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Abstract: Background: Suburethral slings are commonly used for the surgical treatment of female stress incontinence; occasionally they can cause erosion and dyspareunia. Objectives: The primary aim of this study is to determine the outcome after reclosure of the vaginal epithelium for suburethral sling erosion. Sexual function was assessed before and after intervention using the Female Sexual Function Index (FSFI) questionnaire. Design, setting, and participants: This was a prospective case-controlled study in which, between December 2005 and December 2007, we included patients who were referred to the Department of Urogynaecology because of vaginal erosion after suburethral sling insertion for urinary stress incontinence. For evaluation of sexual function, all patients filled in an FSFI questionnaire before intervention and at follow-up. All patients underwent gynaecological examination including colposcopy, and the site and size of the defect were noted. Intervention: The edge of the vaginal epithelium was trimmed, mobilized, and closed with interrupted vertical Vicryl mattress sutures in a single layer. Measurements: FSFI questionnaire and clinical findings. Results and limitations: Twenty-one patients were included in the study. Eighteen patients with larger defects were operated on, and three defects healed after topical application of estrogen cream. In 16 patients, the defect had healed at follow-up; two patients with persisting defects were brought back to surgery and the procedure was repeated, paying particular attention to tension-free adaptation of vaginal tissue. In one patient, partial sling removal was performed after the second failed intervention. The domains of desire (p <0.0001), arousal (p <0.0003), lubrication (p <0.0001), satisfaction (p <0.0130), and pain (p <0.0001) improved significantly. Orgasm remained unchanged (p =0.4130; all two-tailed t-test). Conclusion: Suburethral erosion can be treated effectively by resuturing. Sexual function is improved in regard to desire, arousal, lubrication, satisfaction, and pain, but not orgasm. In septic patients and patients with a history of radiation, grossly infected tissue, or severe pain, excision of the mesh needs to be considered. [Copyright &y& Elsevier]

Objective: The purpose of this study was to compare clinical outcomes and sexual function between transvaginal and transabdominal repairs of vesicovaginal fistulae (VVF). Study Design: Participants (99 women with VVF at a tertiary referral center) were treated with urinary catheterization for 12 weeks and, if the procedure was unsuccessful, underwent repair using either the transvaginal (Latzko) or transabdominal technique. Objective clinical parameters were analyzed; subjective outcomes were recorded prospectively before surgery and at the 6-month follow-up examination with the use of the female sexual function index to evaluate sexual function and the visual analog scale to measure general disturbance by the fistula. Results: After bladder drainage for 12 weeks, 8 patients had spontaneous fistula closure. Demographic variables were similar in the transvaginal (n = 60) and transabdominal (n = 31) repair groups. The transvaginal procedure showed significantly shorter operation times, less blood loss, and shorter hospital stay. Continence rates 6 months after surgery were 82% (transvaginal) and 90% (transabdominal). Sexual function in the 64 sexually active patients was significantly improved, and overall disturbance by the fistula was reduced with both operative techniques. Neither surgical intervention was superior to the other regarding sexual function or visual analog scale. Conclusion: Fistula repair improves sexual function and quality of life with no difference attributable to surgical route. Given this and that operating time, blood loss and length of stay are less with the transvaginal approach, the transvaginal approach is preferred in VVF repair if fistula and patient characteristics are suitable. [Copyright &y& Elsevier]

Aim of our study was to evaluate the therapeutic effect of laser treatment in vulvar lichen sclerosus, mainly the reduction of existing symptoms as itching, burning and pain. We asked about the different outcome by using different application doses. We conducted a prospective randomized double-blind dose-controlled trial in our dysplasia unit specializing vulvar disorders. 67patients with active LS were included. LS was confirmed by biopsy or by the validated CSS (clinical scoring system of vulvar LS). Computer generated randomization resulted in two groups, each group received a different application dose.(LDG- low dose group, NDG- normal dose group) During the study period of 18 weeks all participants received three laser applications in three subsequent sessions of three weeks. Two follow-ups six and twelve weeks after the first application was performed. At every visit, the participants filled in the VAS (visual analogue scale) for recording the actual vulvar symptoms as itching burning or pain on a range from 0 to 10. Before treatment the mean VAS-Score was 4.3 (STD ± 2.4) in the NDG and 5.1(±2.6) in the LDG. After 18 weeks, the mean reduction was −2.4 (±2.3) for NDG and −2.7 (±2.8) for LDG. Four patients (two of each group) reported more pain after than before treatment. Both groups show significant lower VAS-Scores 18 weeks after the treatment than before therapy (p < 0.0001). The reduction of symptoms after 18 weeks between NDG and LDG was not significant (p = 0.6244). Laser treatment with the microablative CO2 laser leads to a significant improvement for symptoms of LS. A higher dosage of laser radiation shows no benefit concerning the symptoms. We have not observed any serious adverse events during this study. [ABSTRACT FROM AUTHOR]

Female genital mutilation (FGM) is defined by the World Health Organization (WHO) as all procedures that involve partial or total removal of the female external genitalia and/or injury to the female genital organs for cultural or any other non-therapeutic reasons. Aim of this study was to determine sexual function before and after defibulation using a CO laser in migrant women who had undergone FGM in the past. Female Sexual Function Index (FSFI) before and 6 months after defibulation. Patients were asked to fill the FSFI before surgery and at 6 months follow-up. Defibulation took place under general anesthetic using a CO laser. Eighteen patients underwent defibulation in a standardized manner and filled in the FSFI completely. Female sexual function improves after surgical defibulation in the domains desire, arousal, satisfaction, and pain whereas lubrification and orgasm remained unchanged. Defibulation using CO laser may improve some aspects of sexual function in patients who undergo defibulation but not all. [ABSTRACT FROM AUTHOR]

Pelvic organ prolapse is a common condition among women with a prevalence of 11% and may affect the anterior, posterior, or apical compartment with a negative impact on sexual function. Aim of the current study was to evaluate sexual function before and after surgical rectocele fascial repair in sexually active patients who suffer from symptomatic rectoceles. Female Sexual Function Index (FSFI) and anatomical outcome after rectocele repair. Between December 2000 and December 2009, we asked sexually active female patients who were to undergo rectocele fascial repair for symptomatic rectoceles to participate in this study. The patients were gynecologically examined before and after surgery and prolapse staging was performed using the ICS-Pelvic Organ Prolapse Staging. Patients were asked to fill in the FSFI before surgery and at 6 months follow-up. For statistical analysis, Graph Pad Prism version 5.0 for Windows was used (Graph Pad, La Jolla, CA, USA). Student's t-test was used after normality tests to compare groups and α was set 0.05. Sixty-eight patients were included in this study. Median age was 72 years (range 47-91), median parity of 2 (range 0-3) and median body mass index was 29 kg/m2 (range 23-31). Main complaints preoperatively were painful prolapse feeling (n = 52), dyspareunia (n = 59), and a feeling of vaginal heaviness (n = 39). One patient who had suffered from postoperative infection that resulted in excessive scar tissue of the posterior wall suffered from de novo dyspareunia. Statistical analyses (paired t-test) showed significant improvement for desire ( P < 0.001), satisfaction ( P < 0.0001), and pain ( P < 0.0001) and no significant changes for arousal ( P = 0.0897), lubrication ( P = 1), and orgasm ( P = 0.0893). Posterior fascial repair improves some domains of sexual function but not all in sexually active patients with symptomatic rectoceles, and local oestrogene treatment may contribute to this finding. [ABSTRACT FROM AUTHOR]