Quality of life and sexual changes after double transobturator tension-free approach to treat severe cystocele Salvatore Caruso a,b, *, Sebastiano Bandiera a,c , Antonino Cavallaro a,d , Stefano Cianci a,c , Salvatore Giovanni Vitale a,c , Salvatore Rugolo a,d a Department of Microbiological and Gynecological Sciences, University of Catania, Italy b Research Group for Sexology of European Federation of Sexology, Italy c Urogynaecologic Service, Italy d Ultrasound Service, Italy 1. Introduction Sexual wellbeing is an important aspect of women’s health, and sexual disorders can decrease the quality of life and affect marital relationships. Sexual function is affected by several factors, including couple relationship conflicts, socioeconomic level, sexual compatibility, and physical and psychiatric disorders of the couple. Prevalence of sexual dysfunction among women has been reported to be as high as 50% [1,2]. Although female sexual dysfunction is a common problem among the general population [3], it has been poorly studied in urogynecological patients [4]. Disorders of desire, arousal, lubrication and orgasm, as well as dyspareunia, are typical complaints reported by women [5]. Pelvic floor weakness and organ prolapse are common physical conditions negatively affecting sexual function and satisfaction [6,7]. Cystocele is the pathological herniation of the anterior vaginal wall and the associated bladder base that, due to anatomical continuity, follows the sliding of the vaginal wall. This sliding is due to laxity or a site-specific defect of pubo-vesico-cervical fascia and the other supporting and sustaining structures [8]. According to the most recent epidemiological data, urogenital prolapse affects about 45% of women after the menopause [9]. The incidence is increasing due to extension of the average lifespan, European Journal of Obstetrics & Gynecology and Reproductive Biology 151 (2010) 106–109 ARTICLE INFO Article history: Received 25 November 2009 Received in revised form 12 March 2010 Accepted 25 March 2010 Keywords: Clitoral blood flow Color Doppler sonography Cystocele Double transobturator tension free Sexuality ABSTRACT Objectives: To study the quality of life and sexual function changes of women affected by severe cystocele and treated with the double transobturator tension-free approach. Study design: 23 women (mean age 60.6) with third and fourth degree cystocele (according to Baden and Walker classification) were monitored by Short Form-36 (SF-36) and Pelvic Organ Prolapse/Urinary Incontinenece Sexual Questionnaire (PISQ-12) before and 12 months after surgical treatment. Each woman also underwent translabial color Doppler ultrasonography to measure the Resistance Index (RI), Pulsatility Index (PI), Peak Systolic Velocity (PSV), and End-Diastolic Velocity (EDV) of the clitoral arteries, before surgery and 12 months postoperatively. Results: SF-36 showed a considerable increase in all of the categories (physical functioning, physical role functioning, bodily pain, general health, vitality, social functioning, emotional role functioning, and mental health) compared to those obtained at baseline (P < 0.05). PISQ-12 also showed a considerable increase in the behavioural emotive factor score, in the physical factor score, in the partner-related factor score and, consequently, in the total score compared to that obtained at baseline (P < 0.05). Color Doppler measurement showed that the mean Pulsatility Index, Peak Systolic Velocity, Resistance Index and End-Diastolic Velocity were not significantly lower to those obtained at baseline (P = NS). Conclusions: Double transobturator tension-free approach to treat severe cystocele considerably improves quality of life and sexual function, and does not significantly influence clitoral blood flow. Our data could add new information about sexual behaviour after prolapse treatment, particularly about the impact on clitoral blood flow changes. ß 2010 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: Department of Microbiological and Gynecological Science, Azienda Universitaria-Ospedaliera Policlinico-Vitt.Emanuela, Via Santa Sofia 78, 95123 Catania, Italy. Tel.: +39 095 3781101; fax: +39 095 3781326. E-mail address: scaruso@unict.it (S. Caruso). Contents lists available at ScienceDirect European Journal of Obstetrics & Gynecology and Reproductive Biology journal homepage: www.elsevier.com/locate/ejogrb 0301-2115/$ – see front matter ß 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejogrb.2010.03.016