Intervention Counseling for Return to Sex After Urogynecologic Surgery: A Randomized Controlled Trial.

Abstract

OBJECTIVE To compare the effect of intervention on patients' postoperative preparedness to return to sexual activity after pelvic organ prolapse (POP) or urinary incontinence (UI) surgery compared with the usual counseling regarding the first sexual encounter. METHODS This multicenter randomized clinical trial recruited individuals who were planning to be sexually active after surgery for POP or UI; the patients who were randomized to intervention or usual counseling at 6 to 8 weeks postoperatively. The primary outcome was preparedness to return to sexual activity. Patients were considered prepared if they answered "strongly agree" or "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 postoperatively; when they reported return to sexual activity, they completed preparedness and pain scales and the PISQ-IR (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised). RESULTS Of 186 patients, 170 (91.4%) completed follow-up and were included in the analyses. There was no difference in preparedness to return to sexual activity, at the time of returning to sexual activity within 6 months. However, there were differences noted 6 to 8 weeks after the intervention counseling. Patients randomized to intervention counseling reported higher preparedness to return to sexual activity (odds ratio [OR] 2.42, 95% CI, 1.03-5.65), lower likelihood of experiencing dyspareunia (OR 0.27, 95% CI, 0.09-0.86), and an earlier return to sexual activity (hazard ratio 1.46, 95% CI, 1.06-2.01). Before the intervention, 57 (33.5%) patients returned to sexual activity. In sensitivity analysis of the remaining 113 participants, intervention counseling remained associated with greater preparedness at 6-8 weeks postoperatively (81.0% vs 56.9%, adjusted OR 4.82, 95% CI, 1.66-13.99). CONCLUSION Intervention counseling regarding return to sexual activity after surgeries for POP or UI was not associated with improved patient preparedness at the time of return to sexual activity but did improve preparedness and decrease dyspareunia at 6-8 weeks, compared with usual counseling. Despite counseling otherwise, nearly a third of participants returned to sexual activity before 6-8 weeks postoperatively. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT05342090.