Relationship of postoperative vaginal anatomy and sexual function: a systematic review with meta-analysis

Shunaha Kim-Fine, Danielle D. Antosh, Ethan M. Balk, Kate V. Meriwether, Gregg Kanter, Alexis A. Dieter, Mamta M. Mamik, Meadow Good, Ruchira Singh, Alexandriah Alas, Mohamed Foda, David D. Rahn, Rebecca G. Rogers

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Introduction and hypothesis: This was a planned secondary analysis of a systematic review that described sexual function outcomes following pelvic organ prolapse (POP) surgery. We aimed to describe the relationship of pre- and postoperative vaginal anatomic measures with sexual function outcomes. Data Sources included the Medline, Embase, and databases from inception to April 2018. Methods: The original systematic review included prospective, comparative studies that reported sexual function outcomes before and following POP surgery. Studies were extracted for population characteristics, sexual function outcomes, and vaginal anatomy, including total vaginal length (TVL) and genital hiatus. By meta-regression, we analyzed associations across studies between vaginal anatomic measurements and sexual function using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12) and dyspareunia outcomes. Results: We screened 3124 abstracts and identified 74 papers representing 67 original studies. Among these, 14 studies reported TVL and PISQ-12 outcomes. Nine studies reported TVL and dyspareunia outcomes, eight studies reported GH and PISQ-12 outcomes, and seven studies reported GH and dyspareunia outcomes. We found no associations between anatomic measures and PISQ-12 or dyspareunia, although, we found a statistically significant association found between preoperative TVL and change in PISQ-12. Conclusion: Across studies, the evidence does not support an association between vaginal anatomy and either validated, condition-specific sexual function questionnaires or dyspareunia. However, no study has directly analyzed these associations in the setting of pelvic floor reconstructive surgery.

Original languageEnglish (US)
Pages (from-to)2125-2134
Number of pages10
JournalInternational Urogynecology Journal
Issue number8
StatePublished - Aug 2021


  • Dyspareunia
  • PISQ-12
  • Pelvic organ prolapse
  • Surgery
  • Systematic review
  • Vaginal anatomy

ASJC Scopus subject areas

  • Urology
  • Obstetrics and Gynecology


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