Improvement of Pelvic Pain Associated with Pelvic Organ Prolapse After Reconstructive Surgery

Improvement of Pelvic Pain Associated with Pelvic Organ Prolapse After Reconstructive Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Improvement of Pelvic Pain Associated with Pelvic Organ Prolapse After Reconstructive Surgery Samia Aijaz, Novera Chughtai, Urooj Kashif, Summera Malik This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8747588/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Pelvic organ prolapse (POP) significantly impacts women's quality of life, with symptoms including pelvic pain and dyspareunia. This study aims to evaluate the improvement of pelvic pain, including low backache, pelvic pain, and dyspareunia, following pelvic floor reconstructive surgery. Methods A prospective cohort study was conducted at the Aga Khan Hospital Karachi, enrolling 35 women with POP. Patients were followed from February 2022 to January 2023, assessing outcomes through validated questionnaires (POPDI-6, FSFI) preoperatively and at 1, 3, and 6 months postoperatively. The study focused on the impact of surgery on pelvic pain and dyspareunia, with an analysis of potential factors influencing pre-operative pain severity. Results The mean POPDI-6 scores significantly decreased from 59.05 ± 45.15 pre-operatively to 7.14 ± 15.54 at 6 months postoperatively, indicating a significant improvement in pelvic pain (p < 0.001). Dyspareunia prevalence reduced from 60.0% pre-operatively to 14.3% six months after surgery. Diabetic patients were more likely to experience severe pre-operative pain (p = 0.007). However, contrasting evidence from Ulrich et al. suggests that specific surgical techniques, like levator plication, may increase postoperative dyspareunia rates. Conclusion Pelvic floor reconstructive surgery effectively improves pelvic pain and reduces dyspareunia in women with POP. The study highlights the need for personalized treatment approaches, considering individual patient characteristics and comorbidities, such as diabetes, which may influence pain severity and surgical outcomes. Pelvic Organ Prolapse Reconstructive Surgery Pelvic Pain Dyspareunia Quality of Life Figures Figure 1 INTRODUCTION Pelvic organ prolapse (POP) occurs when the pelvic floor no longer supports the proper positioning of the pelvic organs, resulting in the descent of organs through the vagina [ 1 ] It is a common gynecologic condition that is strongly associated with childbirth, aging and the menopause [ 1 ]. Women with POP present a variety of symptoms (vaginal, bladder, bowel and sexual) that greatly affect their daily activities and health-related quality of life (HRQoL) [ 2 , 3 ] Pelvic organ prolapse (POP) negatively affects the quality of lives of thousands of women globally. Approximately half of parous women are affected by pelvic organ prolapse while one-fourth of these are symptomatic [ 4 ]. About 19% of these women have to undergo surgery for POP in their lifetime [ 5 ]. Pelvic Organ Prolapse is diagnosed with the help of clinical findings including the symptoms related to the “downward displacement” of a pelvic organ [ 4 ]. The clinical evidence of POP is evaluated using the Pelvic Organ Prolapse Quantification (POP-Q) System [ 6 ]. Clinical evidence of POP does not always correlate with the presence of POP symptoms, as up to 80% of women may be asymptomatic [ 5 ]. Women with pelvic organ prolapse (POP) below the hymen are more frequently presented with bulging symptoms. A common symptom reported by patients with prolapse is the occurrence of pain, which is often attributed to pain in the lower back, abdomen, or pelvic areas. Although lower abdominal and pelvic pain have been found to be highly prevalent among women, little is known about the association between advanced prolapse and specific patient reported pain symptoms [ 7 , 8 ]. One prospective cohort study investigating the symptoms and severity of prolapse reported that 44% of the subjects complained of pelvic pain, and of those subjects experiencing pain, 69% reported that the pain had a negative impact on their quality of life [ 9 ]. Whereas, other investigators have demonstrated that women with a more advanced stage of prolapse report less pelvic and low back pain, thus failing to identify a strong correlation between prolapse and pain symptoms [ 10 ]. Even though backache is associated with POP yet there is only limited evidence that reconstructive surgery improves pelvic pain postoperatively[ 11 ]The Disability-adjusted life years (DALYs) revealed that patients lost years due to symptomatic POP including backache [ 12 ]. In a study by Garcia, the long-term outcomes and complications were assessed postoperatively. It was revealed that postoperatively, constipation and dyspareunia rates worsened, nevertheless, pelvic pain was improved [ 13 ]. Many surgeons counsel women regarding the potential negative effect of prolapse surgery on sexual function, including de novo dyspareunia. However, there is emerging evidence to suggest that, although de novo dyspareunia occurs in approximately 10% of women after native tissue pelvic organ prolapse repair, there are some women who have sexual function improvement [ 14 , 15 ]. In this study we examined the improvement of pelvic pain (low backache, pelvic pain, dyspareunia) in women with pelvic organ prolapse (POP) before and after pelvic floor reconstructive surgery. METHODS All women were diagnosed, treated, and followed up as cases of pelvic organ prolapse in the Gynecology & Obstetrics Department of Aga Khan Hospital Karachi. The cohort study was conducted from February 2022 to July 2022, and the study period ended in January 2023 with the 6-month follow-up of the last study subjects. The sampling methodology employed was non-probability convenience sampling. The eligibility criteria included women diagnosed with pelvic organ prolapse who were surgically treated at AKUH, women over the age of 18, and those with Pelvic Organ Prolapse stage II, III, or IV based on the POP Q classification. Excluded were those who did not give informed written consent. To examine the improvement of pelvic pain (low backache, pelvic pain, dyspareunia) before and after pelvic floor reconstructive surgery, a minimum sample size of 35 women with pelvic organ prolapse was needed to achieve 80% power at a 95% confidence level, assuming a mean decrement of 0.9 in pain [ 16 ]. Operational definitions and outcome variables included low backache related to pelvic organ prolapse, characterized as a complaint of low, sacral (or ‘‘menstrual-like’’) backache temporally associated with vaginal POP and relief when the prolapse was reduced. Dyspareunia was defined as the complaint of persistent or recurrent pain or discomfort associated with attempted or complete vaginal penetration, including both superficial (introital) dyspareunia and deep dyspareunia. Pelvic Organ Prolapse was defined as when one or more of the organs in the pelvis slip down from their normal position and bulge into the vagina. Institutional ethical review committee approval was obtained for the study. Participation was