Mid-urethral slings and sexual function

Mauro Seveso1, Sara Melegari1, Giorgio Bozzini1, Oliviero De Francesco1, Pietro Bono1, Alberto Mandressi1, Gianluigi Taverna1
  • 1 Humanitas Mater Domini (Castellanza)


Stress urinary incontinence (SUI) has been reported to have a negative impact on sexual relations in up to 68% of women. Women with SUI report avoiding sexual intercourse because of wetness at night, leakage during intercourse, embarrassment and depression. Disorders of arousal, desire, and lubrication, as well as anorgasmia and dyspareunia, are typical complaints reported on sexual function questionnaires. Aging and the presence of certain comorbid conditions (i.e., cervical cancer or multiple sclerosis) clearly lead to worsened sexual functioning among women.
Other factors, such as hormonal status and absence of a uterus, have also been implicated,
although much less clearly so, in the development of sexual dysfunction.
Sling procedures are a widely proven treatment for stress urinary incontinence.
The effects of outside-in transobturator midurethral sling procedures on women's sexual function are unclear.
We conducted this study to investigate sexual function alteration among women who underwent TOT for urodynamic stress incontinence.

Materials and Methods

Patients who underwent transobturator sling surgery were included in the present study if information was available on sexual activity before and 12 months after surgery .We included in the final analysis all the women who are sexually active at baseline.
Between September 2010 and June 2015, 86 patients undergoing TOT were enrolled. An
investigation was conducted using a validated, self-administered questionnaire: Female Sexual
Function Index (FSFI). The evaluation was repeated at the 3(rd), 6(th) and 12(th) months post
surgery and then yearly. The association between midurethral sling surgery and sexual function (coital incontinence, satisfaction, and dyspareunia) was compared.


The mean age of patients was 46.7 ± 5.7. The mean follow-up period was 18.2 ± 2.9 months. After the 12-month follow up, 73 out of 86 patients (86%) were dry, 7 improved their symptoms and the remaining 6 were unchanged. After adjusting for multiple testing, only age, menopause, and storage symptoms remained significantly correlated with the FSFI total score post-surgery as independent variable. A significant loss of total FSFI score was observed at postoperative 3 months (P = 0.003), which was regained after postoperative 6 months. In comparison with baseline and postoperative 12 months, total FSFI score showed significant improvement (P < 0.001).
There were significant improvements in desire, arousal, orgasm, and satisfaction on FSFI domain. The frequency improved in 60 (70.5%) patients, lubricity improved in 49 (57.1%) patients, orgasm improved in 57 (67.1%) patients, pain improved in 59 (70%) patients, in leaking patients sexual satisfaction improved in 85.7% while in non-leaking patients improvement was seen in 40%. Sexual relation was not satisfactory in 65 (76.4%) of the patients before surgery; of them, 68 (80%) patients had improved sexual satisfaction after surgery. De novo urgency and dyspareunia developed in 6 and 3 patients, respectively.


Despite the fact that SUI could be harmful in regard to sexual function, there has been little study of sexual function change after treatment of SUI, with most efforts focusing on incontinence, rather than the effect of cure on sexual function.
The sexual satisfaction is a difficult parameter to study. Reports on sexual function after surgery for SUI vary, with some authors reporting improved function and others reporting deterioration of function [1,2]. Improvements in sexual function following vaginal surgery are believed to be due to the cessation of incontinence during intercourse, whereas worsening sexual function is believed to be caused by dyspareunia following colporhaphy [3,4]. This study was undertaken to assess the effect of the midurethral sling procedure for SUI on sexual function using a validated questionnaire.


These data show that midurethral sling surgery has an overall positive influence on
sexual function in women with stress urinary incontinence. The TOT procedure has no significant negative impact on sexual function and it significantly improves female sexual function and overall sexual satisfaction in majority of the patients with SUI. The transobturator tape procedure has a positive effect on female sexual functioning by reducing urinary leakage and pain during or after sexual activity. Women with coital incontinence show a significant higher improvement in sexual function after surgery for SUI compared to women without coital incontinence. Our results suggest that improvement in coital incontinence results in improvement of sexual function. Therefore, coital incontinence is a prognostic factor for improvement of sexual function following incontinence surgery.


1. Ko YH, Song CH, Choi JW, Jung HC, Song PH “Effect on Sexual Function of Patients and Patients' Spouses After Midurethral Sling Procedure for Stress Urinary Incontinence: A Prospective Single Center Study” Low Urin Tract Symptoms. 2016 Sep;8(3):182-5.

2. nKim DY, Choi JD” Change of sexual function after midurethral sling procedure for stress urinary incontinence” Int J Urol. 2008 Aug;15(8):716-9

3. Liang CC, Tseng LH, Lo TS, Lin YH, Lin YJ, Chang SD “Sexual function following outside-in transobturator midurethral sling procedures: a prospective study” Int Urogynecol J. 2012 Dec;23(12):1693-8.

4. Bekker M, Beck J, Putter H, Venema P, Lycklama A, Nijeholt A, Pelger R, Elzevier H “Sexual function improvement following surgery for stress incontinence: the relevance of coital incontinence”. J Sex Med. 2009 Nov;6(11):3208-13.