Quality of Sexual Function After Urogynecological Surgical Procedures: A Cross-Sectional Study

Quality of Sexual Function After Urogynecological Surgical Procedures: A Cross-Sectional Study | 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 Article Quality of Sexual Function After Urogynecological Surgical Procedures: A Cross-Sectional Study Mina Al-Khafaji, Anupama Bondili, Stanisław Wójtowicz, Kornelia Zaręba This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7966203/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 Pelvic floor disorders such as pelvic organ prolapse (POP) and urinary incontinence (UI) are common among women and have a documented negative impact on their sexual function and overall quality of life. This study aimed to assess changes in sexual function and quality of life in women undergoing urogynecological procedures and identify factors associated with postoperative sexual outcomes. A prospective cohort of 59 sexually active women who underwent surgical management for POP or UI at Tawam Hospital was followed up between June 1, 2024, and May 31, 2025. Participants completed a demographic survey and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) before surgery and again three months postoperatively. PISQ scores showed a statistically significant improvement after surgery (33.87 (SD = 7.76) vs 84.98 (SD = 8.07)), with a mean increase of 51.1 points (t = − 36.18, p < 0.001), indicating pelvic discomfort, urinary control, physical mobility, and sexual function. Younger patients experienced greater improvements, while menopausal status appeared to moderate the extent of the benefits (r = − 0.504, p < 0.001). These findings highlight the importance of including sexual health in preoperative counseling and support the use of validated tools such as the PISQ for routine outcome monitoring and introducing surgical interventions at an earlier age. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Urology urogynecology sexual function quality of life PISQ pelvic floor surgery women’s health Figures Figure 1 INTRODUCTION Pelvic floor disorders such as pelvic organ prolapse (POP) and urinary incontinence (UI) are among the most frequently encountered conditions in urogynecology 1 . These disorders not only cause discomfort and physical limitations, but also have profound consequences on women’s psychological and sexual well-being 2 . POP occurs when weakened pelvic muscles and connective tissue fail to support the pelvic organs, leading to the descent of the bladder, uterus, or rectum into the vaginal canal 3 . UI, on the other hand, refers to involuntary urine leakage that may occur during exertion, coughing, or without warning 4 . The coexistence of these conditions is common, particularly in aging women and those with a history of vaginal delivery 1 . Multiple clinical investigations have demonstrated a strong association between pelvic floor disorders and diminished sexual well-being 5 . Women affected by these conditions often report vaginal dryness, discomfort during intercourse (dyspareunia), fear of leakage during intimacy, and diminished sexual desire 2 . These physical symptoms are frequently accompanied by anxiety, embarrassment, and low self-esteem, all of which contribute to avoidance of sexual activity and emotional strain in partner relationships 2 , 5 . However, sexual health remains underdiscussed in clinical practice. Women may hesitate to raise these concerns because of the stigma, and healthcare professionals may overlook them during evaluation or fail to use validated tools 6 . Urogynecological surgical procedures offer effective symptom relief; however, their impact on sexual function remains a complex and often understudied outcome 7 , 8 . Studies have indicated that sexual function may improve after surgery, particularly when symptoms such as bulging and leakage are resolved 9 , 10 . However, other women may experience new challenges such as vaginal tightness, fear of recurrence, or persistent discomfort 11 . Outcomes are often influenced by surgical techniques; for instance, systematic reviews show that procedures such as sacrocolpopexy tend to preserve or improve sexual function more reliably than transvaginal mesh repair, which may be associated with postoperative pain or dyspareunia 12 . Long-term evidence also supports sustained improvements in sexual health following surgical correction of POP. A recent five-year nationwide follow-up study demonstrated that sexual activity and satisfaction improved after surgery, with a notable decrease in dyspareunia rates and an enhanced overall quality of life 13 . Given these multidimensional factors, the assessment of sexual function after urogynecological surgery should be comprehensive, standardized, and sensitive to patient-reported concerns. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) is a validated instrument developed specifically to evaluate sexual function in women with pelvic floor disorders 14 . This tool allows for both clinical comparability and individualized care planning 2 , 14 . This prospective cohort study examined changes in sexual function and quality of life in women undergoing urogynecological procedures at a tertiary care center. We assessed pre-and postoperative sexual function using the PISQ and identified potential predictors of improved or worsened outcomes. Our objective was to contribute meaningful data to the field, support patient-centered surgical counseling, and encourage clinicians to include sexual health as a standard component of pre- and postoperative urogynecological care. MATERIALS AND METHODS Hypothesis We hypothesized that urogynecological surgical procedures, including pelvic organ prolapse (POP) repair and urinary incontinence (UI) intervention, would lead to major improvements in sexual function and quality of life. Additionally, we anticipated that the extent of these improvements would vary according to factors such as patient age, symptom severity, and surgical intervention type or complexity. The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Tawam Hospital (reference number KD/TC/1174). Material This prospective cohort study was conducted between June 1, 2024, and May 31, 2025, at Tawam Hospital, a tertiary care center in the United Arab Emirates. The study included 59 sexually active women scheduled to undergo urogynecological procedures such as POP repair or UI surgery. Participants were recruited during routine outpatient visits and selected consecutively based on their eligibility. Participants were required to meet the following inclusion criteria: Female patients aged 18 years up to 10 years post-menopause. Planned urogynecological procedures (e.g., POP repair and UI surgery) during the study period. Ability to read and understand English or Arabic. Willingness and ability to provide informed consent and complete follow-up assessments. Exclusion criteria included the following: Women who underwent previous urogynecological surgery. Known sexual dysfunction due to non-urogynecological causes. Presence of psychiatric or neurological comorbidities or other chronic conditions that could independently influence sexual function. Incomplete medical records or missed follow-up data. Refusal or inability to provide informed consent. Methodology Written informed consent was obtained from all participants before recruitment. Patients were asked to complete the questionnaires in a private clinical setting, and trained staff were available to offer clarification when needed while ensuring confidentiality. Complementary clinical and surgical data—such as diagnosis, procedure type, and relevant preoperative findings—were extracted from the hospital’s Cerner electronic medical record system. The same set of questionnaires was administered again three months postoperatively, allowing for individual pre- and post-intervention comparisons. All collected data were anonymized and stored securely in compliance with research ethics and institutional privacy guidelines. Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire – International Revised version (PISQ-IR) The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire – International Revised version (PISQ-IR) was used to evaluate changes in sexual function before and after surgery. This is a validated condition-specific patient-reported outcome measure tailored for women with floor disorders 15 . We used the Arabic version of the PISQ-IR, which has been formally translated and psychometrically validated for Arabic-speaking women 16 . It has good internal consistency for five of the six scales in Global Quality (Cronbach's coefficient α = 0.86), Condition Impact (α = 0.87), Desire (α = 0.82), Condition Specific (α = 0.74), and Partner Related (α = 0.75) 16 . The PISQ-IR is divided into two modules, one for sexually active and the other for non-sexually active women, allowing for broad clinical applications. This version of the questionnaire covers several critical domains of female sexual function, including desire and arousal, orgasm and satisfaction, condition-specific symptoms (e.g., urinary leakage or bulging during intercourse), partner-related influences, avoidance behaviors, and overall emotional and relational well-being. In the present study, only the sexually active module was used. The items are scored on a 5-point Likert scale. For most questions, the responses ranged from 1 (always) to 5 (never). Positively worded items were scored directly, whereas negatively worded items were reverse-coded so that higher scores consistently indicated better sexual function. The PISQ-IR does not rely on formal cutoff points; rather, outcomes are assessed based on changes in total and domain-specific scores over time. In addition to the PISQ-IR, all participants completed a structured demographic survey comprising 12 questions on age, marital status, parity, menopausal status, previous pelvic surgery, relevant medical history, physical activity levels, and smoking status. Statistical analysis Statistical analysis was conducted using IBM SPSS Statistics, version 28.0 (IBM Corp., Armonk, NY, USA), with a significance threshold set at p < 0.05. Descriptive statistics were calculated for all demographic and clinical variables, including frequencies (expressed as absolute numbers and percentages), means, standard deviations, and minimum and maximum values. The distribution of continuous variables such as age, gravidity, and parity was assessed using the Shapiro–Wilk test for normality. To evaluate the pre- and post-intervention outcomes (Pelvic Symptom and Quality of Life Inventory Revised, PSQR-IR scores), a paired t-test was applied because of the dependent nature of the measurements. Pearson’s correlation coefficients were used to explore the relationship between continuous variables, including the association between age and quality-of-life scores before and after the intervention, as well as the magnitude of change in scores. Frequency distributions were analyzed for categorical variables. Given the exploratory nature of this study and its predominantly descriptive scope, no additional group comparisons were conducted using nonparametric tests. However, post hoc interpretation considered relevant patterns emerging from cross-tabulations of clinical history (e.g., comorbidities, type of delivery, and complications) with symptom burden and surgical outcomes. All statistical procedures adhered to standard assumptions and reporting practices to ensure reproducibility and clinical relevance of the findings. Results were considered statistically significant at p-value < 0.05. RESULTS Participants’ Demographics and Medical Characteristics of the Study Population A total of 59 women were enrolled in this study. Participants’ ages ranged from 25 to 64 years, with a mean age of 46.76 years (SD = 9.29). Most participants were married (96.6%) and resided in the Emirate of Abu Dhabi. In terms of ethnicity, 74.6% were Emirati nationals, followed by non-local Arabs (13.6%), Asians (8.5%), and Europeans (3.4%). A complete breakdown of demographics is presented in Table 1. Category Variable n % Age (years) 55 10 16.9 % Marital Status Married 57 96.6 % Divorced 2 3.4 % Nationality Emirati 44 74.6 % Non-local Arab 8 13.6 % Asian 5 8.5 % European 2 3.4 % n – number of respondents; % – percentage of respondents Table 1. Sociodemographic characteristics of the respondents (n=59). Obstetric history revealed high reproductive exposure (mean gravidity, 6.08; SD = 3.23) and a mean parity of 5.63 (SD = 2.96). The most common mode of delivery was spontaneous vaginal delivery (SVD), reported in 59.3% of cases, followed by cesarean section (CS1–CS4), accounting for a combined 34.0%. Vacuum-assisted delivery occurred in 3.4% of participants, and one case (1.7%) involved forceps delivery (Table 2). Most participants presented with multiple pelvic floor symptoms reflecting the complex nature of their condition. While 33.9% of women reported POP as an isolated complaint, a substantial proportion experienced overlapping symptoms. The most prevalent mixed condition was stress urinary incontinence (SUI) with POP (27.1%), followed by mixed urinary incontinence (MUI) with POP (8.5%), and urgency urinary incontinence (UUI) with POP (5.1%). Smaller subsets reported isolated SUI (6.8%), UUI (6.8%), or MUI (8.5%). Overflow incontinence (OFI) with POP was rare (3.4%) (Table 2). Surgical treatment was individualized based on symptom presentation, clinical findings, and patient history. Posterior repair was the most frequently performed isolated procedure (11.9%), while combined anterior and posterior repair was performed in 16.9% of patients. Intravesical Botox (13.6%) and Bulkamid injections (6.8%) were primarily used in urgency-dominant incontinence. Less common procedures include sacrospinous fixation, fascial sling, and transobturator tape (TOT). Notably, 20.3% of patients underwent three or more procedures in a single surgical session, reflecting complex pelvic floor pathology. Considering risk factors, only 16,9% delivered macrosomic children, and only 5.1% are smoking cigarettes. Furthermore, regarding preventive factors, estrogen therapy was reported in 11.9% of women, despite most of them being postmenopausal. Interestingly, participants reported high levels of sexual activity. The group of 80% of participants had sexual intercourse at least once per week, and more than 32 % at least three times per week. The complete breakdown of the clinical symptoms and surgical characteristics is presented in Table 2. Category Variable n % Parity P1 3 5.1 P2 3 5.1 P3 8 13.6 P>3 45 76.3 Mode of Delivery SVD 35 59.3 Vacuum-assisted 2 3.4 Forceps Delivery 1 1.7 CS1 12 20.4 CS2 3 5.1 CS3 4 6.8 CS4 1 1.7 CS1 with Complication B 1 1.7 Delivery of a macrosomic child Yes 10 16.9 No 49 83.1 Symptoms Reported POP only 20 33.9 SUI only 4 6.8 UUI only 4 6.8 MUI only 5 8.5 SUI + POP 16 27.1 UUI + POP 3 5.1 MUI + POP 5 8.5 OFI + POP 2 3.4 Surgical Procedures Performed Posterior Repair 7 11.9 Anterior + Posterior Repair 10 16.9 Bulkamid Injection 4 6.8 Intravesical Botox 8 13.6 Fascial Sling 1 1.7 Transobturator Tape 2 3.4 Sacrospinous Fixation 3 5.1 Multi-procedure (≥3 interventions) 12 20.3 Smoking Yes 3 5.1 No 56 94.9 Estrogen Supplement Yes 7 11.9 No 52 88.1 Sexual Activity Three times per week and more 19 32.2 1-2 times per week 27 45.8 Every other week 11 18.6 Rarely 2 3.4 SD = standard deviation; n = number of respondents; % = percentage of respondents; SVD = spontaneous vaginal delivery; CS = cesarean section; POP = pelvic organ prolapse; SUI = stress urinary incontinence; UUI = urgency urinary incontinence; MUI = mixed urinary incontinence; OFI = overflow incontinence. Table 2. Medical and Surgical Characteristics of the Study Population (n=59). Sexual Quality of Life Outcomes Pre- and postoperative quality of life was assessed using the PSQR-IR. At baseline, the mean PSQR-IR score was 33.87 (SD = 7.76), indicating moderate impairment. Following surgical intervention, the mean score increased to 84.98 (SD = 8.07), demonstrating a significant improvement in patient-reported outcomes at the three-month follow-up. The difference between pre- and postoperative scores was statistically significant (t = –36.18, p < 0.0001) (Figure 1). Note: Data represent average scores at baseline and three months postoperatively. Higher scores reflect better subjective quality of life. The Wilcoxon signed-rank test subgroup analysis revealed consistent improvements across all domains of the PSQR-IR, including arousal, desire, and global quality (p < 0.05) (Table 3). It is interesting to note that these patients observed an improvement in partner-related arousal. Moreover, patients reported reduced pelvic heaviness, less urgency or leakage, and fewer limitations on physical activity. Domain Time Mean SD Z p-value Arousal Before surgery 10.27 1.64 -5.933 .0001 After surgery 12.51 1.61 Partner_related Before surgery 7.66 1.03 -5.465 .0001 After surgery 6.49 .77 Condition_specicic Before surgery 9.80 2.30 -6.697 .0001 After surgery 4.19 1.18 Condition_impact Before surgery 8.31 1.48 -6.658 .0001 After surgery 12.47 1.18 Global_quality Before surgery 12.47 .68 -6.464 .0001 After surgery 8.78 1.54 Desire Before surgery 8.10 1.21 -2.241 .025 After surgery 7.76 1.24 SD = standard deviation Table 3. PISQ-IR subgroup analysis Univariate analysis of variance did not show a statistically significant difference between the initial diagnosis and quality of life determined using the PSQR-IR Score, both before (F(2.4), p=0.100) and after surgery (F (1.905), p = 0.158) (Table 4). N Mean SD F p-value PSQR-IR before surgery POP 20 35.90 7.34 2.400 0.100 UI 13 35.77 8.43 MIX 26 31.46 7.46 PSQR-IR after surgery POP 20 87.70 6.58 1.905 0.158 UI 13 83.77 8.99 MIX 26 