voluntary, with patients having the right to not participate or terminate their participation at any time. Consent was sought for participation. Patient identity was treated as confidential, and while study data might be published for scientific purposes, no identifiable references to patients were made. Data or records obtained from participation might be inspected by the AKU Ethical review committee, with study IDs used to protect patient confidentiality. Upon receiving approval from the AKUH Ethics committee, the study commenced with the enrollment of 35 patients meeting the inclusion criteria. All patients were subjected to validated questionnaires of POPDI 6 scale of PFDI 20, FSFI pain-related questions 17,18,19 domain 6 of dyspareunia, and a Likert scale for determining low backache at baseline. They were followed up over a period of 6 months with objective assessments at 1, 3, and 6 months postoperatively during routine follow-up visits. At baseline, data were collected using a predefined structured proforma, including socio-demographic factors (age, marital status), stage of POP, duration of POP, and category of POP. Diagnosis and grading of POP for each patient were made using the Pelvic Organ Prolapse Quantification staging inventory (POP-Q) [ 17 ]. All data were entered and analyzed using the Statistical Package for Social Sciences (SPSS version 25). Means and standard deviations were calculated for all continuous variables, including patient age and body mass index. For categorical variables, such as pain severity, grading of POP, marital status, frequency, and percentages were calculated. Preoperative versus postoperative comparisons were made using chi-square tests and independent student t-tests, with a P-value of < 0.05 considered statistically significant. RESULTS The demographic characteristics of 35 patients undergoing surgery for pelvic organ prolapse (POP), the analysis focused on comparing individuals with moderate (n=25) and severe (n=10) pre-operative pain. The mean age for patients with moderate pain was 55.96 years (SD=10.57), while those with severe pain had a mean age of 50.60 years (SD=7.33), with no significant difference between the groups (p=0.153). Body mass index (BMI) also showed no significant difference (p=0.119), although there was a trend suggesting that diabetic patients were more likely to experience severe pre-operative pain (p=0.007). Hypertension exhibited a trend, with all hypertensive patients experiencing moderate pain (p=0.109). Other demographic factors, pre-operative staging, category of POPDI-6, and duration of POPDI-6 did not show significant differences between the two pain severity groups. These findings suggest a potential association between diabetes and pre-operative pain in the context of POP surgery (TABLE 1). Table I: Demographic Characteristics of the Patient (n=35) Variable Pre-Operative Pain P-Value Moderate (n=25) Severe (n=10) Age , Mean ± SD 55.96 ± 10.57 50.60 ± 7.33 0.153 35-50 Years 7 (53.8) 6 (46.2) 0.077 >50 Years 18 (81.8) 4 (18.2) Body Mass Index , Mean ± SD 23.24 ± 2.58 21.70 ± 2.54 0.119 18-24 kg/m 2 16 (64.0) 9 (36.0) 0.129 >24 kg/m 2 9 (90.0) 1 (10.0) Marital Status Married 25 (71.4) 10 (28.6) N/A Diabetes Mellitus Diabetic 3 (33.3) 6 (66.7) 0.007 Non-Diabetic 22 (84.6) 4 (15.4) Hypertension Hypertensive 6 (100.0) 0 (0.0) 0.109 Non-Hypertensive 19 (65.5) 10 (34.5) Parity , Mean ± SD 3.28 ± 0.93 3.20 ± 1.54 0.852 Mode of Delivery Vaginal Delivery 25 (71.4) 10 (28.6) N/A Menopausal Status Pre-Menopausal 18 (75.0) 6 (25.0) 0.380 Post Menopausal 7 (63.6) 4 (36.4) Pre-Operative Staging Stage II 2 (66.7) 1 (33.3) 0.493 Stage III 13 (81.3) 3 (18.8) Stage IV 10 (62.5) 6 (37.5) Category of POP Cystocele, apical prolapse, rectocele 1 (100.0) 0 (0.0) 0.401 Apical prolapse 2 (66.7) 1 (33.3) Apical prolapse, rectocele 0 (0.0) 1 (100.0) Cystocele, apical prolapse 13 (81.3) 16 (18.8) Cystocele, apical prolapse, rectocele 9 (64.3) 5 (35.7) Duration of POP , Mean ± SD 1.72 ± 0.45 1.60 ± 0.51 0.504 Applied Chi-Square, Fisher’s Exact and Independent t-test **POP (Pelvic Organ Prolapse) **SD (Standard Deviation) Patients undergoing pelvic organ prolapse surgery, the study assessed the improvement and severity of pelvic pain based on the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) scores at different time points (Pre-Operative, 1st Month, 3rd Month, and 6th Month). The mean POPDI-6 scores decreased progressively from 59.05±45.15 pre-operatively to 7.14±15.54 at the 6th Month, indicating a significant improvement in pelvic pain. The majority of patients experienced improvement, with 80.0% reporting improvement at the 6th Month. In terms of pain severity, a notable shift towards lower severity was observed, with 65.7% of patients reporting no pain at the 6th Month, compared to 0.0% pre-operatively. This suggests that pelvic pain significantly improved following surgery, demonstrating the effectiveness of the intervention (TABLE 2). TABLE 2: Improvement and Severity of Pelvic Pain based POPDI-6 (n=35) Pre-Operativ e 1 ST Month 3 RD Month 6 TH Month POPDI-6 59.05±45.15 36.42±28.01 12.14±19.52 7.14±15.54 Improvement Yes 0 (0.0) 8 (22.9) 24 (68.6) 28 (80.0) No 35 (100.0) 27 (77.1) 11 (31.4) 7 (20.0) Pain Severity No Pain 0 (0.0) 4 (11.4) 13 (37.1) 23 (65.7) Mild 0 (0.0) 31 (88.6) 21 (60.0) 12 (34.3) Moderate 25 (71.4) 0 (0.0) 01 (2.9) 0 (0.0) Severe 10 (28.6) 0 (0.0) 0 (0.0) 0 (0.0) **POPDI (Pelvic Organ Prolapse Distress Inventory) The provided data represents the prevalence of dyspareunia before surgery (pre-operative) and six months after surgery. Before surgery, 60.0% (21 cases) reported experiencing dyspareunia, while at the six-month post-operative mark, the prevalence decreased to 14.3% (5 cases). This suggests a notable reduction in dyspareunia following the surgical intervention (Figure 1). In the multivariate regression analysis predicting the change in postoperative pain at 6 months, several variables were assessed. Age exhibited a regression coefficient of 1.339 (95% CI: 0.320 to 5.613) with a non-significant p-value of 0.689. The presence of moderate pain showed a coefficient of 0.706 (95% CI: 0.155 to 3.224) with a p-value of 0.653. The Body Mass Index (BMI) had a coefficient of 1.313 (95% CI: 0.270 to 6.372) with a non-significant p-value of 0.736. Other variables, including post-menopausal status, pre-operative Stage II, duration of POPDI, diabetes mellitus, hypertension, and improvement at 1 month, also demonstrated coefficients and confidence intervals (TABLE 3). Table 3: Multivariate Regression Analysis Predicting Change in Postoperative Pain at 6 Months (n=35) Variables Regression 95% CI P-Value Age 1.339 0.320 ---- 5.613 0.689 Moderate Pain 0.706 0.155 ---- 3.224 0.653 Body Mass Index 1.313 0.270 ---- 6.372 0.736 Post Menopausal 0.875 0.197 ---- 3.895 0.861 Pre-Operative Stage-II 0.833 0.062 ---- 11.27 0.282 Duration of POPDI 1.143 0.257 ---- 5.087 0.861 Diabetes Mellitus 3.393 0.703 ---- 16.38 0.128 Hypertension 0.950 0.148 ---- 6.115 0.957 Improvement at 1 Month 0.567 0.095 ---- 3.363 0.532 **POPDI (Pelvic Organ Prolapse Distress Inventory) DISCUSSION The