Sexual Function Among Women Before and After Urogenital Fistula Repair; A Quasi-Experimental Study

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According to the World Health Organization (WHO), between 50,000 and 100,000 women worldwide develop obstetric fistula each year, which creates an abnormal opening between a woman’s genital tract and her urinary tract or rectum. It is estimated that over 2 million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa. This study aimed to evaluate changes in sexual function among women before and after undergoing urogenital fistula repair. Methods The study used a quasi-experimental design to evaluate the sexual function of respondents before and after urogenital fistula repair. The study recruited all 171 women diagnosed with urogenital fistula and undergoing surgical repair at (give the study sites) over (time period). Data on background characteristics like age and parity and sexual function score using the Female Sexual Function Index (FSFI) questionnaire were collected before repair and during follow-up visits three to six months after repair. The Willcoxon Signed-rank test was used to compare sexual function, before and after fistula repair. Statistical significance was set at p < 0.05. Results About a third of the women (33.9%) were aged 41 to 50, 42.1% were junior high school levers, and 40.4% were married. Almost all (90.1%) of the women had female sexual dysfunction (FSD) before the repair, and 1.7% had it after the repair. FSD after the repair decreased significantly (z = -11.14, p < 0.001), with a mean difference of -26.24 (95% CI: (-28.27, -24.21). Conclusion Urogenital fistula repair improved sexual function among affected women. While successful repair may lead to improvements, necessitating comprehensive post-operative care and support. Addressing sexual concerns in the management of urogenital fistula is essential to optimize the overall well-being of the affected women. Urogenital fistula Sexual function Female Sexual Function Index Reproductive health and Surgical repair Ghana Figures Figure 1 Introduction Urogenital fistula is a debilitating condition characterized by an abnormal communication between the urinary and genital tracts, most commonly presenting as vesicovaginal fistula (between the bladder and vagina) or ureterovaginal fistula (between the ureter and vagina), resulting in continuous and involuntary urinary leakage [ 1 ]. These fistulas arise from a range of etiologies, including surgical trauma, malignancy, radiation therapy, and obstructed labor [ 2 – 3 ]. A key subtype is obstetric fistula, which occurs specifically due to prolonged, obstructed labor in the absence of timely medical intervention. The sustained pressure from the fetal head compromises blood supply, leading to ischemic necrosis of surrounding tissues and the eventual formation of vesicovaginal or rectovaginal fistulas [ 4 ]. Importantly, while all obstetric fistulas are urogenital in nature, not all urogenital fistulas are obstetric in origin an essential distinction for understanding their differing clinical and psychosocial implications. Surgical repair is the mainstay of treatment and is generally effective in restoring urinary continence. However, its effect on sexual function is more variable and less frequently reported. Some studies indicate post-operative improvements in sexual activity and satisfaction, while others reveal persistent issues such as dyspareunia, diminished libido, and fear of recurrence [ 2 , 5 – 6 ]. For instance, Pope et al. found that only 35.6% of women resumed sexual intercourse following repair 5 . In contrast, other studies document women requesting reversal of the repair due to painful intercourse or the loss of alternative sexual practices adapted during the period of incontinence [ 7 – 8 ]. Outcomes may vary depending on the type and timing of surgical intervention. Techniques such as the Latzko partial colpocleisis and transvaginal flap procedures can differentially impact vaginal length, elasticity, and ultimately sexual satisfaction [ 3 – 9 ]. Delayed surgical intervention, particularly after prolonged duration of fistula, may be associated with extensive pelvic scarring and fibrosis, further compromising sexual outcomes. Despite growing recognition of these issues globally, there is a paucity of data from Ghana regarding the sexual health of women before and after fistula repair. This gap limits the ability to provide tailored rehabilitation and counseling. Therefore, this study aims to evaluate changes in sexual function among women undergoing surgical repair for urogenital fistula at Komfo Anokye Teaching Hospital and Mercy Women Hospital in Ghana. Methods Study Design and Setting: This research employed a quasi-experimental study design using before-and-after approach. Given the study's objectives, research inquiries, and aims, a quantitative design was adopted utilizing a descriptive approach. The study was conducted within the Obstetrics and Gynecology Directorate of the Komfo Anokye Teaching Hospital (KATH) in the Ashanti Region of Ghana, and the Mercy Women’s Catholic Hospital in Mankessim, Central Region. KATH offers urogenital fistula care at its urogynecology clinic. The mainstay of treatment is the surgical correction of the fistula if conservative management fails. This is performed via the abdominal route for ureterovaginal fistulae or through the vaginal or abdominal route for vesicovaginal fistulae. There is no dedicated fistula center at KATH; fistula surgery is included in Urogynecology services. The facility sees an average of eighty fistula cases each year. The Mercy Women’s Catholic Hospital, established by the Catholic Archdiocese of Cape Coast in 2009, operates a specialized fistula unit with a 45-bed ward, outpatient department, lab, consulting rooms, and pharmacy. It hosts quarterly repair missions by specialists from Korle Bu and Komfo Anokye Teaching Hospitals. The unit receives patient referrals and conducts outreach programs in villages to identify cases. A multidisciplinary team provides comprehensive care. The center treats approximately 80–100 fistula cases annually. Study population The study population comprised women diagnosed with urogenital fistula who underwent surgical repair at the urogynaecology clinics of KATH and Mercy Women’s Catholic Hospital. Recruitment for the pre-repair phase occurred from 28th February to 30th September 2022. Inclusion Criteria The study included all women diagnosed with urogenital fistula who were scheduled to undergo surgical repair. Eligible participants consented to participate in follow-up assessments and were available for clinical and psychosocial evaluation for a minimum duration of six months post-repair, with potential follow-up extending up to twelve months to monitor outcomes and long-term recovery trajectories. Exclusion criteria Participants were excluded from the study if they were deemed eligible but presented with severe or life-threatening illness at the time of enrolment, as such conditions may confound outcome measures or impede informed participation. Additionally, individuals who were unlikely to be available for follow-up within the 6 to 12 months post-repair period were also be excluded, as consistent follow-up is essential for the accurate assessment of long-term outcomes and the overall effectiveness of the intervention. Surgical Method Overview The respondents were either diagnosed of vesicovaginal fistula or ureterovaginal fistula. Diagnosis of vesicovaginal fistulas were made through history of involuntary urinary leakage per vaginum