Introduction: Balancing Anatomical Success and Quality of Life
Pelvic organ prolapse (POP) is a prevalent condition that significantly impacts the quality of life for millions of women worldwide. Beyond the physical discomfort and mechanical symptoms of a vaginal bulge, POP often exerts a profound influence on sexual health and psychological well-being. Surgical intervention remains a cornerstone of management for symptomatic uterine prolapse, with various techniques available to surgeons today. However, a persistent concern for both clinicians and patients is the potential impact of these procedures on sexual function. While the primary goal is often anatomical restoration, the risk of developing de novo dyspareunia or worsening sexual satisfaction is a critical consideration in preoperative counseling.
Two common surgical approaches for treating primary mild to moderate uterine prolapse are the Manchester procedure (MP) and sacrospinous hysteropexy (SSH). The Manchester procedure involves a partial cervical amputation and shortening of the cardinal ligaments to elevate the uterus, whereas sacrospinous hysteropexy involves suspending the uterus or vaginal apex to the sacrospinous ligament using sutures. A recent randomized clinical trial (RCT) provided pivotal data indicating that the Manchester procedure was superior to SSH regarding anatomical success at a two-year follow-up. Despite these findings, the comparative impact of these two techniques on sexual function remained an open question. This planned analysis of the same RCT seeks to provide definitive evidence regarding the postoperative sexual outcomes of these procedures.