study aimed to evaluate the efficacy of pelvic organ prolapse reconstructive surgery in improving pelvic pain and dyspareunia among affected women. The results clearly demonstrated a significant improvement in pelvic pain post-surgery, with a notable reduction in the prevalence of dyspareunia, and highlighted a potential association between diabetes and pre-operative pain severity. These findings are pivotal in understanding the impact of pelvic reconstructive surgery on improving quality of life among women with pelvic organ prolapse. Pelvic pain associated with pelvic organ prolapse is a debilitating condition that significantly affects women's quality of life. Our study findings corroborate with existing literature [ 16 , 18 , 19 ], indicating that pelvic organ prolapse surgery substantially reduces pelvic pain. The POPDI-6 scores, which measure the distress and impact of pelvic organ prolapse on quality of life, showed a dramatic decrease from pre-operative scores to those recorded six months post-operatively. This improvement is consistent with previous research [ 19 , 20 ], suggesting that reconstructive surgery not only resolves anatomical defects but also ameliorates pain and discomfort associated with the condition. The effectiveness of surgical intervention in alleviating pelvic pain highlights the importance of surgical management in the treatment algorithm for pelvic organ prolapse. Dyspareunia, or painful intercourse, is another significant concern for women with pelvic organ prolapse, impacting sexual function and overall well-being. Our study observed a substantial decrease in the prevalence of dyspareunia from 60.0% pre-operatively to 14.3% at the six-month follow-up. This reduction highlights the potential of pelvic organ prolapse surgery to improve sexual health and intimacy experiences for women. It aligns with the growing body of evidence suggesting that addressing the physical aspects of pelvic organ prolapse can lead to improvements in sexual function [ 21 , 22 ]. However, contrasting evidence from Ulrich et al. [ 19 ] suggests that while surgical intervention generally improves vaginal and sexual matters scores, certain techniques such as levator plication may be associated with increased rates of postoperative dyspareunia and decreased sexual function. This highlights the complexity of surgical outcomes on sexual function, indicating that while overall trends suggest improvement, specific surgical techniques may influence individual outcomes differently. An intriguing aspect of our analysis was the identification of a potential link between diabetes and the severity of pre-operative pain in patients with pelvic organ prolapse. Diabetic patients were more likely to report severe pain, suggesting that diabetes may influence the severity of disease. This association could be attributed to the neurologic changes and increased susceptibility to infections seen in diabetic individuals, potentially worsening the symptoms of pelvic organ prolapse. Some evidence revealed association between diabetes and pelvic organ prolapse [ 23 , 24 ]. Although further research is needed to elucidate the mechanisms underlying this association, our findings highlight the importance of considering comorbid conditions such as diabetes in the management and treatment planning for pelvic organ prolapse. The study's outcomes highlight the necessity for a holistic approach to managing pelvic organ prolapse, emphasizing not only the anatomical repair but also the alleviation of associated symptoms and improvement in the quality of life. The observed association between diabetes and pre-operative pain severity suggests that a comprehensive pre-operative assessment, including the evaluation of comorbid conditions, is crucial for tailoring treatment plans to individual needs. Moreover, the significant improvement in symptoms post-surgery supports the ongoing research and development of surgical techniques and interventions aimed at optimizing outcomes for women with pelvic organ prolapse. Pelvic organ prolapse reconstructive surgery demonstrates significant potential in improving pelvic pain and reducing the prevalence of dyspareunia, thereby enhancing the quality of life among affected women. The potential association between diabetes and pre-operative pain severity highlights the need for comprehensive patient assessments and personalized treatment strategies. Future research should focus on long-term outcomes of surgical interventions and the impact of comorbid conditions on the treatment efficacy of pelvic organ prolapse. LIMITATIONS AND STRENGTHS A key limitation of the study was its relatively small sample size and the absence of a control group, which may limit the generalizability of the findings. Additionally, the study's observational nature restricts the ability to establish causality between surgical intervention and improvements in symptoms. Despite these limitations, the study's strengths include the prospective cohort design, the use of validated outcome measures to assess pain and quality of life, and the identification of a potential novel association between diabetes and pre-operative pain severity, which could inform future research and clinical practice. CONCLUSION The findings from this study highlight the effectiveness of pelvic organ prolapse reconstructive surgery in significantly improving pelvic pain and reducing the incidence of dyspareunia. Moreover, the observed association between diabetes and increased pre-operative pain severity emphasizes the need for a comprehensive approach to patient care. Future studies should aim to explore the long-term benefits of surgical interventions and the impact of comorbidities on outcomes to further enhance treatment strategies for women suffering from pelvic organ prolapse. Declarations Ethics approval and consent to participate This study was approved by the Ethical Review Committee of the Aga Khan University Hospital (AKUH) vide letter number 2021-6855-20196 . All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed written consent was obtained from all individual participants included in the study prior to enrollment. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Author Contribution All authors contributed to the study conception and design. All authors read and approved the final manuscript. Data Availability The datasets generated and/or analyzed during the current study are not publicly available due to patient confidentiality policies but are available from the corresponding author on reasonable request. References Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J (2016) Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev 11:CD004014 Doaee M, Moradi-Lakeh M, Nourmohammadi A, Razavi-Ratki SK, Nojomi M (2014) Management of pelvic organ prolapse and quality of life: a systematic review and meta-analysis. Int Urogynecol J 25(2):153–163 Laganà AS, La Rosa VL, Rapisarda AMC, Vitale SG (2018) Pelvic organ prolapse: the impact on quality of life and psychological well-being. J Psychosom Obstet Gynaecol 39(2):164–166 Løwenstein E, Ottesen B, Gimbel H (2015) Incidence and lifetime risk of pelvic organ prolapse surgery in Denmark from 1977 to 2009. 