that was preceded either by an obstructed labour which may or may not have been relieved by caesarean section or a gynecological surgery, mostly hysterectomy. Diagnosis was confirmed by methylene blue dye test and Goh classification made for all confirmed cases of vesicovaginal fistula. Ureterovaginal fistulas were diagnosed from a history of antecedent gynecological surgery, mostly hysterectomy or a difficult caesarean section which often led to caesarean hysterectomy. Diagnosis was confirmed by abdominal ultrasound, cystoscopy and pyelography. A double dye test was sometimes helpful to differentiate between a vesicovaginal fistula and ureterovaginal fistula. Surgical repair of vesicovaginal fistulas were either done through the vaginal route or the abdominal route based on the Goh classification, the ease of repair and the experience of the surgeon. Ureterovaginal fistula repair was done abdominally, and it was mostly by ureteroneocystostomy (ureteric reimplantation). A few had to undergo Psoas hitch and Boari flaps [ 10 ]. Variables The outcome variable of interest is the sexual function of the participants after they underwent surgical repair of vesicovaginal fistulas. The intervention provided here is the surgical repair of the vesicovaginal fistulas. Vesicovaginal fistula is the main exposure variable. Potential confounders included the age of the participants, their educational backgrounds, marital status and religious affiliations. Sample Size and Sampling All 171 women who were diagnosed and underwent surgical repair from 28th February 2022 to 30th September 2022 were recruited into the study. Ninety were recruited from Mercy Women’s Catholic Hospital, and 81 from KATH. The formula used in the calculation of the sample size required mean scores and standard deviations for quality of life and sexual functions. Means and standard deviation for the sample size determination were taken from a study conducted in Nigeria. Assuming the mean 1 , 67.9 for quality of life; standard deviation 1 of 4.4 for quality of life and mean 2 96.3 for sexual function; standard deviation 2 of 3.4 for sexual function, the sample size was 166 at 90% power using the formular below; Where N = Sample size, V = level of significance, σ 1 = standard deviation for mean score before surgery, σ 2 = standard deviation for mean score after surgery, µ 1 = Mean score before surgery, µ 2 = Mean score after surgery. Ten percent of the calculated sample size were added. However, responses of 171 were achieved. Total sampling was used to recruit participants. Patients who did not give consent were not added to the study. Recruitment of participants were made upon diagnosis of urogenital fistula at the outpatient clinics of Urogynecology, KATH and the fistula outpatient clinic of the Mercy Women’s Catholic Hospital, Mankessim. Data Collection Methods A validated questionnaire was used which comprised the Female Sexual Distress Scale-Revised (FSDS-R) (provide reference for this scale) to measure distress linked to insufficient or impaired sexual function. In order to assess sexually associated distress in women with hypoactive sexual desire disorder or to serve as a screening tool to distinguish between women with high and poor sexual function, a revised 13-item scale (FSDS-R) with robust psychometric qualities was used. The FSDS and/or FSDS-R have received widespread adoption which was offered in ten different languages, and have good internal consistency, reliability, and validity in their translated forms 11 . Statistical Analysis Data was entered in Microsoft Excel and cleaned weekly to ensure accuracy, consistency, and completeness. Statistical analysis was conducted using Stata version 17 (Stata Corp, TX, USA). Means and standard deviations were calculated for the continuous variables. Frequency and percentages were computed for the categorical variables. Shapiro-Wilk test was used to assess the normality of the continuous variables. Wilcoxon Signed-ranked test was used to assess the pair-wise comparison for FSD before urogenital fistula repair and after. Ethical consideration Ethnical clearance was obtained from Komfo Anokye Teaching Hospital Institutional Review Board with reference number KATHIRB/AP/071/21. Permission was obtained from the management of facilities prior to the conduct of the study. Also, a written informed consent was obtained from all the participants. Results Socio-demographic Characteristics of women with urogenital fistula Overall, 171 women who underwent urogenital fistula repair were included in the study. Table 1 shows the socio-demographic characteristics of the participants. Fifty-eight (33.9%) were aged 41 to 50 and only 6 (3.5%) were aged 60 plus. Slightly more than a fifth (21.6%) were aged 17–30 years. Also, 72 (42.1%) of them went to junior high school and 6 (3.5%) had tertiary education. Less than half (n = 69; 40.4%) were married. Table 1 Socio- Demographic characteristics of women with urogenital fistula Variables Frequency (n = 171) Percentage (%) Age in years 17–30 37 21.6 31–40 49 28.7 41–50 58 33.9 51–60 21 12.3 60+ 6 3.5 Education Level No formal Education 41 23.9 Primary 29 17.0 Junior High School 72 42.1 Senior High School 23 13.5 Tertiary 6 3.5 Religion Christian 120 70.2 Islam 51 29.8 Marital Status Married 69 40.4 Single 27 15.8 Widowed/Divorced/Separated 75 43.8 Sexual function before and after fistula repair Figure 1 shows that 154 (90.1%) of the women with urogenital fistula had FSD before repair. Assessment of the FSD was carried which revealed the dysfunction decreased after repair (n = 3; 1.7%) There was a significance decrease in FSD among women with urogenital fistula at the end of the urogenital fistula repair. The mean difference was − 26.24 (95% CI: -28.27, -24.21; p < 0.001) as shown in Table 2 . Table 2 Willcoxon signed-rank showing association between sexual functions before and after fistula repair among women with urogenital fistula Variable Mean SD Diff (95% CI) Wilcoxon signed-rank test z P-value Before fistula repair 3.93 5.21 -26.24 (-28.27, -24.21) -11.14 < 0.001 After fistula repair 30.16 12.53 Discussion The dramatic and statistically significant decline in female sexual distress (FSD) following urogenital fistula repair dropped from 90.1% pre-repair to 1.7% post-repair. This study corroborates a study by Pope et al., who reported a significant reduction in FSD following repair of vesicovaginal fistula (VVF). However, one-third of participants regained normal sexual function, a subset developed new dysfunctions [ 5 ]. Similarly, a longitudinal study observed a decrease in dyspareunia (from 27–10%) alongside increased sexual activity within a year post-repair 12 . Successful anatomical closure of vesicovaginal fistulae results in significant improvement in urinary symptoms, general well-being, and quality of life, with no long-term adverse effects on bowel function more readily than psychological health [ 13 – 15 ]. Globally, young women aged 17 to 30 years represent a significant proportion of those affected 16by urogenital fistula, with studies indicating that up to 65–80% of cases occur in women under the age of 30, often due to prolonged obstructed labor in early childbirth. In Africa, where the condition remains most prevalent due to limited access to quality maternal health care, the proportion is similarly high. Research from countries like Nigeria, Ethiopia, and Uganda consistently shows that the majority of fistula patients fall within this age range, with many being adolescents or in their early twenties at the time of injury. The early age of first childbirth, compounded