Pelvic Floor Disorders and Female Sexuality II: Pelvic Organ Prolapse

Pelvic organ prolapse (POP) and its treatment may affect overall female sexuality dimensions: (1) physical (e.g., discomfort/obstruction/dyspareunia due to POP, associated urinary/anorectal incontinence or urinary tract infection, associated comorbidities, local complications after surgery or pessary use); (2) psychological (e.g., less attractive/sexy due to body image impairment, anxiety/fear); (3) cultural (femininity, identity, feeling old); and (4) social (partner-related concerns for both partnered and unpartnered women). Consequently, both sexual activity (e.g., inactivity due to POP or after treatment, lower sexual frequency than desired) and sexual function (e.g., low desire, arousal, less satisfaction, orgasm difficulties) may be impaired. Unfortunately, women’s sexual life is not systematically evaluated in the clinical practice, although the sexual assessment before and after treatments through standardized terminology and qualitative and quantitative validated instruments is recommended by the international guidelines. Frequently, conservative treatment, the use of pessary, or surgical treatment for POP may benefit female sexuality through the improvement of POP symptoms. However, a multidisciplinary biopsychological approach based on extended PLISSIT model should be recommended to provide a comprehensive assessment and treatment of the complex sexual issues presented by those women.