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Eur J Obstet Gynecol Reprod Biol 197:59–62 Lawrence JM, Lukacz ES, Liu IL, Nager CW, Luber KM (2007) Pelvic floor disorders, diabetes, and obesity in women: findings from the Kaiser Permanente Continence Associated Risk Epidemiology Study. Diabetes Care 30(10):2536–2541 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8747588","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":588585061,"identity":"bd088d29-4f63-4f7d-ba7b-8f16cbd733e4","order_by":0,"name":"Samia Aijaz","email":"","orcid":"","institution":"Aga Khan University","correspondingAuthor":false,"prefix":"","firstName":"Samia","middleName":"","lastName":"Aijaz","suffix":""},{"id":588585062,"identity":"1de7fd77-716b-4080-a0d0-03fd04a17af6","order_by":1,"name":"Novera Chughtai","email":"","orcid":"","institution":"Aga Khan University","correspondingAuthor":false,"prefix":"","firstName":"Novera","middleName":"","lastName":"Chughtai","suffix":""},{"id":588585063,"identity":"32b854eb-1a3f-4771-876e-658b8f2eb783","order_by":2,"name":"Urooj Kashif","email":"data:image/png;base64,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","orcid":"","institution":"Aga Khan University","correspondingAuthor":true,"prefix":"","firstName":"Urooj","middleName":"","lastName":"Kashif","suffix":""},{"id":588585064,"identity":"270710e5-a042-4f9f-a00a-79282d636b7d","order_by":3,"name":"Summera Malik","email":"","orcid":"","institution":"Aga Khan University","correspondingAuthor":false,"prefix":"","firstName":"Summera","middleName":"","lastName":"Malik","suffix":""}],"badges":[],"createdAt":"2026-01-31 07:38:47","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8747588/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8747588/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102328023,"identity":"921837a6-da1f-4fac-aae4-e00f692cc3bf","added_by":"auto","created_at":"2026-02-10 14:44:43","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22369,"visible":true,"origin":"","legend":"\u003cp\u003eDyspareunia (Pre-Operative \u0026amp; After 6 month) **P-Value Pre-Operative \u0026amp; After 6 months (0.063).\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8747588/v1/faa04d79b8e96f2fe88542b9.jpeg"},{"id":102398121,"identity":"bbc3cdfc-84e1-4504-96cc-ba6e916f01e3","added_by":"auto","created_at":"2026-02-11 10:21:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":706295,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8747588/v1/e85db015-cf09-4851-993a-cef4a029b723.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eImprovement of Pelvic Pain Associated with Pelvic Organ Prolapse After Reconstructive Surgery\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePelvic organ prolapse (POP) occurs when the pelvic floor no longer supports the proper positioning of the pelvic organs, resulting in the descent of organs through the vagina [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] It is a common gynecologic condition that is strongly associated with childbirth, aging and the menopause [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Women with POP present a variety of symptoms (vaginal, bladder, bowel and sexual) that greatly affect their daily activities and health-related quality of life (HRQoL) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003ePelvic organ prolapse (POP) negatively affects the quality of lives of thousands of women globally. Approximately half of parous women are affected by pelvic organ prolapse while one-fourth of these are symptomatic [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. About 19% of these women have to undergo surgery for POP in their lifetime [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePelvic Organ Prolapse is diagnosed with the help of clinical findings including the symptoms related to the \u0026ldquo;downward displacement\u0026rdquo; of a pelvic organ [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The clinical evidence of POP is evaluated using the Pelvic Organ Prolapse Quantification (POP-Q) System [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Clinical evidence of POP does not always correlate with the presence of POP symptoms, as up to 80% of women may be asymptomatic [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWomen with pelvic organ prolapse (POP) below the hymen are more frequently presented with bulging symptoms. A common symptom reported by patients with prolapse is the occurrence of pain, which is often attributed to pain in the lower back, abdomen, or pelvic areas. Although lower abdominal and pelvic pain have been found to be highly prevalent among women, little is known about the association between advanced prolapse and specific patient reported pain symptoms [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne prospective cohort study investigating the symptoms and severity of prolapse reported that 44% of the subjects complained of pelvic pain, and of those subjects experiencing pain, 69% reported that the pain had a negative impact on their quality of life [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Whereas, other investigators have demonstrated that women with a more advanced stage of prolapse report less pelvic and low back pain, thus failing to identify a strong correlation between prolapse and pain symptoms [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Even though backache is associated with POP yet there is only limited evidence that reconstructive surgery improves pelvic pain postoperatively[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]The Disability-adjusted life years (DALYs) revealed that patients lost years due to symptomatic POP including backache [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn a study by Garcia, the long-term outcomes and complications were assessed postoperatively. It was revealed that postoperatively, constipation and dyspareunia rates worsened, nevertheless, pelvic pain was improved [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Many surgeons counsel women regarding the potential negative effect of prolapse surgery on sexual function, including de novo dyspareunia. However, there is emerging evidence to suggest that, although de novo dyspareunia occurs in approximately 10% of women after native tissue pelvic organ prolapse repair, there are some women who have sexual function improvement [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study we examined the improvement of pelvic pain (low backache, pelvic pain, dyspareunia) in women with pelvic organ prolapse (POP) before and after pelvic floor reconstructive surgery.