by poverty, limited education, and inadequate health services, contributes significantly to the vulnerability of young women to this debilitating condition [ 16 – 18 ]. The primary cause of urogenital fistula in relatively young women (aged 17 to 30) is prolonged obstructed labor, which occurs when a woman experiences labor that lasts for several hours or even days without adequate medical intervention. This is especially common among adolescents whose bodies may not be fully developed for childbirth, leading to pressure necrosis between the baby’s head and the mother's pelvic tissues, resulting in a hole (fistula) between the bladder and vagina or rectum. Several contributing factors increase the risk in young women, including early marriage and childbearing, poor access to skilled obstetric care, malnutrition (which can lead to stunted growth and a small pelvis), poverty, and lack of education. These social determinants not only delay access to emergency obstetric services but also increase the likelihood of home births without trained attendants, heightening the risk of fistula formation. Several mechanisms plausibly underlie the observed decline in FSD post-repair. Firstly, the surgical closure of the fistula effectively halts involuntary urinary leakage, thereby removing one of the most distressing and stigmatizing symptoms that contribute to sexual avoidance and psychological distress. The restoration of continence enhances self-esteem, body image, and sexual confidence, facilitating re-engagement in intimate relationships. Alleviation of dyspareunia, often secondary to tissue damage or inflammation, further promotes sexual rehabilitation [ 12 ]. Additionally, the symbolic and relational significance of the repair fosters social and marital reintegration, which acts as a psychological catalyst for improved sexual function [ 5 ]. Furthermore, the integration of comprehensive fistula care, including mental health support, marital counselling, and sexual health education, contributes to the reduction of psychological distress and creates a conducive environment for holistic recovery. These supportive interventions, when paired with improved physical health and restored dignity, may reinforce the return to sexual well-being and societal participation. Strengths and Limitations A key strength of this study is its focus on a relatively underexplored yet critically important dimension of post-fistula recovery sexual function. By employing a pre- and post-repair design, the study captures longitudinal changes in FSD, allowing for a robust evaluation of the impact of surgical intervention. The dramatic reduction in FSD from 90.1–1.7% provides compelling evidence of the clinical and psychosocial benefits of fistula repair. Furthermore, the inclusion of participants from two tertiary-level fistula centers (Komfo Anokye Teaching Hospital and Mercy Women’s Hospital) enhances the representativeness of the findings for the Ghanaian context and strengthens the external validity of the results. The use of standardized clinical assessments and the incorporation of psychosocial dimensions (such as marital reintegration and psychological well-being) also underscore the multidimensional approach adopted in evaluating sexual health outcomes. However, several limitations merit consideration. First, the absence of a validated, fistula-specific sexual function questionnaire may have limited the sensitivity of outcome measurement, especially for capturing nuanced changes in desire, arousal, or emotional intimacy. Second, while the study demonstrates a statistically significant decline in FSD, it does not control for potential confounders such as partner support, duration of incontinence before repair, or underlying mental health conditions, all of which may influence sexual function. Additionally, the follow-up period may have been insufficient to fully assess the long-term sustainability of improvements or the emergence of delayed sexual dysfunction. The study's reliance on self-reported data may also introduce recall or social desirability bias, particularly given the cultural sensitivities around discussing sexual matters. Finally, the generalizability of the findings beyond Ghana may be limited, as access to comprehensive fistula care and psychosocial support may vary significantly across different sub-Saharan African contexts. Conclusion This study demonstrates that surgical repair of urogenital fistula leads to a profound and statistically significant reduction in female sexual distress (FSD), with rates dropping from 90.1% pre-repair to just 1.7% post-repair among women treated. These findings not only affirm the physical benefits of fistula repair but also underscore the substantial psychosocial recovery that can occur when surgical treatment is integrated with comprehensive post-operative care. The restoration of continence, reduction in dyspareunia, and enhanced body image collectively contribute to improved sexual function and reintegration into intimate and social life. However, the fact that only one-third of participants achieved full sexual function post-repair, while a subset developed new dysfunctions, highlights the need for a more nuanced and multidisciplinary approach to recovery. From a clinical practice standpoint, this study advocates for the routine incorporation of sexual health evaluation and counselling into the continuum of fistula care. Addressing sexual function as a core outcome, rather than an ancillary concern, is essential to achieving holistic recovery. Health care providers should receive training in the identification and management of sexual dysfunction, and facilities should be equipped to offer individualized psychosocial support, including mental health services and marital or relationship counselling. At the policy level, these findings underscore the urgent need to scale up investments in fistula prevention and rehabilitation services. Strategies should include promoting delayed age at marriage and first childbirth, improving access to emergency obstetric care, and integrating sexual and reproductive health education into national health agendas. Additionally, national fistula programs should adopt standardized post-repair follow-up protocols that include sexual function assessments, particularly for young women who represent a disproportionately affected demographic. Strengthening referral networks for continued care and reintegration services will further support long-term recovery and quality of life. Declarations Ethical Approval and Consent to Participate This study was conducted following the ethical principles outlined in the Declaration of Helsinki. Ethical Approval was obtained from the Komfo Anokye Teaching Hospital Institutional Review Board with reference number KATHIRB/AP/071/21. Permission was obtained from the management of KATH and Mercy Women’s Catholic Hospital prior to the commencement of the study. All participants were informed about the objectives, procedures, potential risks and benefits of the study, and written informed consent was obtained from each participant before data collection. All procedures involving human participants were performed following institutional and national research ethics standards. All participants provided written informed consent to participate in this study. Consent for Publication Not Applicable Availability of Data and Material Data used for the study are available upon request. Please contact the corresponding author for access. Competing Interest Authors have no competing interests. Funding The study was self-funded. No external funding support was obtained for this research. Authors contribution KGA: conceptualization, methodology, investigation, writing - original draft. JA: Methodology, formal analysis, writing JBY: methodology, formal analysis. JA: data curation. VOA: review and editing, Methodology JO: supervision, validation, review and editing. FJO: data curation. SYA: supervision, validation, review and editing. WKA: supervision, validation, review and editing. HSO: supervision, validation, review and editing. All authors approved the version to be published and agreed to be accountable for all aspects of the work. Acknowledgements We acknowledge all the data collectors and study participants for their involvement in the study. We also acknowledge the support of the Head of Department of the KATH Obstetrics and Gynaecology Department and the Administrator of Mercy Women’s Catholic Hospital. References De Ridder D, Badlani GH, Browning A, et al. Fistulas in the developing world. