title: Sexual function following outside-in transobturator midurethral sling procedures: a prospective study.
abstract: OBJECTIVE
  Midurethral tapes have shown favorable clinical outcomes for treating stress urinary incontinence (SUI), but the effects of outside-in transobturator midurethral sling procedures (TOT) on women's sexual function are unclear. We hypothesized that TOT might improve sexual function in women with SUI and therefore conducted this study to investigate sexual function alteration among women who underwent TOT for urodynamic stress incontinence (USI).
  
  
  METHODS
  From November 2009 to October 2010, we recruited 102 women scheduled for correction of USI by TOT procedures in a tertiary hospital. In addition to urogynecologic history, pelvic examination, and urodynamic testing, participants were required to complete three validated questionnaires: Incontinence Impact Questionnaire (IIQ-7), Urogenital Distress Inventory (UDI-6), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Preoperative and postoperative results of these validated questionnaires were evaluated.
  
  
  RESULTS
  Eighty-three patients comprising 57 sexually active and 26 sexually inactive patients participated in the 12-month evaluation. Of the 83 patients undergoing TOT, six (7.2 %) had postoperative SUI 12 months postoperatively. Both UDI-6 and IIQ-7 scores were significantly improved postoperatively. The total PISQ-12 score did not change significantly after surgery. Postoperatively, the individual incontinence-related items of the PISQ-12 improved, but climax with intercourse and negative emotional reactions during intercourse worsened (both with p <0.001). There was a negative correlation between SUI-related items on UDI-6 and those on PISQ-12 preoperatively.
  
  
  CONCLUSIONS
  TOT procedures for correcting USI had favorable clinical outcomes and did not alter overall sexual function; however, climax during sexual intercourse and emotional response worsened postoperatively.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, 5, Fu-Shin Street, Kweishan, Taoyuan, Taiwan 333. ccjoliang@cgmh.org.tw
authors.forename: Ching-Chung
authors.initials: CC
authors.lastname: Liang
authors.forename: Ling-Hong
authors.initials: LH
authors.lastname: Tseng
authors.forename: Tsia-Shu
authors.initials: TS
authors.lastname: Lo
authors.forename: Yi-Hao
authors.initials: YH
authors.lastname: Lin
authors.forename: Yu-Jr
authors.initials: YJ
authors.lastname: Lin
authors.forename: Shuenn-Dhy
authors.initials: SD
authors.lastname: Chang
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013519:Urogenital Surgical Procedures / Q000009:adverse effects