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eAll women were diagnosed, treated, and followed up as cases of pelvic organ prolapse in the Gynecology \u0026amp; Obstetrics Department of Aga Khan Hospital Karachi. The cohort study was conducted from February 2022 to July 2022, and the study period ended in January 2023 with the 6-month follow-up of the last study subjects. The sampling methodology employed was non-probability convenience sampling. The eligibility criteria included women diagnosed with pelvic organ prolapse who were surgically treated at AKUH, women over the age of 18, and those with Pelvic Organ Prolapse stage II, III, or IV based on the POP Q classification. Excluded were those who did not give informed written consent. To examine the improvement of pelvic pain (low backache, pelvic pain, dyspareunia) before and after pelvic floor reconstructive surgery, a minimum sample size of 35 women with pelvic organ prolapse was needed to achieve 80% power at a 95% confidence level, assuming a mean decrement of 0.9 in pain [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOperational definitions and outcome variables included low backache related to pelvic organ prolapse, characterized as a complaint of low, sacral (or \u0026lsquo;\u0026lsquo;menstrual-like\u0026rsquo;\u0026rsquo;) backache temporally associated with vaginal POP and relief when the prolapse was reduced. Dyspareunia was defined as the complaint of persistent or recurrent pain or discomfort associated with attempted or complete vaginal penetration, including both superficial (introital) dyspareunia and deep dyspareunia. Pelvic Organ Prolapse was defined as when one or more of the organs in the pelvis slip down from their normal position and bulge into the vagina.\u003c/p\u003e \u003cp\u003e Institutional ethical review committee approval was obtained for the study. Participation was voluntary, with patients having the right to not participate or terminate their participation at any time. Consent was sought for participation. Patient identity was treated as confidential, and while study data might be published for scientific purposes, no identifiable references to patients were made. Data or records obtained from participation might be inspected by the AKU Ethical review committee, with study IDs used to protect patient confidentiality.\u003c/p\u003e \u003cp\u003e Upon receiving approval from the AKUH Ethics committee, the study commenced with the enrollment of 35 patients meeting the inclusion criteria. All patients were subjected to validated questionnaires of POPDI 6 scale of PFDI 20, FSFI pain-related questions 17,18,19 domain 6 of dyspareunia, and a Likert scale for determining low backache at baseline. They were followed up over a period of 6 months with objective assessments at 1, 3, and 6 months postoperatively during routine follow-up visits.\u003c/p\u003e \u003cp\u003eAt baseline, data were collected using a predefined structured proforma, including socio-demographic factors (age, marital status), stage of POP, duration of POP, and category of POP. Diagnosis and grading of POP for each patient were made using the Pelvic Organ Prolapse Quantification staging inventory (POP-Q) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. All data were entered and analyzed using the Statistical Package for Social Sciences (SPSS version 25). Means and standard deviations were calculated for all continuous variables, including patient age and body mass index. For categorical variables, such as pain severity, grading of POP, marital status, frequency, and percentages were calculated. Preoperative versus postoperative comparisons were made using chi-square tests and independent student t-tests, with a P-value of \u0026lt;\u0026thinsp;0.05 considered statistically significant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe demographic characteristics of 35 patients undergoing surgery for pelvic organ prolapse (POP), the analysis focused on comparing individuals with moderate (n=25) and severe (n=10) pre-operative pain. The mean age for patients with moderate pain was 55.96 years (SD=10.57), while those with severe pain had a mean age of 50.60 years (SD=7.33), with no significant difference between the groups (p=0.153). Body mass index (BMI) also showed no significant difference (p=0.119), although there was a trend suggesting that diabetic patients were more likely to experience severe pre-operative pain (p=0.007). Hypertension exhibited a trend, with all hypertensive patients experiencing moderate pain (p=0.109). Other demographic factors, pre-operative staging, category of POPDI-6, and duration of POPDI-6 did not show significant differences between the two pain severity groups. These findings suggest a potential association between diabetes and pre-operative pain in the context of POP surgery (TABLE 1).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"605\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 528px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable I: Demographic Characteristics of the Patient (n=35)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-Operative Pain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u0026nbsp;\u003c/strong\u003e(n=25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere\u0026nbsp;\u003c/strong\u003e(n=10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e, Mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e55.96 \u0026plusmn; 10.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e50.60 \u0026plusmn; 7.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.153\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e35-50 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e7 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e6 (46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026gt;50 Years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e18 (81.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e4 (18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBody Mass Index\u003c/strong\u003e, Mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e23.24 \u0026plusmn; 2.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e21.70 \u0026plusmn; 2.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.119\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e18-24 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e16 (64.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e9 (36.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u0026gt;24 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e9 (90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e25 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e10 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes Mellitus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eDiabetic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e3 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e6 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eNon-Diabetic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e22 (84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e4 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eHypertensive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e6 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eNon-Hypertensive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e19 (65.