title: The effects of vaginal prolapse surgery using synthetic mesh on vaginal wall sensibility, vaginal vasocongestion, and sexual function: a prospective single-center study.
abstract: BACKGROUND
  Vaginal mesh surgery in patients with pelvic organ prolapse (POP) has been associated with sexual dysfunction. Implantation of synthetic mesh might damage vaginal innervation and vascularization, which could cause sexual dysfunction.
  
  
  OBJECTIVE
  We aim to evaluate the effects of vaginal mesh surgery on vaginal vasocongestion and vaginal wall sensibility in patients with recurrent POP.
  
  
  METHODS
  A prospective study was performed among patients with previous native tissue repair, scheduled for vaginal mesh surgery. Measurements were performed before and 6 months after surgery, during nonerotic and erotic visual stimuli, using a validated vaginal combi-probe.
  
  
  METHODS
  The combi-probe involves 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 (Female Sexual Function Index, Female Sexual Distress Scale-Revised, and Subjective sexual arousal and affect questionnaire).
  
  
  RESULTS
  Sixteen women were included, 14 completed the 6-month follow-up visit. Vaginal vasocongestion under erotic conditions did not significantly alter after mesh implantation. Vaginal wall sensibility of the distal posterior wall was significantly increased after mesh surgery (preoperative threshold 6.3 mA vs. postoperative 3.4 mA, P = 0.03). Sexual function as assessed with questionnaires was not significantly affected.
  
  
  CONCLUSIONS
  In women with a history of vaginal prolapse surgery, vaginal mesh surgery did not decrease vaginal vasocongestion or vaginal wall sensibility. Vaginal vasocongestion prior to mesh surgery appeared to be lower than that of women never operated on. Apparently, native tissue repair decreased preoperative vaginal vasocongestion levels to such extent that subsequent mesh surgery had no additional detrimental effect. Our findings should be interpreted cautiously. Replication of the findings in future studies is essential.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Maaike A
authors.initials: MA
authors.lastname: Weber
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: D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012725:Sexual Behavior; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000523:psychology / Q000601:surgery*; D014621:Vagina / Q000502:physiology* / Q000601:surgery
keywords: Mesh Surgery; Pelvic Organ Prolapse; Physiological; Sexual Function