Since more than thirty years back the mid-urethral sling (MUS) has been used to cure women who suffer from stress urinary incontinence (SUI). Due to last years discussion and doubt about the long-term efficacy and safety we decided to investigate sexual function and risk of pelvic pain for women who had a MUS inserted more than ten years ago.
Our main objective was to examine and assess dyspareunia and pelvic pain after insertion of a MUS due to SUI.

All women who 2006-2010 went through MUS-surgery in Sweden (n=4894) were identified via the Swedish National Quality Register of Gynecological Surgery. Questionnaires were sent to all eligible women in November 2020 (n=4348). By June 2021 the study closed. The two main techniques for inserting the MUS, the retropubic (TVT) technique and the transobturator technique (TVT-O or TOT) were represented by 1562 and 859 women respectively. Nine cases of absorbable slings and 125 cases of mini-slings were also included in the analysis.
Questions being asked concerned general gynecological background, bladder function and dyspareunia, the Pelvic Organ Prolapse/ Urinary Incontinence Sexual Questionnaire short form (PISQ-12) and Urinary Distress Inventory (UDI-6).
Dyspareunia and pelvic pain were defined as primary outcomes.

A total of 2555 (59%) women returned the questionnaires. From this group we excluded women who did not give information concerning childbirth (n=53). Hence, left being 2502 participants. Mean age was 64 years (SD 11) and childbirth was reported by 96% with a median parity of 2. Mean BMI at time for surgery was 26. At the ten-year follow-up 80% reported being in a better or much better condition than before the surgery. 
Among the responding women 71% answered the question concerning dyspareunia and 77% answered whether suffering from pelvic pain or not. In the group that reported better or much better condition after surgery the rate of dyspareunia was 13%, and 14% admitted pelvic pain. In the group that reported stable or worsened condition after surgery 30% reported dyspareunia and 31% reported pelvic pain, respectively.

In a multivariate logistic regression analysis of dyspareunia we found significant difference between women reporting an improved condition ten years after surgery compared with women who reported stable or worsened condition (odds ratio (OR) 2.9 %, 95% CI 1.9-4.4). 
Additionally, pelvic pain turned out to increase with unsuccessful MUS-surgery (OR 1.7 95% CI 1.2-2.3). 
Interestingly, there was no difference in dyspareunia when comparing the different techniques, TVT to TVT-O/ TOT (17% vs 15%, OR 0.9, 95% CI 0.9-1.2). Equally important the same was true for pelvic pain (17% vs 18%, OR 1.1, 95% CI 0.8-1.5).

Ten to fourteen years after having a MUS inserted due to SUI the risk of dyspareunia seems to be higher than normal (1). But, the risk is associated with the outcome of the earlier performed MUS-surgery and depending on whether women consider their condition improved or not. The same applies regarding pelvic pain.
The main techniques, TVT and TVT-O/ TOT do not differ in terms of dyspareunia and pelvic pain.

A successful MUS-surgery due to stress urinary incontinence decrease the risk of developing dyspareunia and pelvic pain, also after many years. The technique used for insertion of the MUS is insignificant regarding dyspareunia and pelvic pain.

Mitchell, K. R., et al. (2017). "Painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey." Bjog 124(11): 1689-1697

Continence 2S2 (2022) 100406
DOI: 10.1016/j.cont.2022.100406