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence. 4th ed. Paris, UK: Health Publications Ltd; 2009. pp. 1419–58. Wall LL. Obstetric vesicovaginal fistula as an international public-health problem. Lancet. 2006;368(9542):1201–9. Tebeu PM, Fomulu JN, Khaddaj S, de Bernis L, Delvaux T, Rochat CH. Risk factors for obstetric fistula: a clinical review. Int Urogynecol J. 2012;23(4):387–94. El AAM, Barageine J, Korn A, Kakaire O, Turan J, Obore S, et al. Trajectories of women’ s physical and psychosocial health following obstetric fistula repair in Uganda: a longitudinal study. Trop Med Int Health. 2019;24(1):53–64. Pope R, Ganesh P, Chalamanda C, Nundwe W, Wilkinson J. Sexual function before and after vesicovaginal fistula repair. J Sex Med. 2018;15(8):1125–32. Raassen TJ, Verdaasdonk EG, Vierhout ME. Prospective results after first-time surgery for obstetric fistulas in East African women. Int Urogynecol J. 2008;19:73–9. Wilkinson JP, Lyerly AD, Masenga G, et al. Ethical dilemmas in women’s health in under-resourced settings. Int J Gynecol Obstet. 2011;113:25–7. Anzaku SA, Lengman SJ, Mikah S, et al. Sexual activity among Nigerian women following successful obstetric fistula repair. Int J Gynecol Obstet. 2017;137:67–171. Hilton P. Vesico-vaginal fistulas in developing countries. Int J Gynaecol Obstet. 2003;82(3):285–95. Hanif MS, Saeed K, Sheikh MA. Surgical management of genitourinary fistula. JOURNAL-PAKISTAN Med ASSOCIATION. 2005;55(7):280. Singh V, Jhanwar A, Mehrotra S, Paul S, Sinha RJ. A comparison of quality of life before and after successful repair of genitourinary fistula: Is there improvement across all domains of WHOQOL-BREF questionnaire? http://dx.doi.org/10.1016/j.afju.2015.06.003 El Ayadi AM, Nalubwama H, Miller S, Mitchell A, Korn AP, Chen CC, Byamugisha J, Painter C, Obore S, Barageine JK. Women’s sexual activity and experiences following female genital fistula surgery. J Sex Med. 2023;20(5):633–44. Umoiyoho AJ, Inyang-Etoh EC, Abah GM, Abasiattai AM, Akaiso OE. Quality of life following successful repair of vesicovaginal fistula in Nigeria. Rural Remote Health. 2011;11(3):102–8. Grewal M, Pakzad MH, Hamid R, Ockrim JL, Greenwell TJ. The medium-to long-term functional outcomes of women who have had successful anatomical closure of vesicovaginal fistulae. Urol Annals. 2019;11(3):247–51. Debela TF, Hordofa ZA, Aregawi AB, Sori DA. Quality of life of obstetrics fistula patients before and after surgical repair in the Jimma University Medical Center, Southwest Ethiopia. BMC Womens Health. 2021;21(1):212. Wall LL, Arrowsmith SD, Briggs ND, Browning A, Lassey A. The obstetric vesicovaginal fistula in the developing world. Obstet Gynecol Surv. 2005;60(7):S3–51. World Health Organization. 10 facts on obstetric fistula [Internet]. 2018 [cited 2025 May 3]. Available from: https://www.who.int/news-room/fact-sheets/detail/obstetric-fistula United Nations Population Fund—UNFPA. InThe Europa Directory of International Organizations 2022 2022 Jul 28 (pp. 293–6). Routledge. 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. 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Sciences","correspondingAuthor":false,"prefix":"","firstName":"Wisdom","middleName":"Klutse","lastName":"Azanu","suffix":""},{"id":501842154,"identity":"f1b4d6f6-999e-4309-906e-8a46e814e688","order_by":9,"name":"Henry Sakyi Opare-Addo","email":"","orcid":"","institution":"Komfo Anokye Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Henry","middleName":"Sakyi","lastName":"Opare-Addo","suffix":""}],"badges":[],"createdAt":"2025-08-11 12:08:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7346142/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7346142/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89388181,"identity":"6070a69e-cab7-4cff-9db9-293de8a1810b","added_by":"auto","created_at":"2025-08-19 12:40:49","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":146958,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSexual function before and after fistula repair (Shouldn’t ‘Before repair’ come before ‘After repair’?)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7346142/v1/ce81efd6508f6d82ad1c0a4d.jpeg"},{"id":89390596,"identity":"3c0ecab4-2abe-46a1-86c8-4298343c7678","added_by":"auto","created_at":"2025-08-19 12:56:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":891442,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7346142/v1/3df6e147-b692-425b-91c8-0f10dce2cc32.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eSexual Function Among Women Before and After Urogenital Fistula Repair; A Quasi-Experimental Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUrogenital fistula is a debilitating condition characterized by an abnormal communication between the urinary and genital tracts, most commonly presenting as vesicovaginal fistula (between the bladder and vagina) or ureterovaginal fistula (between the ureter and vagina), resulting in continuous and involuntary urinary leakage [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These fistulas arise from a range of etiologies, including surgical trauma, malignancy, radiation therapy, and obstructed labor [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA key subtype is obstetric fistula, which occurs specifically due to prolonged, obstructed labor in the absence of timely medical intervention. The sustained pressure from the fetal head compromises blood supply, leading to ischemic necrosis of surrounding tissues and the eventual formation of vesicovaginal or rectovaginal fistulas [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Importantly, while all obstetric fistulas are urogenital in nature, not all urogenital fistulas are obstetric in origin an essential distinction for understanding their differing clinical and psychosocial implications.\u003c/p\u003e\u003cp\u003eSurgical repair is the mainstay of treatment and is generally effective in restoring urinary continence. However, its effect on sexual function is more variable and less frequently reported. Some studies indicate post-operative improvements in sexual activity and satisfaction, while others reveal persistent issues such as dyspareunia, diminished libido, and fear of recurrence [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. For instance, Pope et al. found that only 35.6% of women resumed sexual intercourse following repair\u003csup\u003e5\u003c/sup\u003e. In contrast, other studies document women requesting reversal of the repair due to painful intercourse or the loss of alternative sexual practices adapted during the period of incontinence [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOutcomes may vary depending on the type and timing of surgical intervention. Techniques such as the Latzko partial colpocleisis and transvaginal flap procedures can differentially impact vaginal length, elasticity, and ultimately sexual satisfaction [\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Delayed surgical intervention, particularly after prolonged duration of fistula, may be associated with extensive pelvic scarring and fibrosis, further compromising sexual outcomes.