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Graft use in transvaginal pelvic organ prolapse repair: a systematic review.

To the Editor: We read with great interest the systematic review concerning graft use in transvaginal pelvic organ prolapse repair reported by Sung et al.1 The authors state that “the effect of graft augmentation on sexual function was limited to reports of dyspareunia” and that “limited use of validated measures in most studies, as well as inconsistency in collecting data makes interpretation of these data difficult.”1 Because sexual function has become an important outcome parameter for women who will undergo surgery for pelvic floor disorders,2 we would like to inform your readers that we recently reported a prospective study that has assessed sexual function in 37 sexually active women before and 1 year after synthetic nonabsorbable transvaginal mesh repair for pelvic organ prolapse using a validated questionnaire (the short validated form of the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire [PISQ-12]).3 Although no definitive conclusion can be drawn from a sole prospective study, our series did not find a significant difference in the PISQ-12 scores after surgery (33.4 7.8 compared with 35.5 7.3, P .25), and no other variables were observed to significantly affect PISQ-12 scores, including menopausal status, severity of prolapse, history of previous pelvic surgery, performance of hysterectomy, type of procedure performed, and vaginal erosion.3 Nevertheless, patients complained of sexual-function deterioration after surgery in eight (21.6%) cases, including three (8.1%) cases of de novo dyspareunia, whereas 17 (45.9%) patients reported an improvement in intercourse, suggesting that transvaginal nonabsorbable mesh repair for pelvic organ prolapsed can have a negative but also a positive outcome on sexual function.