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e10 (34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e, Mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e3.28 \u0026plusmn; 0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e3.20 \u0026plusmn; 1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.852\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode of Delivery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eVaginal Delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e25 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e10 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMenopausal Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003ePre-Menopausal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e18 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e6 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.380\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003ePost Menopausal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e7 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e4 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-Operative Staging\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eStage II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e2 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.493\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eStage III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e13 (81.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e3 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eStage IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e10 (62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e6 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory of POP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eCystocele, apical prolapse, rectocele\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e1 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.401\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eApical prolapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e2 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eApical prolapse, rectocele\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eCystocele, apical prolapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e13 (81.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e16 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003eCystocele, apical prolapse, rectocele\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e9 (64.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e5 (35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of POP\u003c/strong\u003e, Mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e1.72 \u0026plusmn; 0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1.60 \u0026plusmn; 0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.504\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eApplied Chi-Square, Fisher\u0026rsquo;s Exact and Independent t-test\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e**POP (Pelvic Organ Prolapse)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e**SD (Standard Deviation)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePatients undergoing pelvic organ prolapse surgery, the study assessed the improvement and severity of pelvic pain based on the Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) scores at different time points (Pre-Operative, 1st Month, 3rd Month, and 6th Month). The mean POPDI-6 scores decreased progressively from 59.05\u0026plusmn;45.15 pre-operatively to 7.14\u0026plusmn;15.54 at the 6th Month, indicating a significant improvement in pelvic pain. The majority of patients experienced improvement, with 80.0% reporting improvement at the 6th Month. In terms of pain severity, a notable shift towards lower severity was observed, with 65.7% of patients reporting no pain at the 6th Month, compared to 0.0% pre-operatively. This suggests that pelvic pain significantly improved following surgery, demonstrating the effectiveness of the intervention (TABLE 2).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"537\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 537px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTABLE 2: Improvement and Severity of Pelvic Pain based POPDI-6 (n=35)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-Operativ e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003csup\u003eST\u0026nbsp;\u003c/sup\u003eMonth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003csup\u003eRD\u0026nbsp;\u003c/sup\u003eMonth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003csup\u003eTH\u0026nbsp;\u003c/sup\u003eMonth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePOPDI-6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e59.05\u0026plusmn;45.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e36.42\u0026plusmn;28.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e12.14\u0026plusmn;19.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e7.14\u0026plusmn;15.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 537px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImprovement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e8 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e24 (68.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e28 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e35 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e27 (77.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e11 (31.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e7 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 537px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain Severity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eNo Pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4 (11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e13 (37.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e23 (65.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e31 (88.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e21 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e12 (34.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e25 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e01 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e10 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e**POPDI (Pelvic Organ Prolapse Distress Inventory)\u003c/p\u003e\n\u003cp\u003eThe provided data represents the prevalence of dyspareunia before surgery (pre-operative) and six months after surgery. Before surgery, 60.0% (21 cases) reported experiencing dyspareunia, while at the six-month post-operative mark, the prevalence decreased to 14.3% (5 cases). This suggests a notable reduction in dyspareunia following the surgical intervention (Figure 1).\u003c/p\u003e\n\u003cp\u003eIn the multivariate regression analysis predicting the change in postoperative pain at 6 months, several variables were assessed. Age exhibited a regression coefficient of 1.339 (95% CI: 0.320 to 5.613) with a non-significant p-value of 0.689. The presence of moderate pain showed a coefficient of 0.706 (95% CI: 0.155 to 3.224) with a p-value of 0.653. The Body Mass Index (BMI) had a coefficient of 1.313 (95% CI: 0.270 to 6.372) with a non-significant p-value of 0.736. Other variables, including post-menopausal status, pre-operative Stage II, duration of POPDI, diabetes mellitus, hypertension, and improvement at 1 month, also demonstrated coefficients and confidence intervals (TABLE 3).