title: The effects of prolapse surgery on vaginal wall sensibility, vaginal vasocongestion, and sexual function: a prospective single centre study.
abstract: OBJECTIVE
  Prolapse surgery has been shown to positively alter body image and decrease pelvic floor symptoms, hereby possibly improving sexual function. However, the surgical trauma itself may adversely affect sexual function, by damaging vaginal innervation and vascularization. The aim of this study is to evaluate the effects of vaginal prolapse surgery on vaginal vasocongestion, vaginal wall sensibility, and sexual function.
  
  
  METHODS
  A prospective study was performed, including patients scheduled for vaginal prolapse surgery. Participants underwent measurements before and 6 months after surgery, during non-erotic and erotic visual stimuli. Measurements were performed using a vaginal combi-probe which includes vaginal photoplethysmography to assess vaginal pulse amplitude (VPA) (representing vaginal vasocongestion), and four pulse-generating electrodes to measure vaginal wall sensibility (representing vaginal innervation). Sexual function was assessed using validated questionnaires (FSFI, FSDS-R, SSAQ).
  
  
  RESULTS
  Twenty-nine women were included, 24 (83%) completed the 6 months follow-up. VPA analysis showed a significant reduction in vaginal vasocongestion during sexual stimulation post-operatively (pre-op 2.4 mV (SD 2.5) vs. post-op 1.7 mV (SD 2.4), P = 0.05). Vaginal wall sensibility in the cranial posterior vaginal wall was significantly reduced after surgery (pre-op 13.3 mA vs. post-op 17.5 mA, P < 0.05). Vaginal wall sensibility in the other three locations was not affected by surgery. Sexual function as assessed with questionnaires, was not significantly affected.
  
  
  CONCLUSIONS
  Prolapse surgery negatively impacted levels of vaginal vasocongestion during erotic stimuli as well as vaginal wall sensibility in the cranial posterior wall. Future studies are needed to tease out if these changes in physiological factors are relevant for subjective sexual function.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Marielle M E
authors.initials: MM
authors.lastname: Lakeman
authors.forename: Ellen
authors.initials: E
authors.lastname: Laan
authors.forename: Jan-Paul W R
authors.initials: JP
authors.lastname: Roovers
mesh_terms: D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011446:Prospective Studies; D012677:Sensation; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D019529:Sexuality / Q000502:physiology*; D011795:Surveys and Questionnaires; D014621:Vagina / Q000098:blood supply* / Q000502:physiology*
keywords: pelvic organ prolapse; physiological; prolapse surgery; sexual dysfunction; sexual function