Changes in Vaginal Accommodation and Sexual Function Following Vaginal Reconstructive Surgery

Objectives: The study objectives were to determine changes in vaginal length and caliber after vaginal surgery and correlate them with sexual function, evaluate changes in sexual function following vaginal reconstructive surgery and identify barriers preventing sexual activity and factors interfering with sexual activity. We also sought to validate a Visual Analog Scale (VAS) form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12).;Methods: This prospective study measured vaginal length and caliber before, immediately after, and at 5- to 8-week after vaginal reconstructive surgery. The PISQ-12 in its original Likert form as well as a VAF format was administered preoperatively and 6 months postoperatively for evaluation of sexual function.;Results: Ninety-two women were enrolled (mean age, 64 years); 44 (47.8%) were sexually active. The most common procedure performed was Mayo-McCall culdoplasty in 85 women (92.4%). Fourteen (15.2%) had intentional vaginal shortening and narrowing (coning). Mean vaginal length changed from 10.4 cm preoperatively to 8.7 cm at 5- to 8-week follow-up in women not having coning. Mean vaginal caliber changed from 3.2 cm to 2.8 cm. Overall, sexual function scores, as measured by the PISQ-12 in Likert and VAS forms, were unchanged preoperatively and postoperatively, and vaginal measurements were not correlated with sexual function. The most common factor affecting sexual activity pre- and postoperatively was partner problems. A high correlation was seen between the Likert and VAS format of the PISQ-12 in both the pre- and postoperative setting.;Conclusions: Vaginal shortening and narrowing occurred after vaginal surgery; sexual function was unchanged. The VAS for of the PISQ-12 is both a reliable and reproducible instrument for measuring sexual function.