83.27 8.42 Difference between PSQR-IR results before and after surgery POP 20 51.80 8,84 0.600 0.552 UI 13 48.00 14.14 MIX 26 51.81 10.88 n – number of respondents; % – percentage of respondents; SD – standard deviation; POP = pelvic organ prolapse; UI = urinary incontinence; MIX= both POP+ UI Table 4. Correlation Between Initial Diagnosis and PSQR-IR Outcomes Risk and Protective Factors Analysis Pearson’s correlation coefficient revealed no significant relationship between age and baseline PSQR-IR scores (r = –0.110, p = 0.408). However, a significant negative correlation was identified between age and postoperative PSQR-IR scores (r = –0.504, p < 0.001), indicating that younger women tended to report greater improvements. The change in scores (postoperative minus preoperative) also showed a statistically significant negative correlation with age (r = –0.305, p = 0.019), suggesting that age may be an independent predictor of perceived benefit (Table 5). Variable Pair Correlation Coefficient (r) p-value Age & PSQR-IR1 -0.110 0.408 Age & PSQR-IR2 -0.504 0.000 Age & Score Change -0.305 0.019 Table 5. Correlation Between Age and PSQR-IR Outcomes No statistically significant correlations were observed between protective factors (estrogen supplementation), risk factors (fetal macrosomia, parity, smoking, and mode of delivery) on the one hand, and sexual satisfaction (measured by the PSQR-IR score). DISCUSSION Sexual dysfunction in women with POP and UI is multifactorial. It frequently results from a combination of physical symptoms such as vaginal bulging, dyspareunia, and involuntary leakage during intercourse, as well as emotional distress, reduced self-esteem, and alterations in body image 2 , 5 . These factors can jointly affect sexual desire, arousal, and satisfaction, often leading to avoidance of intimacy or strain in partner relationships 17 . In the present study, the resolution of these symptoms through surgical intervention was associated with substantial improvements in the reported sexual well-being. This reinforces the notion that surgical intervention for POP and UI can significantly improve both sexual function and overall quality of life. Moreover, the findings suggest that, while all patients benefit from surgery, younger individuals may experience greater perceived quality-of-life gains. Using the validated PISQ-IR questionnaire, our findings revealed statistically and clinically meaningful improvements in patient-reported outcomes, a trend that mirrors the conclusions drawn in similar research 1 . The use of a condition-specific tool such as the PISQ has proven to be essential in evaluating the nuanced aspects of sexual recovery 14 . The positive outcomes observed in our cohort align with existing evidence, suggesting that prolapse and continence surgeries can help restore self-confidence, improve genital self-perception, and enhance communication with partners 7 , 9 . Notably, younger participants in our study reported a greater magnitude of improvement, which echoes prior findings linking age, hormonal environment, and baseline sexual function with postoperative success 1 , 13 . Conversely, older women demonstrate modest gains, potentially attributable to estrogen deficiency, tissue atrophy, or reduced baseline intimacy 9 , 18 , 19 . The observed improvements were most notable in younger women; however, the benefits were evident across the cohort, emphasizing the broad therapeutic potential of such interventions. However, we did not find any correlation between estrogen supplementation and higher PISQ scores. The reason for this might be the size of the group, where below 12% of participants have estrogen supplementation. This pattern highlights an ongoing gap in the awareness or accessibility of localized estrogen interventions despite the documented benefits in optimizing surgical recovery and comfort 20 , 21 . It may be beneficial for clinicians to proactively address the hormonal status in the perioperative setting, particularly in postmenopausal patients. Our findings also support the use of individualized surgical approaches such as native tissue repair, biological grafts, and minimally invasive slings, all of which have demonstrated favorable outcomes when appropriately applied 22 . Avoidance of transvaginal meshes in our cohort is consistent with recent shifts in surgical practice due to concerns about postoperative pain, dyspareunia, and erosion risks 23 , 24 . Taking into account risk factors such as multiparity, delivery of macrosomic babies, and smoking, the present study did not show any influence on women’s sexual quality of life either before or after surgery. Considering that multiparity and births in macrosomic children are associated with vaginal prolapse and enlargement of their size, these results are surprising 25 . Likewise, protective factors, such as estrogen therapy, which improves the biological quality of vaginal tissues and their lubrication, did not substantially improve sexual satisfaction among the women studied 26 . Contrary to expectations, the results may be explained by Rosemary Basson’s notion that the emotional component of sexual satisfaction predominates over the biological component among the women examined 27 , 28 . Nonetheless, it is important to acknowledge that not all women in our study experienced resolution of their sexual concerns. A subset reported persistent discomfort, vaginal tightness, or fear of recurrence, findings that were echoed in qualitative studies exploring the emotional aftermath of reconstructive pelvic surgery 29 – 31 . These insights emphasize the importance of comprehensive preoperative counseling that extends beyond anatomical outcomes to include honest discussions about expectations of sexual function. What is reassuring is that in the present study, the frequency of sexual activity was high, with more than 96% reporting sexual activity at least once a week. Considering the decreasing sexual activity among middle-aged women in Europe and the US, these results are really reassuring 32 , 33 . These results might be due to the specific group of participants who underwent vaginal surgery. We can hypothesize that they pay more attention to aesthetics and functionality of their genital areas than the general population. In summary, our study adds to the growing call for sexual health to be treated as an integral component of urogynaecologic care. As highlighted in prior research, women’s sexual function is influenced not only by physical and hormonal factors but also by psychological, emotional, and interpersonal elements 21 , 27 . Future research and clinical practice should continue to consider this complexity in the pursuit of holistic recovery. Limitations This study has several limitations that should be considered when interpreting the results. First, it was conducted at a single tertiary care center and reflects the experience of a specific patient population, which may limit its generalizability to other settings. While the PISQ is a validated and sensitive instrument, it is a self-reported measure that is subject to recall bias and social desirability effects. Additionally, factors known to influence sexual function, such as partner satisfaction, mental health, and relationship quality, were excluded from the dataset. Another key limitation is the short follow-up period of three months. Although this enables the assessment of early postoperative outcomes, it may not reflect the long-term durability of improvements or delayed complications. Furthermore, the role of hormonal status, particularly estrogen use, has not been fully standardized, making it difficult to assess its effect on postoperative recovery, especially in postmenopausal women. Strengths Despite the limitations, this study had several strengths. This is among the few prospective investigations in the region that have explicitly evaluated sexual function after pelvic floor surgery. Moreover, it presents the sexual activity of patients in the region. The use of a validated condition-specific tool (PISQ) allowed for a nuanced and targeted evaluation of sexual health outcomes that were most relevant to this population. We documented significant postoperative gains across multiple domains of physical and emotional well-being. Generic quality-of-life metrics often lack sensitivity to specific domains of interest in pelvic floor research 2 , 14 . By employing the PISQ, we were able to generate richer and more meaningful data that could directly inform patient counseling and shared decision-making. Moreover, all procedures were conducted by a specialized urogynecology team to ensure surgical consistency and adherence to best practices. Clinical documentation was thorough, and patient characteristics were well defined, supporting the reliability of the findings. Importantly, this study contributes region-specific data to the global evidence base and underscores the importance of integrating sexual health considerations into routine urogynaecologic care. CONCLUSIONS This study confirmed that urogynaecological surgical treatment for pelvic organ prolapse and urinary incontinence can substantially improve sexual function and quality of life in women. These findings support the value of integrating sexual health into standard pre- and postoperative evaluations and counseling. Moreover, the present findings highlight the importance of age-related factors in outcome interpretation, suggesting that early surgical interventions should be considered. However, the persistence of postoperative sexual concerns in a subset of patients reinforces the importance of comprehensive patient education and realistic goal-setting. By adopting a patient-centered approach and addressing both the anatomical and psychosocial dimensions, clinicians can enhance long-term outcomes and support holistic recovery in women with pelvic floor disorders. Declarations All authors have read and agreed to the published version of the manuscript. Additional Information : Conflicts of Interest: The authors declare no conflict of interest. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution Conceptualization: M. A-K.; A.B.; K.Z., methodology: M. A-K.; A.B.; K.Z., formal analysis: K.Z. S.W., investigation: M. A-K.; A.B., resources: M. A-K., data curation: M. A-K., writing—original draft preparation: M.A-K.; K.Z., writing—review and editing: K.Z., supervision: K.Z.; A.B., project administration: M.A-K.; K.Z. Data Availability The datasets generated and/or analyzed in the current study are available as supplementary materials. 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Trends in Frequency of Sexual Activity and Number of Sexual Partners Among Adults Aged 18 to 44 Years in the US, 2000–2018. JAMA Netw. Open. 3 , e203833 (2020). 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-7966203","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":546329489,"identity":"24db411f-79c1-44a1-8779-cd5bf8475c3a","order_by":0,"name":"Mina Al-Khafaji","email":"","orcid":"","institution":"Tawam Hospital, United Arab Emirates University (UAEU)","correspondingAuthor":false,"prefix":"","firstName":"Mina","middleName":"","lastName":"Al-Khafaji","suffix":""},{"id":546329490,"identity":"b84428da-e7c3-4e4c-b838-f5b9b9a65bf4","order_by":1,"name":"Anupama Bondili","email":"","orcid":"","institution":"Tawam Hospital, United Arab Emirates University (UAEU)","correspondingAuthor":false,"prefix":"","firstName":"Anupama","middleName":"","lastName":"Bondili","suffix":""},{"id":546329491,"identity":"a3290d99-19d7-4f6d-90f5-f1455e9e058a","order_by":2,"name":"Stanisław Wójtowicz","email":"","orcid":"","institution":"Medical University of Warsaw","correspondingAuthor":false,"prefix":"","firstName":"Stanisław","middleName":"","lastName":"Wójtowicz","suffix":""},{"id":546329492,"identity":"70bf4504-9441-4e74-acdf-acae60aeb6d2","order_by":3,"name":"Kornelia 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12:01:14","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4511,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7966203/v1/fce9543a4402d3bd9bae1994.png"},{"id":96286199,"identity":"d893baa8-ab3f-4e8e-8605-5dfd42a7ecd1","added_by":"auto","created_at":"2025-11-19 12:01:14","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":105281,"visible":true,"origin":"","legend":"","description":"","filename":"5d94ee5b540d4a0295a6ef76e397f6441structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7966203/v1/d19a1064fa6d520517ff07fc.xml"},{"id":96364407,"identity":"82648f24-43cb-4153-99db-d879ffca77ab","added_by":"auto","created_at":"2025-11-20 10:09:16","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":116459,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7966203/v1/174b4a103bd10d0d94402341.html"},{"id":96286195,"identity":"b7915450-510e-4413-a227-c72958f94b25","added_by":"auto","created_at":"2025-11-19 12:01:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":13050,"visible":true,"origin":"","legend":"\u003cp\u003ePSQR-IR Scores Before and After Postoperative Intervention\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote: Data represent average scores at baseline and three months postoperatively. Higher scores reflect better subjective quality of life.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7966203/v1/4aaf17a83909d5b6067687ee.png"},{"id":108007806,"identity":"e65cbe95-6629-4a25-84d9-4bdbe8748e7b","added_by":"auto","created_at":"2026-04-28 13:02:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":431662,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7966203/v1/6e9be30a-b399-4152-878b-ba2cc280fc8c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Quality of Sexual Function After Urogynecological Surgical Procedures: A Cross-Sectional Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePelvic floor disorders such as pelvic organ prolapse (POP) and urinary incontinence (UI) are among the most frequently encountered conditions in urogynecology \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. These disorders not only cause discomfort and physical limitations, but also have profound consequences on women\u0026rsquo;s psychological and sexual well-being \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003ePOP occurs when weakened pelvic muscles and connective tissue fail to support the pelvic organs, leading to the descent of the bladder, uterus, or rectum into the vaginal canal \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. UI, on the other hand, refers to involuntary urine leakage that may occur during exertion, coughing, or without warning \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. The coexistence of these conditions is common, particularly in aging women and those with a history of vaginal delivery \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMultiple clinical investigations have demonstrated a strong association between pelvic floor disorders and diminished sexual well-being \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Women affected by these conditions often report vaginal dryness, discomfort during intercourse (dyspareunia), fear of leakage during intimacy, and diminished sexual desire \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. These physical symptoms are frequently accompanied by anxiety, embarrassment, and low self-esteem, all of which contribute to avoidance of sexual activity and emotional strain in partner relationships \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. However, sexual health remains underdiscussed in clinical practice. Women may hesitate to raise these concerns because of the stigma, and healthcare professionals may overlook them during evaluation or fail to use validated tools \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eUrogynecological surgical procedures offer effective symptom relief; however, their impact on sexual function remains a complex and often understudied outcome \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Studies have indicated that sexual function may improve after surgery, particularly when symptoms such as bulging and leakage are resolved \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. However, other women may experience new challenges such as vaginal tightness, fear of recurrence, or persistent discomfort \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Outcomes are often influenced by surgical techniques; for instance, systematic reviews show that procedures such as sacrocolpopexy tend to preserve or improve sexual function more reliably than transvaginal mesh repair, which may be associated with postoperative pain or dyspareunia \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Long-term evidence also supports sustained improvements in sexual health following surgical correction of POP. A recent five-year nationwide follow-up study demonstrated that sexual activity and satisfaction improved after surgery, with a notable decrease in dyspareunia rates and an enhanced overall quality of life \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eGiven these multidimensional factors, the assessment of sexual function after urogynecological surgery should be comprehensive, standardized, and sensitive to patient-reported concerns. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) is a validated instrument developed specifically to evaluate sexual function in women with pelvic floor disorders \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. This tool allows for both clinical comparability and individualized care planning \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis prospective cohort study examined changes in sexual function and quality of life in women undergoing urogynecological procedures at a tertiary care center. We assessed pre-and postoperative sexual function using the PISQ and identified potential predictors of improved or worsened outcomes. Our objective was to contribute meaningful data to the field, support patient-centered surgical counseling, and encourage clinicians to include sexual health as a standard component of pre- and postoperative urogynecological care.