Improved body image after uterovaginal prolapse surgery with or without hysterectomy

Abstract

Introduction and hypothesis: The objective was to compare body image and sexual activity and function changes up to 3 years after sacrospinous ligament fixation with graft hysteropexy or vaginal hysterectomy with uterosacral ligament suspension (hysterectomy).

Methods: This was a planned secondary analysis of a multi-center randomized trial of women undergoing prolapse repair with mesh hysteropexy versus hysterectomy. Women were masked to intervention. The modified Body Image Scale (BIS), sexual activity status, and Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR) scores were reported at baseline and 1.5, 6, 12, 18, 24, and 36 months after surgery. We compared mean BIS and PISQ-IR scores, the proportion of women whose BIS scores met a distribution-based estimate of the minimally important difference (MID), and sexual activity status. Comparisons were analyzed with linear and logistic repeated measures models adjusted for site, intervention, visit, and intervention by visit interaction.

Results: Eighty-eight women underwent mesh hysteropexy; 87 underwent hysterectomy. Women were similar with regard to baseline characteristics, mean age 65.9 ± 7.3 years, and most had stage III or IV prolapse (81%). Baseline mean BIS scores were not significantly different, improved in both groups by 1.5 months, and were sustained through 36 months with no differences between groups (all p > 0.05). The estimated BIS MID was 3; and by 36 months, more women in the mesh hysteropexy group achieved the MID than in the hysterectomy group (62% vs 44%, p = 0.04). The makeup of the sexually active cohort changed throughout the study, making function comparisons difficult.

Conclusions: Body image improves following prolapse surgery whether or not hysterectomy is performed or transvaginal mesh is used at the time of repair; sexual activity status changes over time following prolapse surgery.

Keywords: Body image; Hysteropexy; Mesh; Pelvic organ prolapse; Sexual function.

Figure 1:

BIS Change from Baseline - Adjusted Means^{a a} Adjusted means, mean difference, 95% confidence intervals, and p-values comparing the change from baseline of continuous outcomes of the intervention arms are obtained from general linear mixed models adjusted for site, intervention, visit, interaction between intervention and visit, while modeling the within participant correlations across visits with an auto-regressive order 1 (i.e. AR(1)). Models were fitted using all participants with at least 1 post-baseline visit (N=88 for Hysteropexy and N=84 for Hysterectomy).

Figure 2:

PISQ-IR Change from Baseline of Sexually Active - Adjusted Means^{a a} Adjusted means, mean difference, 95% confidence intervals, and p-values comparing the change from baseline of continuous outcomes of the intervention arms are obtained from general linear mixed models adjusted for site, intervention, visit, interaction between intervention and visit, while modeling the within participant correlations across visits with an auto-regressive order 1 (i.e. AR(1)). Models were fitted using all participants with at least 1 baseline and 1 post-baseline visit that have indicated Sexually Active (N=29 for Hysteropexy and N=35 for Hysterectomy).