Ventral rectoplexy helps recover sexual function

By Lynda Williams

Laparoscopic ventral rectoplexy (LVR) may reduce sexual dysfunction in women with complex posterior floor prolapse, say researchers who found many patients appreciated having postoperative investigation of their symptoms.

The majority of sexually active patients who underwent LVR for complex rectocoele were willing to complete the Brief Index Sexual Functioning for Women (BISF-W) questionnaire, report Guillaume Meurette (University Hospital of Nantes - Hôtel Dieu, France) and co-authors.

This "confirms the acceptability of including an assessment of female sexual function in clinical practice," they say, noting that embarrassment and the perception that sexual dysfunction is not a medical problem means that around half of women do not mention problems to their doctor.

The team assessed the impact of LVR on sexual function and dyspareunia in 41 women aged an average of 61.7 years who underwent standard (n=23) or robotic-assisted (n=15) LVR between 2009 and 2010. Surgery was converted to an open procedure in three patients.

The patients all had symptomatic complex rectocoele, defined as a prolapse larger than 3 cm in diameter, or associated enterocoele or internal rectal prolapse, and 68.4% of patients had concurrent cystocoele.

Importantly, no new cases of dyspareunia were recorded after surgery, contrasting with reports of new symptoms following perineal or vaginal approaches to rectocoele correction, Meurette et al say.

Twenty-two (57.9%) patients were sexually active before surgery. Of these, 18 (47.4%) were sexually active at an average of 7 months after surgery, and therefore eligible to complete the BISF-W questionnaire. The BISF-W assesses hormonal, neurologic, psychologic, and environmental factors affecting sexual activity, including desire, arousal, frequency, and dysfunction, the team explains.

Just three women refused to complete the survey, finding it intrusive. Twelve (63%) patients were pleased to answer the questionnaire and stated they believed "sexual activity to be important or very important."

The 12 patients who completed the BISF-W had scores indicating that their comfort levels during sexual activity did not significantly differ from that of the general French population (32.2 vs 26.7).

While acknowledging that the study did not compare pre- and postoperative BISF-W scores due to practical and psychologic reasons, the researchers say: "Nevertheless, the extensive postoperative evaluation has demonstrated that LVR is not detrimental to sexual function."

They conclude: "It appears that surgery whether laparoscopic, robotic or open improves sexual function in sexually active female patients treated for rectocele. This should help clinicians when obtaining consent for this form of surgery."

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