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eHypothesis\u003c/h2\u003e\u003cp\u003eWe hypothesized that urogynecological surgical procedures, including pelvic organ prolapse (POP) repair and urinary incontinence (UI) intervention, would lead to major improvements in sexual function and quality of life. Additionally, we anticipated that the extent of these improvements would vary according to factors such as patient age, symptom severity, and surgical intervention type or complexity.\u003c/p\u003e\u003cp\u003e The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Tawam Hospital (reference number KD/TC/1174).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMaterial\u003c/h3\u003e\n\u003cp\u003e This prospective cohort study was conducted between June 1, 2024, and May 31, 2025, at Tawam Hospital, a tertiary care center in the United Arab Emirates. The study included 59 sexually active women scheduled to undergo urogynecological procedures such as POP repair or UI surgery. Participants were recruited during routine outpatient visits and selected consecutively based on their eligibility.\u003c/p\u003e\u003cp\u003eParticipants were required to meet the following inclusion criteria:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eFemale patients aged 18 years up to 10 years post-menopause.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePlanned urogynecological procedures (e.g., POP repair and UI surgery) during the study period.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAbility to read and understand English or Arabic.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eWillingness and ability to provide informed consent and complete follow-up assessments.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eExclusion criteria included the following:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eWomen who underwent previous urogynecological surgery.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eKnown sexual dysfunction due to non-urogynecological causes.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePresence of psychiatric or neurological comorbidities or other chronic conditions that could independently influence sexual function.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIncomplete medical records or missed follow-up data.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eRefusal or inability to provide informed consent.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\n\u003ch3\u003eMethodology\u003c/h3\u003e\n\u003cp\u003e Written informed consent was obtained from all participants before recruitment. Patients were asked to complete the questionnaires in a private clinical setting, and trained staff were available to offer clarification when needed while ensuring confidentiality.\u003c/p\u003e\u003cp\u003eComplementary clinical and surgical data\u0026mdash;such as diagnosis, procedure type, and relevant preoperative findings\u0026mdash;were extracted from the hospital\u0026rsquo;s Cerner electronic medical record system. The same set of questionnaires was administered again three months postoperatively, allowing for individual pre- and post-intervention comparisons. All collected data were anonymized and stored securely in compliance with research ethics and institutional privacy guidelines.\u003c/p\u003e\n\u003ch3\u003ePelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire – International Revised version (PISQ-IR)\u003c/h3\u003e\n\u003cp\u003eThe Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire \u0026ndash; International Revised version (PISQ-IR) was used to evaluate changes in sexual function before and after surgery. This is a validated condition-specific patient-reported outcome measure tailored for women with floor disorders \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. We used the Arabic version of the PISQ-IR, which has been formally translated and psychometrically validated for Arabic-speaking women \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. It has good internal consistency for five of the six scales in Global Quality (Cronbach's coefficient α\u0026thinsp;=\u0026thinsp;0.86), Condition Impact (α\u0026thinsp;=\u0026thinsp;0.87), Desire (α\u0026thinsp;=\u0026thinsp;0.82), Condition Specific (α\u0026thinsp;=\u0026thinsp;0.74), and Partner Related (α\u0026thinsp;=\u0026thinsp;0.75) \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe PISQ-IR is divided into two modules, one for sexually active and the other for non-sexually active women, allowing for broad clinical applications. This version of the questionnaire covers several critical domains of female sexual function, including desire and arousal, orgasm and satisfaction, condition-specific symptoms (e.g., urinary leakage or bulging during intercourse), partner-related influences, avoidance behaviors, and overall emotional and relational well-being. In the present study, only the sexually active module was used. The items are scored on a 5-point Likert scale. For most questions, the responses ranged from 1 (always) to 5 (never). Positively worded items were scored directly, whereas negatively worded items were reverse-coded so that higher scores consistently indicated better sexual function. The PISQ-IR does not rely on formal cutoff points; rather, outcomes are assessed based on changes in total and domain-specific scores over time.\u003c/p\u003e\u003cp\u003eIn addition to the PISQ-IR, all participants completed a structured demographic survey comprising 12 questions on age, marital status, parity, menopausal status, previous pelvic surgery, relevant medical history, physical activity levels, and smoking status.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eStatistical analysis was conducted using IBM SPSS Statistics, version 28.0 (IBM Corp., Armonk, NY, USA), with a significance threshold set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Descriptive statistics were calculated for all demographic and clinical variables, including frequencies (expressed as absolute numbers and percentages), means, standard deviations, and minimum and maximum values. The distribution of continuous variables such as age, gravidity, and parity was assessed using the Shapiro\u0026ndash;Wilk test for normality. To evaluate the pre- and post-intervention outcomes (Pelvic Symptom and Quality of Life Inventory Revised, PSQR-IR scores), a paired t-test was applied because of the dependent nature of the measurements. Pearson\u0026rsquo;s correlation coefficients were used to explore the relationship between continuous variables, including the association between age and quality-of-life scores before and after the intervention, as well as the magnitude of change in scores.\u003c/p\u003e\u003cp\u003eFrequency distributions were analyzed for categorical variables. Given the exploratory nature of this study and its predominantly descriptive scope, no additional group comparisons were conducted using nonparametric tests. However, post hoc interpretation considered relevant patterns emerging from cross-tabulations of clinical history (e.g., comorbidities, type of delivery, and complications) with symptom burden and surgical outcomes.\u003c/p\u003e\u003cp\u003eAll statistical procedures adhered to standard assumptions and reporting practices to ensure reproducibility and clinical relevance of the findings. Results were considered statistically significant at p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cem\u003eParticipants\u0026rsquo; Demographics and Medical Characteristics of the Study Population\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA total of 59 women were enrolled in this study. Participants\u0026rsquo; ages ranged from 25 to 64 years, with a mean age of 46.76 years (SD = 9.29). Most participants were married (96.6%) and resided in the Emirate of Abu Dhabi. In terms of ethnicity, 74.6% were Emirati nationals, followed by non-local Arabs (13.6%), Asians (8.5%), and Europeans (3.4%). A complete breakdown of demographics is presented in Table 1.