Sexual Function Following Trocar-guided Mesh or Vaginal Native Tissue Repair in Recurrent Prolapse: A Randomized Controlled Trial


Alfredo L. Milani, MD, Obstetrics & Gynecology, Reinier de Graaf Group, PO Box 5011, Delft 2600 GA, The Netherlands. Tel: (31) 15 2604097; Fax: (31) 15 2603188; E-mail:,


Introduction.  Surgical treatment of pelvic organ prolapse (POP) affects sexual function. Generally, this results in improved sexual function, but deterioration is reported also.

Aim.  The purpose of this study was to evaluate and compare sexual function in patients with recurrent POP undergoing either a vaginal surgical repair with native tissue or a trocar-guided mesh insertion.

Methods.  Sexually active patients randomly assigned to either native tissue repair or trocar-guided mesh insertion, which had completed the pelvic organ prolapse (POP)/urinary incontinence sexual questionnaire (PISQ-12) both at baseline and at 12 months, were included. Total, subscale, and individual question analysis were performed. Logistic regression was used to identify factors that were independently associated with improvement/deterioration in total PISQ-12 scores.

Main Outcome Measures.  Primary outcome was sexual function at 12 months following surgery, measured by the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12). Secondary outcomes were the identification of factors independently associated with change in PISQ-12 scores and changes in individual PISQ-12 question scores.

Results.  Sixty patients were included; 32 in the mesh arm and 28 in the native tissue arm. At 12 months, PISQ-12 scores were not different in both treatment arms (34.3, standard deviation [SD] 6.7 vs. 34.7, SD 5.7), but improvement was detected in the native tissue arm, whereas PISQ-12 total score remained unchanged in the mesh arm. Deteriorations were observed in the behavioral/emotive subscale and partner-related items in the mesh arm. In the native tissue arm, significant improvements in the physical and partner-related subscales were observed. The presence of mesh exposure was independently associated with deterioration in total PISQ-12 score.

Conclusion.  At 12 months, PISQ-12 scores were not different in either treatment arm, but were affected differently by trocar-guided mesh insertion or by native tissue repair. Mesh exposure was independently associated with deterioration in sexual function. Milani AL, Withagen MIJ, The HS, Nedelcu-van der Wijk I, and Vierhout ME. Sexual function following trocar-guided mesh or vaginal native tissue repair in recurrent prolapse: A randomized controlled trial. J Sex Med 2011;8:2944–2953.