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"588\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 588px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3: Multivariate Regression Analysis Predicting Change in Postoperative Pain at 6 Months (n=35)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.339\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.320 ---- 5.613\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.689\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eModerate Pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.706\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.155 ---- 3.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.653\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eBody Mass Index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.270 ---- 6.372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.736\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003ePost Menopausal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.875\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.197 ---- 3.895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.861\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003ePre-Operative Stage-II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.062 ---- 11.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.282\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eDuration of POPDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.257 ---- 5.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.861\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eDiabetes Mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3.393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.703 ---- 16.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.950\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.148 ---- 6.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.957\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003eImprovement at 1 Month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.095 ---- 3.363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e0.532\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e**POPDI (Pelvic Organ Prolapse Distress Inventory)\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe study aimed to evaluate the efficacy of pelvic organ prolapse reconstructive surgery in improving pelvic pain and dyspareunia among affected women. The results clearly demonstrated a significant improvement in pelvic pain post-surgery, with a notable reduction in the prevalence of dyspareunia, and highlighted a potential association between diabetes and pre-operative pain severity. These findings are pivotal in understanding the impact of pelvic reconstructive surgery on improving quality of life among women with pelvic organ prolapse.\u003c/p\u003e \u003cp\u003ePelvic pain associated with pelvic organ prolapse is a debilitating condition that significantly affects women's quality of life. Our study findings corroborate with existing literature [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], indicating that pelvic organ prolapse surgery substantially reduces pelvic pain. The POPDI-6 scores, which measure the distress and impact of pelvic organ prolapse on quality of life, showed a dramatic decrease from pre-operative scores to those recorded six months post-operatively. This improvement is consistent with previous research [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], suggesting that reconstructive surgery not only resolves anatomical defects but also ameliorates pain and discomfort associated with the condition. The effectiveness of surgical intervention in alleviating pelvic pain highlights the importance of surgical management in the treatment algorithm for pelvic organ prolapse.\u003c/p\u003e \u003cp\u003eDyspareunia, or painful intercourse, is another significant concern for women with pelvic organ prolapse, impacting sexual function and overall well-being. Our study observed a substantial decrease in the prevalence of dyspareunia from 60.0% pre-operatively to 14.3% at the six-month follow-up. This reduction highlights the potential of pelvic organ prolapse surgery to improve sexual health and intimacy experiences for women. It aligns with the growing body of evidence suggesting that addressing the physical aspects of pelvic organ prolapse can lead to improvements in sexual function [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, contrasting evidence from Ulrich et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] suggests that while surgical intervention generally improves vaginal and sexual matters scores, certain techniques such as levator plication may be associated with increased rates of postoperative dyspareunia and decreased sexual function. This highlights the complexity of surgical outcomes on sexual function, indicating that while overall trends suggest improvement, specific surgical techniques may influence individual outcomes differently.\u003c/p\u003e \u003cp\u003eAn intriguing aspect of our analysis was the identification of a potential link between diabetes and the severity of pre-operative pain in patients with pelvic organ prolapse. Diabetic patients were more likely to report severe pain, suggesting that diabetes may influence the severity of disease. This association could be attributed to the neurologic changes and increased susceptibility to infections seen in diabetic individuals, potentially worsening the symptoms of pelvic organ prolapse. Some evidence revealed association between diabetes and pelvic organ prolapse [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Although further research is needed to elucidate the mechanisms underlying this association, our findings highlight the importance of considering comorbid conditions such as diabetes in the management and treatment planning for pelvic organ prolapse.\u003c/p\u003e \u003cp\u003eThe study's outcomes highlight the necessity for a holistic approach to managing pelvic organ prolapse, emphasizing not only the anatomical repair but also the alleviation of associated symptoms and improvement in the quality of life. The observed association between diabetes and pre-operative pain severity suggests that a comprehensive pre-operative assessment, including the evaluation of comorbid conditions, is crucial for tailoring treatment plans to individual needs. Moreover, the significant improvement in symptoms post-surgery supports the ongoing research and development of surgical techniques and interventions aimed at optimizing outcomes for women with pelvic organ prolapse.\u003c/p\u003e \u003cp\u003ePelvic organ prolapse reconstructive surgery demonstrates significant potential in improving pelvic pain and reducing the prevalence of dyspareunia, thereby enhancing the quality of life among affected women. The potential association between diabetes and pre-operative pain severity highlights the need for comprehensive patient assessments and personalized treatment strategies. Future research should focus on long-term outcomes of surgical interventions and the impact of comorbid conditions on the treatment efficacy of pelvic organ prolapse.