Pelvic organ prolapse (POP) significantly impacts women's quality of life, with symptoms including pelvic pain and dyspareunia. This study aims to evaluate the improvement of pelvic pain, including low backache, pelvic pain, and dyspareunia, following pelvic floor reconstructive surgery.

A prospective cohort study was conducted at the Aga Khan Hospital Karachi, enrolling 35 women with POP. Patients were followed from February 2022 to January 2023, assessing outcomes through validated questionnaires (POPDI-6, FSFI) preoperatively and at 1, 3, and 6 months postoperatively. The study focused on the impact of surgery on pelvic pain and dyspareunia, with an analysis of potential factors influencing pre-operative pain severity.

The mean POPDI-6 scores significantly decreased from 59.05±45.15 pre-operatively to 7.14±15.54 at 6 months postoperatively, indicating a significant improvement in pelvic pain (p<0.001). Dyspareunia prevalence reduced from 60.0% pre-operatively to 14.3% six months after surgery. Diabetic patients were more likely to experience severe pre-operative pain (p=0.007). However, contrasting evidence from Ulrich et al. suggests that specific surgical techniques, like levator plication, may increase postoperative dyspareunia rates.

The demographic characteristics of 35 patients undergoing surgery for pelvic organ prolapse (POP), the analysis focused on comparing individuals with moderate (n=25) and severe (n=10)

 pre-operative pain. The mean age for patients with moderate pain was 55.96 years (SD=10.57), while those with severe pain had a mean age of 50.60 years (SD=7.33), with no significant difference between the groups (p=0.153). Body mass index (BMI) also showed no significant difference (p=0.119), although there was a trend suggesting that diabetic patients were more likely to experience severe pre-operative pain (p=0.007). Hypertension exhibited a trend, with all hypertensive patients experiencing moderate pain (p=0.109). Other demographic factors, pre-operative staging, category of POPDI-6, and duration of POPDI-6 did not show significant differences between the two pain severity groups. These findings suggest a potential association between diabetes and pre-operative pain in the context of POP surgery (TABLE 1).
Patients undergoing pelvic organ prolapse surgery, the study assessed the improvement and severity of pelvic pain based on the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) scores at different time points (Pre-Operative, 1st Month, 3rd Month, and 6th Month). The mean POPDI-6 scores decreased progressively from 59.05±45.15 pre-operatively to 7.14±15.54 at the 6th Month, indicating a significant improvement in pelvic pain. The majority of patients experienced improvement, with 80.0% reporting improvement at the 6th Month. In terms of pain severity, a notable shift towards lower severity was observed, with 65.7% of patients reporting no pain at the 6th Month, compared to 0.0% pre-operatively. This suggests that pelvic pain significantly improved following surgery, demonstrating the effectiveness of the intervention (TABLE 2).
The provided data represents the prevalence of dyspareunia before surgery (pre-operative) and six months after surgery. Before surgery, 60.0% (21 cases) reported experiencing dyspareunia, while at the six-month post-operative mark, the prevalence decreased to 14.3% (5 cases). This suggests a notable reduction in dyspareunia following the surgical intervention (Figure 1).
In the multivariate regression analysis predicting the change in postoperative pain at 6 months, several variables were assessed. Age exhibited a regression coefficient of 1.339 (95% CI: 0.320 to 5.613) with a non-significant p-value of 0.689. The presence of moderate pain showed a coefficient of 0.706 (95% CI: 0.155 to 3.224) with a p-value of 0.653. The Body Mass Index (BMI) had a coefficient of 1.313 (95% CI: 0.270 to 6.372) with a non-significant p-value of 0.736. Other variables, including post-menopausal status, pre-operative Stage II, duration of POPDI, diabetes mellitus, hypertension, and improvement at 1 month, also demonstrated coefficients and confidence intervals (TABLE 3).

The findings from this study highlight the effectiveness of pelvic organ prolapse reconstructive surgery in significantly improving pelvic pain and reducing the incidence of dyspareunia. Moreover, the observed association between diabetes and increased pre-operative pain severity emphasizes the need for a comprehensive approach to patient care. Future studies should aim to explore the long-term benefits of surgical interventions and the impact of comorbidities on outcomes to further enhance treatment strategies for women suffering from pelvic organ prolapse.

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