\u003c/p\u003e\u003cp\u003eDespite growing recognition of these issues globally, there is a paucity of data from Ghana regarding the sexual health of women before and after fistula repair. This gap limits the ability to provide tailored rehabilitation and counseling. Therefore, this study aims to evaluate changes in sexual function among women undergoing surgical repair for urogenital fistula at Komfo Anokye Teaching Hospital and Mercy Women Hospital in Ghana.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Setting:\u003c/h2\u003e\u003cp\u003eThis research employed a quasi-experimental study design using before-and-after approach. Given the study's objectives, research inquiries, and aims, a quantitative design was adopted utilizing a descriptive approach. The study was conducted within the Obstetrics and Gynecology Directorate of the Komfo Anokye Teaching Hospital (KATH) in the Ashanti Region of Ghana, and the Mercy Women\u0026rsquo;s Catholic Hospital in Mankessim, Central Region.\u003c/p\u003e\u003cp\u003eKATH offers urogenital fistula care at its urogynecology clinic. The mainstay of treatment is the surgical correction of the fistula if conservative management fails. This is performed via the abdominal route for ureterovaginal fistulae or through the vaginal or abdominal route for vesicovaginal fistulae. There is no dedicated fistula center at KATH; fistula surgery is included in Urogynecology services. The facility sees an average of eighty fistula cases each year.\u003c/p\u003e\u003cp\u003eThe Mercy Women\u0026rsquo;s Catholic Hospital, established by the Catholic Archdiocese of Cape Coast in 2009, operates a specialized fistula unit with a 45-bed ward, outpatient department, lab, consulting rooms, and pharmacy. It hosts quarterly repair missions by specialists from Korle Bu and Komfo Anokye Teaching Hospitals. The unit receives patient referrals and conducts outreach programs in villages to identify cases. A multidisciplinary team provides comprehensive care. The center treats approximately 80\u0026ndash;100 fistula cases annually.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThe study population comprised women diagnosed with urogenital fistula who underwent surgical repair at the urogynaecology clinics of KATH and Mercy Women\u0026rsquo;s Catholic Hospital. Recruitment for the pre-repair phase occurred from 28th February to 30th September 2022.\u003c/p\u003e\n\u003ch3\u003eInclusion Criteria\u003c/h3\u003e\n\u003cp\u003eThe study included all women diagnosed with urogenital fistula who were scheduled to undergo surgical repair. Eligible participants consented to participate in follow-up assessments and were available for clinical and psychosocial evaluation for a minimum duration of six months post-repair, with potential follow-up extending up to twelve months to monitor outcomes and long-term recovery trajectories.\u003c/p\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003eParticipants were excluded from the study if they were deemed eligible but presented with severe or life-threatening illness at the time of enrolment, as such conditions may confound outcome measures or impede informed participation. Additionally, individuals who were unlikely to be available for follow-up within the 6 to 12 months post-repair period were also be excluded, as consistent follow-up is essential for the accurate assessment of long-term outcomes and the overall effectiveness of the intervention.\u003c/p\u003e\n\u003ch3\u003eSurgical Method Overview\u003c/h3\u003e\n\u003cp\u003eThe respondents were either diagnosed of vesicovaginal fistula or ureterovaginal fistula. Diagnosis of vesicovaginal fistulas were made through history of involuntary urinary leakage per vaginum that was preceded either by an obstructed labour which may or may not have been relieved by caesarean section or a gynecological surgery, mostly hysterectomy. Diagnosis was confirmed by methylene blue dye test and Goh classification made for all confirmed cases of vesicovaginal fistula. Ureterovaginal fistulas were diagnosed from a history of antecedent gynecological surgery, mostly hysterectomy or a difficult caesarean section which often led to caesarean hysterectomy. Diagnosis was confirmed by abdominal ultrasound, cystoscopy and pyelography. A double dye test was sometimes helpful to differentiate between a vesicovaginal fistula and ureterovaginal fistula.\u003c/p\u003e\u003cp\u003eSurgical repair of vesicovaginal fistulas were either done through the vaginal route or the abdominal route based on the Goh classification, the ease of repair and the experience of the surgeon. Ureterovaginal fistula repair was done abdominally, and it was mostly by ureteroneocystostomy (ureteric reimplantation). A few had to undergo Psoas hitch and Boari flaps [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eVariables\u003c/h2\u003e\u003cp\u003eThe outcome variable of interest is the sexual function of the participants after they underwent surgical repair of vesicovaginal fistulas. The intervention provided here is the surgical repair of the vesicovaginal fistulas. Vesicovaginal fistula is the main exposure variable. Potential confounders included the age of the participants, their educational backgrounds, marital status and religious affiliations.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSample Size and Sampling\u003c/h3\u003e\n\u003cp\u003eAll 171 women who were diagnosed and underwent surgical repair from 28th February 2022 to 30th September 2022 were recruited into the study. Ninety were recruited from Mercy Women\u0026rsquo;s Catholic Hospital, and 81 from KATH. The formula used in the calculation of the sample size required mean scores and standard deviations for quality of life and sexual functions. Means and standard deviation for the sample size determination were taken from a study conducted in Nigeria. Assuming the mean\u003csub\u003e1\u003c/sub\u003e, 67.9 for quality of life; standard deviation\u003csub\u003e1\u003c/sub\u003e of 4.4 for quality of life and mean\u003csub\u003e2\u003c/sub\u003e 96.3 for sexual function; standard deviation\u003csub\u003e2\u003c/sub\u003e of 3.4 for sexual function, the sample size was 166 at 90% power using the formular below;\u003c/p\u003e\u003cp\u003e\u003cimg src=\"data:image/png;base64,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\" width=\"170\" height=\"43\"\u003e\u003c/p\u003e\n\u003cp\u003eWhere N\u0026thinsp;=\u0026thinsp;Sample size, V\u0026thinsp;=\u0026thinsp;level of significance, σ\u003csub\u003e1\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;standard deviation for mean score before surgery,\u003c/p\u003e\u003cp\u003eσ\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;standard deviation for mean score after surgery, \u0026micro;\u003csub\u003e1\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;Mean score before surgery, \u0026micro;\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;=\u0026thinsp;Mean score after surgery.\u003c/p\u003e\u003cp\u003eTen percent of the calculated sample size were added. However, responses of 171 were achieved.