Genital and subjective sexual response in women after restorative proctocolectomy with ileal pouch anal anastomosis--a prospective clinical trial.
BACKGROUND
Sexual dysfunction after ileo pouch anal anastomosis (IPAA) is common. The most systematic physical reaction to sexual stimulation is an increase in vaginal vasocongestion. Genital response can be assessed by vaginal pulse amplitude (VPA) using vaginal photoplethysmography.


OBJECTIVE
To assess whether restorative proctocolectomy with IPAA is associated with autonomic pelvic nerve damage and changes in subjective indices of sexual function in women.


METHODS
Female patients undergoing IPAA between April 2004 and January 2006 were included. During sexual stimulation (visual and vibrotactile) changes in vaginal vasocongestion were measured by vaginal photoplethysmography. Concurrently, quality of life (SF-36) and sexual functioning (FSFI, FSDS) were assessed using validated questionnaires.


METHODS
Primary endpoint was difference in VPA pre- and postoperatively. Secondary endpoints were differences in feelings of sexual arousal and estimated lubrication pre- and postoperatively and difference in psychological and sexual functioning pre-and postoperatively.


RESULTS
Eleven patients were included. For eight patients (median age 37 [22-49 years]) pre- and postoperative data were collected. VPA analysis showed a significant reduction in vaginal vasocongestion during sexual stimulation postoperatively, P = 0.012. Subjective sexual arousal and estimated lubrication during the experiment, reported psychological and sexual functioning pre- and postoperative were not different.


CONCLUSIONS
Vaginal vasocongestion after IPAA was significantly reduced in this small study; indicating that IPAA in women might possibly be associated with autonomic pelvic nerve damage or partial devascularization of the vagina. Subjectively reported sexual arousal, estimated lubrication, psychological and sexual functioning were not diminished. Future research should focus on the possible advantage of a full close rectal dissection in these patients.
Vlug
Malaika S
MS
University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
Laan
Ellen T
ET
van Lunsen
Rik H W
RH
van Koperen
Paul J
PJ
Polle
Sebastiaan W
SW
Bemelman
Willem A
WA
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000523:psychology; D039021:Colonic Pouches / Q000009:adverse effects*; D003627:Data Interpretation, Statistical; D005260:Female; D005836:Genitalia, Female / Q000098:blood supply; D006305:Health Status Indicators; D006801:Humans; D008153:Lubrication; D008875:Middle Aged; D017156:Photoplethysmography / Q000295:instrumentation / Q000379:methods; D011184:Postoperative Period; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D019529:Sexuality / Q000502:physiology* / Q000523:psychology; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D014621:Vagina / Q000098:blood supply*; D055815:Young Adult