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Pelvic Organ Prolapse Surgery May Also Improve Body Image


 

HOLLYWOOD, FLA. — Reconstructive surgery for pelvic organ prolapse not only improves physical distress but can significantly improve a woman's body image and depressive symptoms, according to results of a prospective, case-control study.

“Body image can be used as an indicator of quality of life after reconstructive surgery,” said Dr. Jerry L. Lowder of the division of urogynecology and pelvic reconstructive surgery at the University of Pittsburgh Medical Center.

Body image is a neuropsychiatric construct, and dissatisfaction with body image is associated with anxiety and depression, he said. “Prolapse is a disfiguring disorder of the urogenital tract that is often hidden” but could still have negative effects on body image.

Dr. Lowder and his associates hypothesized that reconstructive surgery would improve body image scores. They enrolled 85 sexually active women over age 40 who were planning surgery to correct stage II or greater prolapse. A total of 57 participants had complete data at 6 months and were assessed further.

Participants had a variety of surgery types. “Surgical choice was not part of the design,” Dr. Lowder said at the annual meeting of the American Urogynecologic Society. A total of 42 of the 57 patients (74%) had sacral colpopexy; 7 (12%) had uterosacral suspension; 6 (11%) had total vaginal mesh placed; and 2 (3%) had posterior colporrhaphy.

The mean age of patients was 60 years, and mean body mass index was 28 kg/m

Prolapse stage significantly improved according to standard Pelvic Organ Prolapse Quantitative (POP-Q) examinations at baseline and at 6 months. Initial prolapse improved from an average stage III to stage I at 6 months.

The researchers assessed other effects of the surgery using questionnaires at baseline and follow-up.

For example, the women had a significant improvement on the Body Exposure in Sexual Activities Questionnaire (BESAQ), a 28-item “prolapse-specific body image proxy,” Dr. Lowder said. Scores range from 0 to 112, with a lower result representing a better body image. Mean scores changed from 41 at baseline to 34 at 6 months.

Patients also self-administered the Body Image Quality of Life Inventory (BIQLI), a 19-item general body image questionnaire. Results are expressed within a range of -3 to +3, with a higher score translating to a better body image. The scores went from a mean 0.9 at baseline to 1.2 at 6 months, which was not a significant difference.

There were, however, significant improvements in symptoms on both the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) by 6 months. The median PFDI score decreased from 282 at baseline to 45 at 6 months. The median PFIQ score improved from 212 at baseline to 22 at follow-up.

Significant improvements also were demonstrated with the Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ-12). Results went from a mean 32 at baseline to 35 at 6 months. Similarly, the median scores on the Patient Health Questionnaire (PHQ-9) improved from 3 at baseline to 2 at follow-up.

Reports of depressive symptoms improved as well following reconstructive surgery. Patients had a mean of 14 moderate to severe depressive symptoms preoperatively,” Dr. Lowder said. “There were a mean of five moderate to severe depressive symptoms postoperatively without a change in treatment.”

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