No evidence of association between native tissue vault suspension and risk of pelvic pain or sexual dysfunction

Hysterectomy is suspected of increasing risk of subsequent pelvic organ prolapse (POP). In attempt to prevent this, several suspension methods during hysterectomy on benign indication are used as a prophylactic procedure. However, possible complications to the use of prophylactic vaginal vault suspension to prevent POP are not fully investigated. We aimed to elucidate prophylactic vaginal vault suspension as a possible cause for pelvic pain and sexual dysfunction.

We included all women registered with a total hysterectomy on benign indication and registered with a suspension method or specifically no suspension in the nationwide Danish Hysterectomy and Hysteroscopy Database (DHHD) between 10 May 2012 and 4 September 2013 (N = 3999). A postal questionnaire on pelvic pain and sexual dysfunction was sent to women 25.8 (range 23.8-28.4) months after hysterectomy. Questions were selected from a previous study as well as from the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). We used independent samples t-tests and χ2-tests for univariate analyses. In multivariable analyses, we used log-binomial - and linear regression models adjusted for risk factors of pelvic pain and sexual dysfunction, respectively.

The response rate was 60.3% (N = 2412). Of the respondents, 88.8% (N = 2143) were registered with a suspension method and 11.2% (N = 269) were registered with specifically no suspension. Overall, pelvic pain of any kind was reported in 24.3% (N = 576) of the respondents. In adjusted log-binomial regression, suspension did not increase risk of pelvic pain compared to no suspension (RR 0.92; 95% CI 0.75 to 1.14; p-value 0.45). In adjusted linear regression, suspension was significantly associated with less degree of sexual dysfunction (regression coefficient -0.92; 95% CI -1.70 to -0.14; p-value 0.02).

In women undergoing prophylactic vaginal vault suspension during hysterectomy, we found less sexual dysfunction and no evidence of increased risk of pelvic pain compared to women with no vaginal vault suspension.

European journal of obstetrics, gynecology, and reproductive biology. 2018 Apr 20 [Epub ahead of print]

Lisbeth Bonde, Ida C Püschl, Lars Alling Møller, Bent Ottesen, Nina Breinegaard, Helga Gimbel

Department of Obstetrics and Gynecology, Nykoebing Falster Hospital, Nykoebing Falster, Denmark; University of Southern Denmark, Odense, Denmark. Electronic address: ., Department of Obstetrics and Gynecology, Zealand University Hospital, Roskilde, Denmark., Department of Gynecology, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark., Section of Biostatistics, University of Copenhagen, Denmark., University of Southern Denmark, Odense, Denmark; Department of Obstetrics and Gynecology, Zealand University Hospital, Roskilde, Denmark.

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