Body Image Improves Following Prolapse Repair and Impacts Sexual Function

Friday, October 25, 2024

2:34 PM – 2:38 PM EDT

Location: Liberty Ballroom (Meeting Level 4)

Figure 1. BIPOP Total Score Change from Baseline Over Time, Adjusted Means by Study Arm

Figure 2. Scatterplots and Regression of Improvement in Sexual Function and Improvement in Body Image by Study Visit/Month

Objectives: Body image (a woman’s perceptions and attitudes about her body) likely plays a role in pelvic organ prolapse treatment satisfaction and post-operative sexual function. The primary aim of this study was to describe changes in body image after surgical repair of vaginal vault prolapse. The secondary aim was to evaluate whether changes in sexual function are correlated with changes in body image.

Methods: This was a planned secondary analysis of a randomized three-arm trial comparing surgical approaches for vaginal vault prolapse. Women with symptomatic post-hysterectomy vault prolapse were randomized to: transvaginal native tissue repair (NTR), mesh placed abdominally (Sacrocolpopexy; SC), or mesh placed transvaginally (TVM). Body image was measured using the Body Image in Pelvic Organ Prolapse (BIPOP) questionnaire at baseline, 6-, 12-, 24- and 36-months. The BIPOP is a validated instrument assessing how pelvic organ prolapse affects body image. Sexual activity and function were measured using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA revised (PISQ-IR) at similar time points. Longitudinal analysis for changes from baseline in mean BIPOP score and the proportion of women who met a distribution-based estimate of the minimally important difference (MID) was performed using general mixed models for repeated measures. The same method was used to model changes in body image as a dependent variable for change in sexual function.

Results: A total of 335 women were included in the analysis: NTR =123, SC=107, TVM = 105. Mean age was 66.1±8.5 years and a majority (242, 72%) had Stage 3 prolapse. Baseline total and subscale BIPOP scores were not significantly different by treatment arm. All arms improved by 6-months, and this improvement was sustained to 36-months with no significant differences between the groups for change in BIPOP score (Figure 1) nor MID-equivalent improvement.
99(30%) women reported being sexually active at all visits, 131(39%) reported they were not sexually active at all visits, and the remainder changed sexual activity status throughout the study. There were no baseline differences in PISQ-IR scores amongst sexually active patients between groups (NTR, 54 women, 3.2+/-0.7; SC, 43 women, 3.3+/-0.7; TVM, 46 women, 3.1+/-0.6). In sexually active women, change in BIPOP and PISQ-IR scores were correlated at each visit (Figure 2) and a significant association between these measures (p < 0.001) remained after adjustment for baseline sexual function, site, age, surgical treatment arm, and baseline dyspareunia.

Conclusions: Body image improves following repair of vaginal vault prolapse, regardless of the surgical approach. Improvements in body image and sexual function are positively correlated among sexually active women.

Disclosure(s):

Uduak Andy, MD: No financial relationships to disclose

Kayla J. Nowak, BS: No financial relationships to disclose

Shawn Menefee, MD: No financial relationships to disclose

Julia K. Shinnick, MD: No financial relationships to disclose

Margaret Mueller, MD: No relevant disclosure to display

Abbigail Woll, MD: No financial relationships to disclose

Maria E. Florian-Rodriguez, MD: No financial relationships to disclose

Donna Mazloomdoost, MD: No financial relationships to disclose

Ryan Whitworth, PhD: No financial relationships to disclose

Presenting Author(s)

Uduak Andy, MD

Associate Professor
University of Pennsylvania School of Medicine
Philadelphia, Pennsylvania, United States

Disclosure(s): No financial relationships to disclose

Co-Author(s)

KN

Kayla J. Nowak, BS

Research Statistician
RTI International
Durham, North Carolina, United States

Disclosure(s): No financial relationships to disclose
Shawn Menefee, MD

Division Director
Kaiser Permanente
San Diego, California, United States

Disclosure(s): No financial relationships to disclose
Julia K. Shinnick, MD (she/her/hers)

Assistant Professor of Obstetrics and Gynecology
Brown University/Women & Infants Hospital
Providence, Rhode Island, United States

Disclosure(s): No financial relationships to disclose
MM

Margaret Mueller, MD

Associate Professor
University of Chicago Medicine
Glencoe, Illinois, United States

Disclosure(s): No relevant disclosure to display
AW

Abbigail Woll, MD

Fellow
Duke Urogynecology and Reconstructive Pelvic Surgery
Durham, North Carolina, United States

Disclosure(s): No financial relationships to disclose
MF

Maria E. Florian-Rodriguez, MD

Assistant Professor
UT Southwestern Medical Center
Dallas, Texas, United States

Disclosure(s): No financial relationships to disclose
Donna Mazloomdoost, MD (she/her/hers)

Medical Officer
NIH
Bethesda, Maryland, United States

Disclosure(s): No financial relationships to disclose
RW

Ryan Whitworth, PhD (he/him/his)

Senior Research Statistician
RTI International
Houston, Texas, United States

Disclosure(s): No financial relationships to disclose