Sexual dysfunction is very common and affects around 50% of women. Stress urinary incontinence is associated with an increased prevalence of sexual dysfunction. The most common surgical procedures used for management of stress incontinence include TVT, Burch colposuspension and autologous fascial sling. These procedures are associated with a general improvement in coital incontinence however, common complications include persistent pain and dyspareunia. This can have an adverse effect on sexual function and therefore a detrimental impact on patients' quality of life. 

The aim of this study was to evaluate the effect of different surgeries for stress urinary incontinence on sexual function in women.

This retrospective analysis included 90 women who had undergone surgery for stress urinary incontinence at a tertiary unit in the UK over a 10-year period. 30 women were selected from each surgical cohort. A database of pre-completed validated pelvic floor questionnaires: Electronic Personal Assessment Questionnaire (ePAQ), was used to analyse pre-operative and postoperative results at 3-12 months on average from each cohort.  Answers to forty-two questions in the sexual function dimension of the ePAQ were explored.  Data was analysed in accordance with four ePAQ domains within the sexual function dimension: urinary, vaginal, dyspareunia and general sex life. Domain scores and impact factor were calculated. Data was collated and analysis completed using paired T-test to compare pre- and post-operative values. A one-way analysis of variance (ANOVA) test was used to compare general sex life scores between the three different procedures.

The mean age of patients in our study was 50.9 years. The autologous fascial sling and colposuspension cohort had a mean follow up of 9 months and TVT had a mean follow up of 3.4 months postoperatively.

The level of sexual activity post-operatively did not change for the three cohorts of patients. All three procedures showed an improvement in the impact of urinary symptoms on sexual activity (p = <0.05) Dyspareunia following both TVT and slings was shown to have significantly improved in the post operative period however the results were not statistically significant within the colposuspension group (p = 0.09). On analysis of the general sex life domain, there was improvement noted following autologous fascial sling (p=0.005) and colposuspension (p=<0.001).  

One-way ANOVA revealed a statistically significant effect of the choice of SUI procedure on symptoms of sexual satisfaction, partner sexual avoidance and impact on quality of life, F(2,51)=7.117, p<0.001.

Our findings show that sexual function does improve after surgery for stress urinary incontinence. The choice of surgery, however, may have a different impact on sexual function and therefore, patient quality of life. It is therefore important that women are adequately counselled regarding this during the consent process. Further research using larger study numbers and a longer follow up period is needed to analyse this key area.

Kershaw, V. and Jha, S. (2021) ‘Impact of incontinence on female sexual function’, Sexual Function and Pelvic Floor Dysfunction, pp. 23–34.
Glass Clark, S.M. et al. (2020) ‘Effect of surgery for stress incontinence on female sexual function’, Obstetrics & Gynecology, 135(2), pp. 352–360.
Kershaw V, Jha S. Female sexual dysfunction. The Obstetrician & Gynaecologist2022;24:12–23