Pelvic organ prolapse (POP) is a common pelvic floor disorders affecting women, with one in four experiencing a pelvic floor disorder and one in five ultimately undergoing surgery. Yet despite the prevalence of prolapse — and the profound impact it has on quality of life — sexual function remains an underexamined outcome in surgical research.

Dr. Danielle Antosh, a urogynecologist at Houston Methodist, has spent years studying the intersection of prolapse repair and sexual function. Her recent comprehensive narrative review synthesizes available evidence across surgical approaches and sexual function domains, offering clinicians a clearer framework for counseling patients.

The data are reassuring, she says, but the field still has meaningful gaps to close.

Why sexual function deserves more attention

Although surgeons often categorize complications as bleeding, organ injury or ICU admission, patients often define them differently. Dr. Antosh notes that qualitative studies indicate that women may view a negative impact on sexual function as equivalent in severity to a major postoperative complication.

“Most women want to see an improvement in sexual function,” she says. “Prolapse negatively impacts sexual function in multiple ways — body image, discomfort, decreased sensation — and patients want to know how surgery will affect that.”

Questionnaires indicate that approximately 64% of women presenting with prolapse experience sexual dysfunction, and 22–36% report dyspareunia before surgery. Understanding how surgical repair affects these symptoms is essential for shared decision-making.

What the evidence shows across surgical approaches

Dr. Antosh’s review examines native tissue repairs, abdominal sacrocolpopexy and historical data on transvaginal mesh (no longer used since the 2019 FDA withdrawal). Across these categories, several consistent themes emerge.

1. Overall sexual function tends to improve or remain stable

Across validated measures, none of the major prolapse repair techniques are associated with declines in overall sexual function scores.

This includes:

• Native tissue vaginal repairs

• Abdominal sacrocolpopexy

• Posterior repairs (even though they involve tightening)

• Historical transvaginal mesh data

“We’re not generally negatively affecting women’s sex lives. That’s one of the strongest and most reassuring findings.”

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Dr. Danielle Antosh, urogynecologist

2. Dyspareunia improves for most women

Among women with baseline dyspareunia, more than half experience resolution of pain with sex after prolapse repair.

The review shows that dyspareunia rates decrease across all surgical types, including posterior repairs and mesh‑based procedures.

3. New‑onset dyspareunia is uncommon

De novo dyspareunia occurs in 0–9% of patients, depending on the procedure.

Risk factors include younger age, lower prolapse stage, prior incontinence surgery and posterior repair. Overall risk rates remain low, and most cases resolve with conservative management, including pelvic floor physical therapy or dilator therapy.

4. Improvements vary by domain

The review breaks down sexual function into specific domains, an area rarely examined in prior research.

Domains most likely to improve:

• Desire

• Arousal

• Satisfaction
  
  

Domains with less consistent change:

• Orgasm

• Lubrication
  
  

These findings reflect the multifactorial nature of sexual function, particularly orgasm, which depends on neurologic, vascular, hormonal and psychological factors beyond anatomic correction.

What physicians should know

Dr. Antosh stresses that while the data are reassuring, individualized counseling remains essential. Before preoperative discussions begin, a few topics should be addressed:

• Prolapse can cause discomfort with sex, body‑image concerns and fear of worsening symptoms

• Sexual function is a major goal for many patients, and should be discussed directly

• Most women will see improvement or no change in sexual function after surgery

• A small percentage may develop new pain with sex

• Surgery choice is not primarily driven by sexual function outcomes, as differences between procedures are minimal in this domain

• Patient values matter. For example, women who feel strongly about preserving the uterus or cervix may experience better sexual outcomes when those preferences are honored.
  
  

“If a patient believes their cervix is important to their sexual function, it probably is,” she notes. “We have to listen to that.”

Don’t overlook urinary incontinence

Up to 40–50% of women may develop new stress urinary incontinence after prolapse repair if not screened and treated concurrently. Addressing incontinence at the time of prolapse surgery can also improve sexual function, particularly for women who experience leakage during intercourse.

Where research needs to go next

Despite the encouraging findings, Dr. Antosh emphasizes that sexual function is still understudied in prolapse surgery.

Gaps in knowledge include:

• Standardized reporting of sexual function outcomes

• Better understanding of domain‑specific changes

• Identification of patients at risk for persistent or new dyspareunia

• Research on partner‑related sexual outcomes

• Mechanistic studies on orgasm and anatomic repair
  
  

Her review is one of the first to synthesize data across both overall sexual function and individual domains, offering a more nuanced picture for clinicians.

The bottom line

Pelvic organ prolapse surgery is unlikely to harm sexual function and often improves it — particularly desire, arousal, satisfaction and pain with sex. New‑onset dyspareunia is uncommon, and most women with baseline pain improve.

It is important to initiate conversations about sexual function. Patients should understand the evidence behind each surgical approach, and physicians should incorporate patient values into surgical planning. Realistic, evidence‑based counseling should be shared.

As Dr. Antosh puts it, “These are quality‑of‑life surgeries. Sexual function is a major part of that quality of life, and we need to treat it as such.”