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLIMITATIONS AND STRENGTHS\u003c/h2\u003e \u003cp\u003eA key limitation of the study was its relatively small sample size and the absence of a control group, which may limit the generalizability of the findings. Additionally, the study's observational nature restricts the ability to establish causality between surgical intervention and improvements in symptoms. Despite these limitations, the study's strengths include the prospective cohort design, the use of validated outcome measures to assess pain and quality of life, and the identification of a potential novel association between diabetes and pre-operative pain severity, which could inform future research and clinical practice.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe findings from this study highlight the effectiveness of pelvic organ prolapse reconstructive surgery in significantly improving pelvic pain and reducing the incidence of dyspareunia. Moreover, the observed association between diabetes and increased pre-operative pain severity emphasizes the need for a comprehensive approach to patient care. Future studies should aim to explore the long-term benefits of surgical interventions and the impact of comorbidities on outcomes to further enhance treatment strategies for women suffering from pelvic organ prolapse.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThis study was approved by the Ethical Review Committee of the Aga Khan University Hospital (AKUH) vide letter number \u003cem\u003e2021-6855-20196\u003c/em\u003e. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed written consent was obtained from all individual participants included in the study prior to enrollment.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to patient confidentiality policies but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMaher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J (2016) Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev 11:CD004014\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDoaee M, Moradi-Lakeh M, Nourmohammadi A, Razavi-Ratki SK, Nojomi M (2014) Management of pelvic organ prolapse and quality of life: a systematic review and meta-analysis. Int Urogynecol J 25(2):153\u0026ndash;163\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLagan\u0026agrave; AS, La Rosa VL, Rapisarda AMC, Vitale SG (2018) Pelvic organ prolapse: the impact on quality of life and psychological well-being. J Psychosom Obstet Gynaecol 39(2):164\u0026ndash;166\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eL\u0026oslash;wenstein E, Ottesen B, Gimbel H (2015) Incidence and lifetime risk of pelvic organ prolapse surgery in Denmark from 1977 to 2009. Int Urogynecol J 26(1):49\u0026ndash;55\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith FJ, Holman CA, Moorin RE, Tsokos N (2010) Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol 116(5):1096\u0026ndash;1100\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMadhu C, Swift S, Moloney-Geany S, Drake MJ (2018) How to use the pelvic organ prolapse quantification (POP-Q) system? Neurourol Urodyn 37(S6):S39\u0026ndash;43\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMathias SD, Kuppermann M, Liberman RF, Lipschutz RC, Steege JF (1996) Chronic pelvic pain: prevalence, health-related quality of life and economic correlates. Obstet Gynecol 87(3):321\u0026ndash;327\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZondervan KT, Yudkin PL, Vessey MP, Dawes MG, Barlow DH, Kennedy SH (1999) Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database. 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Obstet Gynecol 136(3):492\u0026ndash;500\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsık H, Aynıoglu O, Sahbaz A, Selimoglu R, Timur H, Harma M (2016) Are hypertension and diabetes mellitus risk factors for pelvic organ prolapse? Eur J Obstet Gynecol Reprod Biol 197:59\u0026ndash;62\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLawrence JM, Lukacz ES, Liu IL, Nager CW, Luber KM (2007) Pelvic floor disorders, diabetes, and obesity in women: findings from the Kaiser Permanente Continence Associated Risk Epidemiology Study. Diabetes Care 30(10):2536\u0026ndash;2541\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pelvic Organ Prolapse, Reconstructive Surgery, Pelvic Pain, Dyspareunia, Quality of Life","lastPublishedDoi":"10.21203/rs.3.rs-8747588/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8747588/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePelvic organ prolapse (POP) significantly impacts women's quality of life, with symptoms including pelvic pain and dyspareunia. This study aims to evaluate the improvement of pelvic pain, including low backache, pelvic pain, and dyspareunia, following pelvic floor reconstructive surgery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA prospective cohort study was conducted at the Aga Khan Hospital Karachi, enrolling 35 women with POP. Patients were followed from February 2022 to January 2023, assessing outcomes through validated questionnaires (POPDI-6, FSFI) preoperatively and at 1, 3, and 6 months postoperatively. The study focused on the impact of surgery on pelvic pain and dyspareunia, with an analysis of potential factors influencing pre-operative pain severity.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean POPDI-6 scores significantly decreased from 59.05\u0026thinsp;\u0026plusmn;\u0026thinsp;45.15 pre-operatively to 7.14\u0026thinsp;\u0026plusmn;\u0026thinsp;15.54 at 6 months postoperatively, indicating a significant improvement in pelvic pain (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Dyspareunia prevalence reduced from 60.0% pre-operatively to 14.3% six months after surgery. Diabetic patients were more likely to experience severe pre-operative pain (p\u0026thinsp;=\u0026thinsp;0.007). However, contrasting evidence from Ulrich et al. suggests that specific surgical techniques, like levator plication, may increase postoperative dyspareunia rates.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePelvic floor reconstructive surgery effectively improves pelvic pain and reduces dyspareunia in women with POP. The study highlights the need for personalized treatment approaches, considering individual patient characteristics and comorbidities, such as diabetes, which may influence pain severity and surgical outcomes.\u003c/p\u003e","manuscriptTitle":"Improvement of Pelvic Pain Associated with Pelvic Organ Prolapse After Reconstructive Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-10 14:44:29","doi":"10.21203/rs.3.rs-8747588/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9d712160-9cf5-4365-9cd7-7f3d06f78c80","owner":[],"postedDate":"February 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-10T14:44:38+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-10 14:44:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8747588","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8747588","identity":"rs-8747588","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}