\u003c/p\u003e\u003cp\u003eTotal sampling was used to recruit participants. Patients who did not give consent were not added to the study. Recruitment of participants were made upon diagnosis of urogenital fistula at the outpatient clinics of Urogynecology, KATH and the fistula outpatient clinic of the Mercy Women\u0026rsquo;s Catholic Hospital, Mankessim.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eData Collection Methods\u003c/h2\u003e\u003cp\u003eA validated questionnaire was used which comprised the Female Sexual Distress Scale-Revised (FSDS-R) (provide reference for this scale) to measure distress linked to insufficient or impaired sexual function. In order to assess sexually associated distress in women with hypoactive sexual desire disorder or to serve as a screening tool to distinguish between women with high and poor sexual function, a revised 13-item scale (FSDS-R) with robust psychometric qualities was used. The FSDS and/or FSDS-R have received widespread adoption which was offered in ten different languages, and have good internal consistency, reliability, and validity in their translated forms\u003csup\u003e11\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e\u003cb\u003eStatistical Analysis\u003c/b\u003e\u003c/h2\u003e\u003cp\u003eData was entered in Microsoft Excel and cleaned weekly to ensure accuracy, consistency, and completeness. Statistical analysis was conducted using Stata version 17 (Stata Corp, TX, USA). Means and standard deviations were calculated for the continuous variables. Frequency and percentages were computed for the categorical variables. Shapiro-Wilk test was used to assess the normality of the continuous variables. Wilcoxon Signed-ranked test was used to assess the pair-wise comparison for FSD before urogenital fistula repair and after.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eEthical consideration\u003c/h2\u003e\u003cp\u003eEthnical clearance was obtained from Komfo Anokye Teaching Hospital Institutional Review Board with reference number \u003cb\u003eKATHIRB/AP/071/21.\u003c/b\u003e Permission was obtained from the management of facilities prior to the conduct of the study. Also, a written informed consent was obtained from all the participants.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eSocio-demographic Characteristics of women with urogenital fistula\u003c/h2\u003e\u003cp\u003eOverall, 171 women who underwent urogenital fistula repair were included in the study. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the socio-demographic characteristics of the participants. Fifty-eight (33.9%) were aged 41 to 50 and only 6 (3.5%) were aged 60 plus. Slightly more than a fifth (21.6%) were aged 17\u0026ndash;30 years. Also, 72 (42.1%) of them went to junior high school and 6 (3.5%) had tertiary education. Less than half (n\u0026thinsp;=\u0026thinsp;69; 40.4%) were married.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio- Demographic characteristics of women with urogenital fistula\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;171)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge in years\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17\u0026ndash;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e41\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e51\u0026ndash;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation Level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo formal Education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJunior High School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSenior High School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChristian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIslam\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidowed/Divorced/Separated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eSexual function before and after fistula repair\u003c/h2\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows that 154 (90.1%) of the women with urogenital fistula had FSD before repair. Assessment of the FSD was carried which revealed the dysfunction decreased after repair (n\u0026thinsp;=\u0026thinsp;3; 1.7%)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThere was a significance decrease in FSD among women with urogenital fistula at the end of the urogenital fistula repair. The mean difference was \u0026minus;\u0026thinsp;26.24 (95% CI: -28.27, -24.21; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eWillcoxon signed-rank showing association between sexual functions before and after fistula repair among women with urogenital fistula\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDiff (95% CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eWilcoxon signed-rank test\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ez\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBefore fistula repair\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e-26.24 (-28.27, -24.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e-11.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAfter fistula repair\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe dramatic and statistically significant decline in female sexual distress (FSD) following urogenital fistula repair dropped from 90.1% pre-repair to 1.7% post-repair. This study corroborates a study by Pope et al., who reported a significant reduction in FSD following repair of vesicovaginal fistula (VVF). However, one-third of participants regained normal sexual function, a subset developed new dysfunctions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Similarly, a longitudinal study observed a decrease in dyspareunia (from 27\u0026ndash;10%) alongside increased sexual activity within a year post-repair\u003csup\u003e12\u003c/sup\u003e. Successful anatomical closure of vesicovaginal fistulae results in significant improvement in urinary symptoms, general well-being, and quality of life, with no long-term adverse effects on bowel function more readily than psychological health [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGlobally, young women aged 17 to 30 years represent a significant proportion of those affected 16by urogenital fistula, with studies indicating that up to 65\u0026ndash;80% of cases occur in women under the age of 30, often due to prolonged obstructed labor in early childbirth. In Africa, where the condition remains most prevalent due to limited access to quality maternal health care, the proportion is similarly high. Research from countries like Nigeria, Ethiopia, and Uganda consistently shows that the majority of fistula patients fall within this age range, with many being adolescents or in their early twenties at the time of injury. The early age of first childbirth, compounded by poverty, limited education, and inadequate health services, contributes significantly to the vulnerability of young women to this debilitating condition [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe primary cause of urogenital fistula in relatively young women (aged 17 to 30) is prolonged obstructed labor, which occurs when a woman experiences labor that lasts for several hours or even days without adequate medical intervention. This is especially common among adolescents whose bodies may not be fully developed for childbirth, leading to pressure necrosis between the baby\u0026rsquo;s head and the mother's pelvic tissues, resulting in a hole (fistula) between the bladder and vagina or rectum. Several contributing factors increase the risk in young women, including early marriage and childbearing, poor access to skilled obstetric care, malnutrition (which can lead to stunted growth and a small pelvis), poverty, and lack of education. These social determinants not only delay access to emergency obstetric services but also increase the likelihood of home births without trained attendants, heightening the risk of fistula formation.