Vaginal vault prolapse surgery improves body image

Vaginal vault prolapse surgery improves body image | Image Credit: © pikselstock - © pikselstock - stock.adobe.com.

All surgical approaches for vaginal vault prolapse repair improve body image, leading to greater sexual function among sexually active women, according to a recent study published in the American Journal of Obstetrics & Gynecology.¹

Components of personal body image include positive and negative perception, thoughts, behaviors, and attitudes. Increased odds of depression, reduced self-confidence, and poor sexual health have been reported in individuals with poor body image, adversely impacting multiple facets of life.²

“The improvement of body image and sexual function with treatment of POP has previously been demonstrated,” wrote investigators.¹ “However, there are limited data available regarding whether a particular method of treatment is superior to another with respect to improvement of body image and sexual health.”

Surgical approaches and assessing body image

Investigators conducted a multicenter randomized clinical trial to evaluate the safety and efficacy of 3 apical repair methods for vaginal vault prolapse. These methods included transvaginal native tissue repair (NTR), mesh placed abdominally through sacrocolpopexy (SC), and mesh placed transvaginally (TVM).

Participants completed the Body Image in Pelvic Organ Prolapse (BIPOP) questionnaire at baseline and at 6, 12, 18, 24, 30, and 36 months. Responses were used to determine the impact of pelvic organ prolapse (POP) on body image. The questionnaire included 10 questions, with responses ranging from strongly disagree to strongly agree.

Subscales of the BIPOP questionnaire included the attractiveness subscale and partner subscale. Each score ranged from 1 to 5, with higher values indicating worse prolapse-related body image. Strongly agree and agree responses indicated poor body image, while other responses indicated not poor body image.

During each visit, patients reported sexual activity status as a binary yes or no variable. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire was used to measure sexual function.

Improvements across all surgical methods

There were 335 women included in the final analysis, 123 of whom received NTR, 107 SC, and 105 TVM. The study population was aged a mean 66.1±8.5 years, and 72% had stage 3 POP. Being White was reported in 84%, living with a partner in 69%, and sexually active in 44%. Baseline BIPOC scores did not significantly differ between groups.

While all groups reported significantly improved total and subscale BIPOC scores across the 36 months following surgery, no significant differences in improvement were reported based on surgical method. When assessing individual BIPOC items, rates of poor body image were reduced in all 10 items compared to baseline.

These results were mirrored by models repeated for mesh vs no mesh and vaginal vs abdominal comparisons. Additionally, being sexually active at all visits was reported by 30% of women. However, 39% reported not being sexually active at all visits.

Being nonsexually active at first but becoming sexually active at least once following surgery was reported by 17% of participants. The remaining participants changed their sexual activity status throughout the study.

Sexual function findings

Participants with sexual activity in all groups reported improved sexual function following surgery. However, no differences were reported based on treatment method, nor in mesh vs no mesh and vaginal vs abdominal comparisons.

Positive correlations were found between improved body image and improved sexual function at each visit, with sexual function scores significantly altered by reversed BIPOC scores. Additionally, 37% of women met the criteria for surgical failure by 36 months.

Poorer body image was reported in these patients based on significantly increased BIPOC scores at 36 months. Overall, the data highlighted improved body image and sexual function following repair of vaginal vault prolapse, regardless of the surgical method used.

“Improvements in body image and sexual function are positively correlated among sexually active women,” wrote investigators.

References

1. Andy UU, Nowak K, Menefee SA, et al. Body image and sexual function improve following prolapse repair. Am J Obstet Gynecol. 2025;233:182.e1-12. doi:10.1016/j.ajog.2025.01.042
2. Jelovsek JE, Barber MD. Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life. Am J Obstet Gynecol. 2006;194(5):1455-61. doi:10.1016/j.ajog.2006.01.060