Spanish Language Counseling Tool for Postoperative Return to Sexual Activity

Objectives: Sexual function following pelvic reconstructive surgery is important to patients. Current surgeon counseling practices about the return to sexual activity postoperatively vary widely. Prior work regarding this topic has focused on English-speaking patients. We aimed to create a Spanish language standardized counseling tool for return to sexual activity after pelvic reconstructive surgery based on patient experiences and feedback.

Methods: An expert panel created an initial counseling tool in English based on the conceptual framework previously developed in a rigorous qualitative analysis of women's experience of their first sexual encounters after pelvic reconstructive surgery. This tool was first refined through cognitive patients interviews and then translated into Spanish by a native Spanish speaker and content expert in gynecologic surgery. Back translation was performed by a second native Spanish speaker to ensure quality and accuracy of translation. Women with a primary language of Spanish who had previously undergone reconstructive surgery for pelvic organ prolapse (POP) and/or urinary incontinence (UI) and returned to sexual activity were recruited from three clinical sites for participation in cognitive interviews. Interviews were conducted in English for participants proficient in both English and Spanish, or by a bilingual study team member for patients who spoke only Spanish. Participants were read the Spanish language counseling statements and asked to describe their meaning, suggest any necessary changes and rate their importance. Summaries of the ongoing cognitive interviews were periodically presented to the working group for discussion and the instrument was revised accordingly. Interviews were conducted until no new substantive comments were made. We anticipated that 20 interviews would be adequate for saturation.

Results: A total of 19 cognitive patient interviews were conducted and 3 rounds of modifications were made to arrive at the final standardized counseling tool (Figure 1). Modifications were primarily focused on vocabulary and grammar edits for clarity. There were some differences in preferred Spanish terminology based on dialect differences in patients' region of origin. All statements were consistently rated as highly important or very important by study participants.

Conclusions: We validated a novel, Spanish language patient-centered counseling tool regarding the return to sexual activity after pelvic reconstructive surgery based on a previously established conceptual framework and cognitive patient interviews. This tool addresses an important outcome for patients after surgery and offers surgeons a concise, high-value counseling tool for Spanish-speaking patients. Further study on the impact of this standardized tool utilization on the postoperative patient experience is needed.