• Female Sexual Function;
  • Incontinence;
  • Transobturator Suburethral (TOT);
  • Tension-Free Vaginal Tape Obturator (TVT-O)


Introduction.  The transobturator suburethral tape (TOT) and tension-free vaginal tape obturator (TVT-O) procedures are relatively new incontinence treatment procedures. Studies on the influence on sexual function as a result of these procedures are limited.

Aim.  The influence of TOT or TVT-O for the surgical treatment of stress urinary incontinence (SUI) on female sexual function.

Methods.  We evaluated 77 sexually active patients after TVT-O (N = 34, mean age 53.2 years) and TOT (OB-TAPE, Porges) (N = 44, mean age 52.0 years) placement for SUI based on the responses to a mailed questionnaire 3 months after the operation.

Main Outcome Measure.  Difference in postoperative sexual complaints related to the TVT-O (inside-out) and TOT (outside-in) procedure.

Results.  Postoperative TOT and TVT-O: There was almost no difference in frequency of sexual intercourse and an improvement of the continence during intercourse; continence was reported in 33 patients (42.3%) before and 67 patients (78.4%) after operation. The appreciation of sexual intercourse was improved in 15 patients (19.2%) and worsened in eight patients (10.3%). Postoperative TVT-O vs. TOT: No difference was seen in lost of lubrication, clitoral tumescence reduction, and clitoral sensibility reduction between both procedures. Pain because of vaginal narrowing was seen significantly more in the TOT procedure group.

Conclusion.  Overall, in this study, the technique of TOT gave rise to more sexual dysfunction than TVT-O. However, because of the successful outcome on incontinence, both procedures had, overall, a positive effect on sexual function. The cause of significant more pain during intercourse as a result of vaginal narrowing in the TOT procedure requires further investigation. Like other studies, this study demonstrated that incontinence surgery can have a positive and negative outcome on sexual function. It is important to put this issue in the informed consent. Elzevier HW, Putter H, Delaere KPJ, Venema PL, Lycklama à Nijeholt AAB, and Pelger RCM. Female sexual function after surgery for stress urinary incontinence: Transobturator suburethral tape vs. tension-free vaginal tape obturator. J Sex Med 2008;5:400–406.