TITLE:
Change in Deferring Time Correlate to Improved Female Sexual Function after Anal Sphincter Repair: A Prospective Study
AUTHORS:
Johan Danielson, Urban Karlbom, Ann-Cathrine Sonesson, Wilhelm Graf
KEYWORDS:
Sexual Function, Anal Sphincter Repair, Fecal Incontinence, Anal Sphincter Injury
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.10 No.5,
May
13,
2020
ABSTRACT: Background: Many women suffer from sexual problems after anal sphincter tears due to
obstetric trauma. Aim: The study aimed to assess changes in sexual function after anal
sphincter repair. Methods: The study was a non-randomized prospective observational cohort study.
Inclusion of the study was done at the University Hospital, Uppsala, Sweden,
between 2002 and 2007. Thirty-nine consecutive female patients admitted for
anal sphincter repair were invited to the study. Twenty patients accepted and
were included, four were lost to follow up
and one was unevaluable (due to the formation of a stoma) leaving a
study group of 15 patients. The patients were assessed with questionnaires before surgery and at three and 12 months after surgery. Outcomes: Change
in reported sexual activity and dyspareunia. Results: Before surgery, 12/15
patients reported that their sexual life was impaired due to anal incontinence.
The corresponding figure at 12 months was 9/15 (p = 0.43). Three patients remained sexually inactive
throughout the study, five patients increased their sexual activity and one had
decreased activity. Out of the 12 who were active, four stated dyspareunia at
baseline, and only one reported dyspareunia at 12 months. The mean Miller
incontinence scores at baseline and 12 months were 10.1 and 8.7, respectively.
The change in incontinence score did not differ between those with decreased,
stable or increased sexual activity. However, there was a definite correlation
(r = 0.54 - 0.60, p 0.05)
between change in sexual function and deferring time for stool. Clinical Implications: Operative
management of anal sphincter tears alone is not curative for sexual problems
due to anal incontinence but can be a part of the treatment. Strengths
and Limitations: The study is a prospective study of sexual function.
The limitations are that the questionnaires were not validated due to lack of
such questionnaires at the time of the study and that the study population is
quite small. Conclusion: Patients with a sphincter injury and fecal incontinence often have an
impaired sexual function. Increased deferring time for stools after surgery
increases the likelihood of improved sexual function.