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.1 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37.3 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45-55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40.7 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.9 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e96.6 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.4 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eNationality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEmirati\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e74.6 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNon-local Arab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.6 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAsian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.5 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEuropean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.4 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003en \u0026ndash; number of respondents; % \u0026ndash; percentage of respondents\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Sociodemographic characteristics of the respondents (n=59).\u003c/p\u003e\n\u003cp\u003eObstetric history revealed high reproductive exposure (mean gravidity, 6.08; SD = 3.23) and a mean parity of 5.63 (SD = 2.96). The most common mode of delivery was spontaneous vaginal delivery (SVD), reported in 59.3% of cases, followed by cesarean section (CS1\u0026ndash;CS4), accounting for a combined 34.0%. Vacuum-assisted delivery occurred in 3.4% of participants, and one case (1.7%) involved forceps delivery (Table 2).\u003c/p\u003e\n\u003cp\u003eMost participants presented with multiple pelvic floor symptoms reflecting the complex nature of their condition. While 33.9% of women reported POP as an isolated complaint, a substantial proportion experienced overlapping symptoms. The most prevalent mixed condition was stress urinary incontinence (SUI) with POP (27.1%), followed by mixed urinary incontinence (MUI) with POP (8.5%), and urgency urinary incontinence (UUI) with POP (5.1%). Smaller subsets reported isolated SUI (6.8%), UUI (6.8%), or MUI (8.5%). Overflow incontinence (OFI) with POP was rare (3.4%) (Table 2).\u003c/p\u003e\n\u003cp\u003eSurgical treatment was individualized based on symptom presentation, clinical findings, and patient history. Posterior repair was the most frequently performed isolated procedure (11.9%), while combined anterior and posterior repair was performed in 16.9% of patients. Intravesical Botox (13.6%) and Bulkamid injections (6.8%) were primarily used in urgency-dominant incontinence. Less common procedures include sacrospinous fixation, fascial sling, and transobturator tape (TOT). Notably, 20.3% of patients underwent three or more procedures in a single surgical session, reflecting complex pelvic floor pathology.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsidering risk factors, only 16,9% delivered macrosomic children, and only 5.1% are smoking cigarettes. Furthermore, regarding preventive factors, estrogen therapy was reported in 11.9% of women, despite most of them being postmenopausal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInterestingly, participants reported high levels of sexual activity. The group of 80% of participants had sexual intercourse at least once per week, and more than 32 % at least three times per week. The complete breakdown of the clinical symptoms and surgical characteristics is presented in Table 2.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eP1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eP2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eP3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eP\u0026gt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e76.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eMode of Delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSVD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e59.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVacuum-assisted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eForceps Delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCS1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCS2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCS3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCS4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCS1 with Complication B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDelivery of a macrosomic child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e83.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eSymptoms Reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePOP only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSUI only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUUI only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMUI only\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSUI + POP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUUI + POP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMUI + POP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOFI + POP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eSurgical Procedures Performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePosterior Repair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAnterior + Posterior Repair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBulkamid Injection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eIntravesical Botox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFascial Sling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eTransobturator Tape\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSacrospinous Fixation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMulti-procedure (\u0026ge;3 interventions)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e94.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eEstrogen Supplement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e88.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eSexual Activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eThree times per week and more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1-2 times per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEvery other week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRarely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSD = standard deviation; n = number of respondents; % = percentage of respondents; SVD = spontaneous vaginal delivery; CS = cesarean section; POP = pelvic organ prolapse; SUI = stress urinary incontinence; UUI = urgency urinary incontinence; MUI = mixed urinary incontinence; OFI = overflow incontinence.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eMedical and Surgical Characteristics of the Study Population (n=59).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSexual Quality of Life Outcomes\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePre- and postoperative quality of life was assessed using the PSQR-IR. At baseline, the mean PSQR-IR score was 33.87 (SD = 7.76), indicating moderate impairment. Following surgical intervention, the mean score increased to 84.98 (SD = 8.07), demonstrating a significant improvement in patient-reported outcomes at the three-month follow-up. The difference between pre- and postoperative scores was statistically significant (t = \u0026ndash;36.18, p \u0026lt; 0.0001) (Figure 1). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cbr\u003e \u003cem\u003eNote: Data represent average scores at baseline and three months postoperatively. Higher scores reflect better subjective quality of life.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Wilcoxon signed-rank test subgroup analysis revealed consistent improvements across all domains of the PSQR-IR, including arousal, desire, and global quality (p \u0026lt; 0.05) (Table 3). It is interesting to note that these patients observed an improvement in partner-related arousal. \u0026nbsp;Moreover, patients reported reduced pelvic heaviness, less urgency or leakage, and fewer limitations on physical activity.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"607\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDomain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTime\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eZ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\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 rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eArousal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBefore surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-5.933\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;After surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePartner_related\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBefore surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-5.465\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAfter surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eCondition_specicic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBefore surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-6.697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;After surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eCondition_impact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBefore surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-6.658\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAfter surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eGlobal_quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBefore surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-6.464\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAfter surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDesire\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBefore surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e-2.241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAfter surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSD = standard deviation\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e PISQ-IR subgroup analysis\u003c/p\u003e\n\u003cp\u003eUnivariate analysis of variance did not show a statistically significant difference between the initial diagnosis and quality of life determined using the PSQR-IR Score, both before (F(2.4), p=0.100) and after surgery (F (1.905), p = 0.158) (Table 4).