\u003c/p\u003e\u003cp\u003eSeveral mechanisms plausibly underlie the observed decline in FSD post-repair. Firstly, the surgical closure of the fistula effectively halts involuntary urinary leakage, thereby removing one of the most distressing and stigmatizing symptoms that contribute to sexual avoidance and psychological distress. The restoration of continence enhances self-esteem, body image, and sexual confidence, facilitating re-engagement in intimate relationships. Alleviation of dyspareunia, often secondary to tissue damage or inflammation, further promotes sexual rehabilitation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, the symbolic and relational significance of the repair fosters social and marital reintegration, which acts as a psychological catalyst for improved sexual function [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurthermore, the integration of comprehensive fistula care, including mental health support, marital counselling, and sexual health education, contributes to the reduction of psychological distress and creates a conducive environment for holistic recovery. These supportive interventions, when paired with improved physical health and restored dignity, may reinforce the return to sexual well-being and societal participation.\u003c/p\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and Limitations\u003c/h2\u003e\u003cp\u003eA key strength of this study is its focus on a relatively underexplored yet critically important dimension of post-fistula recovery sexual function. By employing a pre- and post-repair design, the study captures longitudinal changes in FSD, allowing for a robust evaluation of the impact of surgical intervention. The dramatic reduction in FSD from 90.1\u0026ndash;1.7% provides compelling evidence of the clinical and psychosocial benefits of fistula repair. Furthermore, the inclusion of participants from two tertiary-level fistula centers (Komfo Anokye Teaching Hospital and Mercy Women\u0026rsquo;s Hospital) enhances the representativeness of the findings for the Ghanaian context and strengthens the external validity of the results. The use of standardized clinical assessments and the incorporation of psychosocial dimensions (such as marital reintegration and psychological well-being) also underscore the multidimensional approach adopted in evaluating sexual health outcomes.\u003c/p\u003e\u003cp\u003eHowever, several limitations merit consideration. First, the absence of a validated, fistula-specific sexual function questionnaire may have limited the sensitivity of outcome measurement, especially for capturing nuanced changes in desire, arousal, or emotional intimacy. Second, while the study demonstrates a statistically significant decline in FSD, it does not control for potential confounders such as partner support, duration of incontinence before repair, or underlying mental health conditions, all of which may influence sexual function. Additionally, the follow-up period may have been insufficient to fully assess the long-term sustainability of improvements or the emergence of delayed sexual dysfunction. The study's reliance on self-reported data may also introduce recall or social desirability bias, particularly given the cultural sensitivities around discussing sexual matters. Finally, the generalizability of the findings beyond Ghana may be limited, as access to comprehensive fistula care and psychosocial support may vary significantly across different sub-Saharan African contexts.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that surgical repair of urogenital fistula leads to a profound and statistically significant reduction in female sexual distress (FSD), with rates dropping from 90.1% pre-repair to just 1.7% post-repair among women treated. These findings not only affirm the physical benefits of fistula repair but also underscore the substantial psychosocial recovery that can occur when surgical treatment is integrated with comprehensive post-operative care. The restoration of continence, reduction in dyspareunia, and enhanced body image collectively contribute to improved sexual function and reintegration into intimate and social life. However, the fact that only one-third of participants achieved full sexual function post-repair, while a subset developed new dysfunctions, highlights the need for a more nuanced and multidisciplinary approach to recovery.\u003c/p\u003e\u003cp\u003eFrom a clinical practice standpoint, this study advocates for the routine incorporation of sexual health evaluation and counselling into the continuum of fistula care. Addressing sexual function as a core outcome, rather than an ancillary concern, is essential to achieving holistic recovery. Health care providers should receive training in the identification and management of sexual dysfunction, and facilities should be equipped to offer individualized psychosocial support, including mental health services and marital or relationship counselling.\u003c/p\u003e\u003cp\u003eAt the policy level, these findings underscore the urgent need to scale up investments in fistula prevention and rehabilitation services. Strategies should include promoting delayed age at marriage and first childbirth, improving access to emergency obstetric care, and integrating sexual and reproductive health education into national health agendas. Additionally, national fistula programs should adopt standardized post-repair follow-up protocols that include sexual function assessments, particularly for young women who represent a disproportionately affected demographic. Strengthening referral networks for continued care and reintegration services will further support long-term recovery and quality of life.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted following the ethical principles outlined in the Declaration of Helsinki. Ethical Approval was obtained from the Komfo Anokye Teaching Hospital Institutional Review Board with reference number \u003cstrong\u003eKATHIRB/AP/071/21.\u0026nbsp;\u003c/strong\u003ePermission was obtained from the management of KATH and Mercy Women\u0026rsquo;s Catholic Hospital prior to the commencement of the study. All participants were informed about the objectives, procedures, potential risks and benefits of the study, and written informed consent was obtained from each participant before data collection.\u003c/p\u003e\n\u003cp\u003eAll procedures involving human participants were performed following institutional and national research ethics standards.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll participants provided written informed consent to participate in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData used for the study are available upon request. Please contact the corresponding author for access.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was self-funded. No external funding support was obtained for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKGA: conceptualization, methodology, investigation, writing - original draft. JA: Methodology, formal analysis, writing JBY: methodology, formal analysis. JA: data curation. VOA: review and editing, Methodology JO: supervision, validation, review and editing. FJO: data curation. SYA: supervision, validation, review and editing. WKA: supervision, validation, review and editing. HSO: supervision, validation, review and editing. \u0026nbsp;All authors approved the version to be published and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge all the data collectors and study participants for their involvement in the study. We also acknowledge the support of the Head of Department of the KATH Obstetrics and Gynaecology Department and the Administrator of Mercy Women\u0026rsquo;s Catholic Hospital.