D006801:Humans; D013519:Urogenital Surgical Procedures / Q000009:adverse effects