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\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 rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003ePSQR-IR before surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePOP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e2.400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMIX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003ePSQR-IR after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePOP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e87.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e1.905\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e83.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMIX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e83.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eDifference between PSQR-IR results before and after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePOP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8,84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.552\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMIX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003en \u0026ndash; number of respondents; % \u0026ndash; percentage of respondents; SD \u0026ndash; standard deviation; POP = pelvic organ prolapse; UI = urinary incontinence; MIX= both POP+ UI\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eCorrelation Between Initial Diagnosis and PSQR-IR Outcomes\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRisk and Protective Factors Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePearson\u0026rsquo;s correlation coefficient revealed no significant relationship between age and baseline PSQR-IR scores (r = \u0026ndash;0.110, p = 0.408). However, a significant negative correlation was identified between age and postoperative PSQR-IR scores (r = \u0026ndash;0.504, p \u0026lt; 0.001), indicating that younger women tended to report greater improvements. The change in scores (postoperative minus preoperative) also showed a statistically significant negative correlation with age (r = \u0026ndash;0.305, p = 0.019), suggesting that age may be an independent predictor of perceived benefit (Table 5).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable Pair\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation Coefficient (r)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\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\"\u003e\n \u003cp\u003eAge \u0026amp; PSQR-IR1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.408\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge \u0026amp; PSQR-IR2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.504\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge \u0026amp; Score Change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u0026nbsp;\u003c/strong\u003eCorrelation Between Age and PSQR-IR Outcomes\u003c/p\u003e\n\u003cp\u003eNo statistically significant correlations were observed between protective factors (estrogen supplementation), risk factors (fetal macrosomia, parity, smoking, and mode of delivery) on the one hand, and sexual satisfaction (measured by the PSQR-IR score).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eSexual dysfunction in women with POP and UI is multifactorial. It frequently results from a combination of physical symptoms such as vaginal bulging, dyspareunia, and involuntary leakage during intercourse, as well as emotional distress, reduced self-esteem, and alterations in body image \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. These factors can jointly affect sexual desire, arousal, and satisfaction, often leading to avoidance of intimacy or strain in partner relationships \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn the present study, the resolution of these symptoms through surgical intervention was associated with substantial improvements in the reported sexual well-being. This reinforces the notion that surgical intervention for POP and UI can significantly improve both sexual function and overall quality of life. Moreover, the findings suggest that, while all patients benefit from surgery, younger individuals may experience greater perceived quality-of-life gains.\u003c/p\u003e\u003cp\u003eUsing the validated PISQ-IR questionnaire, our findings revealed statistically and clinically meaningful improvements in patient-reported outcomes, a trend that mirrors the conclusions drawn in similar research \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. The use of a condition-specific tool such as the PISQ has proven to be essential in evaluating the nuanced aspects of sexual recovery \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe positive outcomes observed in our cohort align with existing evidence, suggesting that prolapse and continence surgeries can help restore self-confidence, improve genital self-perception, and enhance communication with partners \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Notably, younger participants in our study reported a greater magnitude of improvement, which echoes prior findings linking age, hormonal environment, and baseline sexual function with postoperative success \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Conversely, older women demonstrate modest gains, potentially attributable to estrogen deficiency, tissue atrophy, or reduced baseline intimacy \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. The observed improvements were most notable in younger women; however, the benefits were evident across the cohort, emphasizing the broad therapeutic potential of such interventions. However, we did not find any correlation between estrogen supplementation and higher PISQ scores. The reason for this might be the size of the group, where below 12% of participants have estrogen supplementation. This pattern highlights an ongoing gap in the awareness or accessibility of localized estrogen interventions despite the documented benefits in optimizing surgical recovery and comfort \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. It may be beneficial for clinicians to proactively address the hormonal status in the perioperative setting, particularly in postmenopausal patients.\u003c/p\u003e\u003cp\u003eOur findings also support the use of individualized surgical approaches such as native tissue repair, biological grafts, and minimally invasive slings, all of which have demonstrated favorable outcomes when appropriately applied \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Avoidance of transvaginal meshes in our cohort is consistent with recent shifts in surgical practice due to concerns about postoperative pain, dyspareunia, and erosion risks \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eTaking into account risk factors such as multiparity, delivery of macrosomic babies, and smoking, the present study did not show any influence on women\u0026rsquo;s sexual quality of life either before or after surgery. Considering that multiparity and births in macrosomic children are associated with vaginal prolapse and enlargement of their size, these results are surprising \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Likewise, protective factors, such as estrogen therapy, which improves the biological quality of vaginal tissues and their lubrication, did not substantially improve sexual satisfaction among the women studied \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Contrary to expectations, the results may be explained by Rosemary Basson\u0026rsquo;s notion that the emotional component of sexual satisfaction predominates over the biological component among the women examined \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eNonetheless, it is important to acknowledge that not all women in our study experienced resolution of their sexual concerns. A subset reported persistent discomfort, vaginal tightness, or fear of recurrence, findings that were echoed in qualitative studies exploring the emotional aftermath of reconstructive pelvic surgery \u003csup\u003e\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. These insights emphasize the importance of comprehensive preoperative counseling that extends beyond anatomical outcomes to include honest discussions about expectations of sexual function. What is reassuring is that in the present study, the frequency of sexual activity was high, with more than 96% reporting sexual activity at least once a week. Considering the decreasing sexual activity among middle-aged women in Europe and the US, these results are really reassuring \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. These results might be due to the specific group of participants who underwent vaginal surgery. We can hypothesize that they pay more attention to aesthetics and functionality of their genital areas than the general population.