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDe Ridder D, Badlani GH, Browning A, et al. Fistulas in the developing world. In: Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence. 4th ed. Paris, UK: Health Publications Ltd; 2009. pp. 1419\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWall LL. Obstetric vesicovaginal fistula as an international public-health problem. Lancet. 2006;368(9542):1201\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTebeu PM, Fomulu JN, Khaddaj S, de Bernis L, Delvaux T, Rochat CH. Risk factors for obstetric fistula: a clinical review. Int Urogynecol J. 2012;23(4):387\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEl AAM, Barageine J, Korn A, Kakaire O, Turan J, Obore S, et al. Trajectories of women\u0026rsquo; s physical and psychosocial health following obstetric fistula repair in Uganda: a longitudinal study. Trop Med Int Health. 2019;24(1):53\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePope R, Ganesh P, Chalamanda C, Nundwe W, Wilkinson J. Sexual function before and after vesicovaginal fistula repair. J Sex Med. 2018;15(8):1125\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRaassen TJ, Verdaasdonk EG, Vierhout ME. Prospective results after first-time surgery for obstetric fistulas in East African women. Int Urogynecol J. 2008;19:73\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilkinson JP, Lyerly AD, Masenga G, et al. Ethical dilemmas in women\u0026rsquo;s health in under-resourced settings. Int J Gynecol Obstet. 2011;113:25\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnzaku SA, Lengman SJ, Mikah S, et al. Sexual activity among Nigerian women following successful obstetric fistula repair. Int J Gynecol Obstet. 2017;137:67\u0026ndash;171.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHilton P. Vesico-vaginal fistulas in developing countries. Int J Gynaecol Obstet. 2003;82(3):285\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHanif MS, Saeed K, Sheikh MA. Surgical management of genitourinary fistula. JOURNAL-PAKISTAN Med ASSOCIATION. 2005;55(7):280.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh V, Jhanwar A, Mehrotra S, Paul S, Sinha RJ. A comparison of quality of life before and after successful repair of genitourinary fistula: Is there improvement across all domains of WHOQOL-BREF questionnaire? \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.afju.2015.06.003\u003c/span\u003e\u003cspan address=\"10.1016/j.afju.2015.06.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEl Ayadi AM, Nalubwama H, Miller S, Mitchell A, Korn AP, Chen CC, Byamugisha J, Painter C, Obore S, Barageine JK. Women\u0026rsquo;s sexual activity and experiences following female genital fistula surgery. J Sex Med. 2023;20(5):633\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUmoiyoho AJ, Inyang-Etoh EC, Abah GM, Abasiattai AM, Akaiso OE. Quality of life following successful repair of vesicovaginal fistula in Nigeria. Rural Remote Health. 2011;11(3):102\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGrewal M, Pakzad MH, Hamid R, Ockrim JL, Greenwell TJ. The medium-to long-term functional outcomes of women who have had successful anatomical closure of vesicovaginal fistulae. Urol Annals. 2019;11(3):247\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDebela TF, Hordofa ZA, Aregawi AB, Sori DA. Quality of life of obstetrics fistula patients before and after surgical repair in the Jimma University Medical Center, Southwest Ethiopia. BMC Womens Health. 2021;21(1):212.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWall LL, Arrowsmith SD, Briggs ND, Browning A, Lassey A. The obstetric vesicovaginal fistula in the developing world. Obstet Gynecol Surv. 2005;60(7):S3\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. 10 facts on obstetric fistula [Internet]. 2018 [cited 2025 May 3]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/obstetric-fistula\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/obstetric-fistula\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUnited Nations Population Fund\u0026mdash;UNFPA. InThe Europa Directory of International Organizations 2022 2022 Jul 28 (pp. 293\u0026ndash;6). Routledge.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Urogenital fistula, Sexual function, Female Sexual Function Index, Reproductive health and Surgical repair, Ghana","lastPublishedDoi":"10.21203/rs.3.rs-7346142/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7346142/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eUrogenital fistula, particularly obstetric fistula, poses a major health challenge for women, especially in low-resource settings. According to the World Health Organization (WHO), between 50,000 and 100,000 women worldwide develop obstetric fistula each year, which creates an abnormal opening between a woman\u0026rsquo;s genital tract and her urinary tract or rectum. It is estimated that over 2\u0026nbsp;million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa. This study aimed to evaluate changes in sexual function among women before and after undergoing urogenital fistula repair.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThe study used a quasi-experimental design to evaluate the sexual function of respondents before and after urogenital fistula repair. The study recruited all 171 women diagnosed with urogenital fistula and undergoing surgical repair at (give the study sites) over (time period). Data on background characteristics like age and parity and sexual function score using the Female Sexual Function Index (FSFI) questionnaire were collected before repair and during follow-up visits three to six months after repair. The Willcoxon Signed-rank test was used to compare sexual function, before and after fistula repair. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAbout a third of the women (33.9%) were aged 41 to 50, 42.1% were junior high school levers, and 40.4% were married. Almost all (90.1%) of the women had female sexual dysfunction (FSD) before the repair, and 1.7% had it after the repair. FSD after the repair decreased significantly (z = -11.14, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with a mean difference of -26.24 (95% CI: (-28.27, -24.21).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eUrogenital fistula repair improved sexual function among affected women. While successful repair may lead to improvements, necessitating comprehensive post-operative care and support. Addressing sexual concerns in the management of urogenital fistula is essential to optimize the overall well-being of the affected women.\u003c/p\u003e","manuscriptTitle":"Sexual Function Among Women Before and After Urogenital Fistula Repair; A Quasi-Experimental Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 12:40:44","doi":"10.21203/rs.3.rs-7346142/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":"e3be148e-859e-41cb-91f0-c6cc87c06df0","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-19T12:40:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-19 12:40:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7346142","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7346142","identity":"rs-7346142","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}