Randomized Controlled Trial of Postoperative Standardized Counseling Regarding Return to Sexual Activity After Pelvic Reconstructive Surgery

INTRODUCTION: Women are concerned about return to sexual activity following surgery for pelvic organ prolapse (POP) and urinary incontinence (UI). A qualitative study of first sexual experiences after pelvic reconstructive surgery found that surgeon counseling about resumption of sexual intercourse was important to patients. We developed a patient-centered, standardized counseling tool for return to sexual activity after POP/UI surgery. OBJECTIVE: To determine if standardized counselling regarding first sexual encounter after POP and/or UI surgery improves postoperative preparedness to return to sexual activity and sexual function. METHODS: This multicenter randomized clinical trial recruited women planning to be sexually active after surgery for POP and/or UI who were randomized to standardized or routine counselling at the 6–8 week postoperative visit. The primary outcome was preparedness to return to sexual activity and was measured by an item from a validated questionnaire at 6–8 weeks postoperatively. Patients were considered prepared if patients answered “strongly agree” on a 6-point Likert scale to the statement “Overall, I feel prepared for resuming sexual activity after my surgery.” Participants were contacted at 1-month intervals up to 6 months postoperative, and, when return to sexual activity was reported, patients completed the preparedness and pain scales and the PISQ-IR. Primary analyses were by intention-to-treat, and per-protocol analyses included only women who returned to sexual activity after the 6–8 weeks’ interventions. Preparedness, PISQ-IR scores, pelvic pain, and dyspareunia at 6–8 weeks and survival analyses of time to return to sexual activity were adjusted for covariates as appropriate. RESULTS: 186 patients were randomized with a mean age of 53.0±11.5 years, the majority identified as White (86.4%) and parous (97.6%). Because of baseline differences, odds ratios were adjusted for age, surgery type, PISQ-IR score at baseline, vaginal estrogen use at 6–8 weeks, and education level. Survival analysis of time to return to sexual activity was adjusted for age and presence of POP surgery. 170/186 (91%) completed follow-up and were included in the intention-to-treat analyses. Patients randomized to standardized counseling reported higher preparedness to return to sexual activity (adj OR 2.42, 95% CI 1.03–5.55), lower likelihood of experiencing dyspareunia (adj OR 0.27, 95% CI 0.09–0.86), and earlier return to sexual activity (adj HR 1.46, 95% CI 1.06–2.01) (Table 1) (Figure 1). Prior to the intervention, 57 (33.5%) patients returned to sexual activity; 123 women were included in the per-protocol analyses. In per-protocol analyses, standardized counseling remained associated with greater preparedness at 6–8 weeks postoperative (81 vs. 57%; adj OR 4.8, 95% CI 1.66–13.99) (Table 2). CONCLUSIONS: Standardized counseling regarding return to sexual activity following surgery for POP and UI improves patient preparedness to return to sexual activity compared to routine counseling. Surprisingly, nearly a third of women returned to sexual activity before 6–8 weeks postoperatively.