\u003c/p\u003e\u003cp\u003eIn summary, our study adds to the growing call for sexual health to be treated as an integral component of urogynaecologic care. As highlighted in prior research, women\u0026rsquo;s sexual function is influenced not only by physical and hormonal factors but also by psychological, emotional, and interpersonal elements \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Future research and clinical practice should continue to consider this complexity in the pursuit of holistic recovery.\u003c/p\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis study has several limitations that should be considered when interpreting the results. First, it was conducted at a single tertiary care center and reflects the experience of a specific patient population, which may limit its generalizability to other settings. While the PISQ is a validated and sensitive instrument, it is a self-reported measure that is subject to recall bias and social desirability effects. Additionally, factors known to influence sexual function, such as partner satisfaction, mental health, and relationship quality, were excluded from the dataset.\u003c/p\u003e\u003cp\u003eAnother key limitation is the short follow-up period of three months. Although this enables the assessment of early postoperative outcomes, it may not reflect the long-term durability of improvements or delayed complications. Furthermore, the role of hormonal status, particularly estrogen use, has not been fully standardized, making it difficult to assess its effect on postoperative recovery, especially in postmenopausal women.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eStrengths\u003c/h2\u003e\u003cp\u003eDespite the limitations, this study had several strengths. This is among the few prospective investigations in the region that have explicitly evaluated sexual function after pelvic floor surgery. Moreover, it presents the sexual activity of patients in the region. The use of a validated condition-specific tool (PISQ) allowed for a nuanced and targeted evaluation of sexual health outcomes that were most relevant to this population. We documented significant postoperative gains across multiple domains of physical and emotional well-being. Generic quality-of-life metrics often lack sensitivity to specific domains of interest in pelvic floor research \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. By employing the PISQ, we were able to generate richer and more meaningful data that could directly inform patient counseling and shared decision-making.\u003c/p\u003e\u003cp\u003eMoreover, all procedures were conducted by a specialized urogynecology team to ensure surgical consistency and adherence to best practices. Clinical documentation was thorough, and patient characteristics were well defined, supporting the reliability of the findings. Importantly, this study contributes region-specific data to the global evidence base and underscores the importance of integrating sexual health considerations into routine urogynaecologic care.\u003c/p\u003e\u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThis study confirmed that urogynaecological surgical treatment for pelvic organ prolapse and urinary incontinence can substantially improve sexual function and quality of life in women. These findings support the value of integrating sexual health into standard pre- and postoperative evaluations and counseling. Moreover, the present findings highlight the importance of age-related factors in outcome interpretation, suggesting that early surgical interventions should be considered. However, the persistence of postoperative sexual concerns in a subset of patients reinforces the importance of comprehensive patient education and realistic goal-setting. By adopting a patient-centered approach and addressing both the anatomical and psychosocial dimensions, clinicians can enhance long-term outcomes and support holistic recovery in women with pelvic floor disorders.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003e\u003cb\u003eAdditional Information\u003c/b\u003e:\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization: M. A-K.; A.B.; K.Z., methodology: M. A-K.; A.B.; K.Z., formal analysis: K.Z. S.W., investigation: M. A-K.; A.B., resources: M. A-K., data curation: M. A-K., writing\u0026mdash;original draft preparation: M.A-K.; K.Z., writing\u0026mdash;review and editing: K.Z., supervision: K.Z.; A.B., project administration: M.A-K.; K.Z.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed in the current study are available as supplementary materials.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSurgical management of. pelvic organ prolapse in women. in Cochrane Database of Systematic Reviews (ed. Maher, C.) (John Wiley \u0026amp; Sons, Ltd, Chichester, UK, doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/14651858.cd004014.pub5\u003c/span\u003e\u003cspan address=\"10.1002/14651858.cd004014.pub5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 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Trends in Frequency of Sexual Activity and Number of Sexual Partners Among Adults Aged 18 to 44 Years in the US, 2000\u0026ndash;2018. \u003cem\u003eJAMA Netw. Open.\u003c/em\u003e \u003cb\u003e3\u003c/b\u003e, e203833 (2020).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"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":"urogynecology, sexual function, quality of life, PISQ, pelvic floor surgery, women’s health","lastPublishedDoi":"10.21203/rs.3.rs-7966203/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7966203/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePelvic floor disorders such as pelvic organ prolapse (POP) and urinary incontinence (UI) are common among women and have a documented negative impact on their sexual function and overall quality of life. This study aimed to assess changes in sexual function and quality of life in women undergoing urogynecological procedures and identify factors associated with postoperative sexual outcomes. A prospective cohort of 59 sexually active women who underwent surgical management for POP or UI at Tawam Hospital was followed up between June 1, 2024, and May 31, 2025. Participants completed a demographic survey and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) before surgery and again three months postoperatively. PISQ scores showed a statistically significant improvement after surgery (33.87 (SD\u0026thinsp;=\u0026thinsp;7.76) vs 84.98 (SD\u0026thinsp;=\u0026thinsp;8.07)), with a mean increase of 51.1 points (t = \u0026minus;\u0026thinsp;36.18, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating pelvic discomfort, urinary control, physical mobility, and sexual function. Younger patients experienced greater improvements, while menopausal status appeared to moderate the extent of the benefits (r = \u0026minus;\u0026thinsp;0.504, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These findings highlight the importance of including sexual health in preoperative counseling and support the use of validated tools such as the PISQ for routine outcome monitoring and introducing surgical interventions at an earlier age.\u003c/p\u003e","manuscriptTitle":"Quality of Sexual Function After Urogynecological Surgical Procedures: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-19 12:01:09","doi":"10.21203/rs.3.rs-7966203/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":"da832168-e854-4576-92fb-8d1fb2fe151c","owner":[],"postedDate":"November 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":58117348,"name":"Health sciences/Diseases"},{"id":58117349,"name":"Health sciences/Health care"},{"id":58117350,"name":"Health sciences/Medical research"},{"id":58117351,"name":"Health sciences/Urology"}],"tags":[],"updatedAt":"2026-04-28T12:11:00+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-19 12:01:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7966203","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7966203","identity":"rs-7966203","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}