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Sir,

None of the 19 women who had recurrent prolapse at any vaginal site after they underwent Burch colposuspension was submitted for repeat surgery, although six women were symptomatic. Glazener and Cooper assumed that presumably these women were not sufficiently troubled by their condition. However, when we recommended a second operation for prolapse recurrence, the women generally refused because they did not want to run the risk of undergoing a second operation which could fail in the future as did the first one. This was the main reason for declining subsequent prolapse surgery. Unfortunately we did not include in our protocol any objective scoring measure of the women's self-assessment of success.

Twenty-four of the 35 women who had a Burch colposuspension were sexually active (the remaining 11 were sexually inactive). A posterior colporrhaphy was performed in 10 of 24 sexually active women and in 2 of 11 sexually inactive women. In other words, among the 12 women in the Burch arm who had a posterior colporrhaphy, 10 were sexually active and 2 were not. Two of 10 sexually active women who underwent posterior repair had mild (one woman) or severe (one woman) dyspareunia after surgery.

Post-operative vaginal lengths of the women who had the Burch operation according to whether they did or did not have a posterior repair were:

  • Posterior repair (n= 12): mean 7.2 (SD 1.4),

  • median 7 (range 5–9) cm.

  • No posterior repair (n= 23): mean 8.0 (SD 0.9),

  • median 8 (range 6–10) cm; P= 0.12 (Mann-Whitney U test).

Post-operative vaginal lengths of the sexually active women who had a posterior repair in both groups were:

  • Burch colposuspension (n= 10): mean 7.0 (SD 1.3),

  • median 7 (range 5–9) cm.

  • Anterior colporrhaphy (n= 23): mean 4.7 (SD 1.2),

  • median 5 (range 3–7) cm; P= 0.003 (Mann-Whitney U test).

These data imply that posterior repair causes dyspareunia mainly because it determines an over-narrowing of the vaginal introitus (and not an actual shortening of the vaginal length).