Randomized Controlled Trial of Postoperative Standardized Counseling Regarding Return to Sexual Activity After Pelvic Reconstructive Surgery
Bibliographic record
Abstract
INTRODUCTION: Women are concerned about return to sexual activity following surgery for pelvic organ prolapse (POP) and urinary incontinence (UI). A qualitative study of first sexual experiences after pelvic reconstructive surgery found that surgeon counseling about resumption of sexual intercourse was important to patients. We developed a patient-centered, standardized counseling tool for return to sexual activity after POP/UI surgery. OBJECTIVE: To determine if standardized counselling regarding first sexual encounter after POP and/or UI surgery improves postoperative preparedness to return to sexual activity and sexual function. METHODS: This multicenter randomized clinical trial recruited women planning to be sexually active after surgery for POP and/or UI who were randomized to standardized or routine counselling at the 6–8 week postoperative visit. The primary outcome was preparedness to return to sexual activity and was measured by an item from a validated questionnaire at 6–8 weeks postoperatively. Patients were considered prepared if patients answered “strongly agree” on a 6-point Likert scale to the statement “Overall, I feel prepared for resuming sexual activity after my surgery.” Participants were contacted at 1-month intervals up to 6 months postoperative, and, when return to sexual activity was reported, patients completed the preparedness and pain scales and the PISQ-IR. Primary analyses were by intention-to-treat, and per-protocol analyses included only women who returned to sexual activity after the 6–8 weeks’ interventions. Preparedness, PISQ-IR scores, pelvic pain, and dyspareunia at 6–8 weeks and survival analyses of time to return to sexual activity were adjusted for covariates as appropriate. RESULTS: 186 patients were randomized with a mean age of 53.0±11.5 years, the majority identified as White (86.4%) and parous (97.6%). Because of baseline differences, odds ratios were adjusted for age, surgery type, PISQ-IR score at baseline, vaginal estrogen use at 6–8 weeks, and education level. Survival analysis of time to return to sexual activity was adjusted for age and presence of POP surgery. 170/186 (91%) completed follow-up and were included in the intention-to-treat analyses. Patients randomized to standardized counseling reported higher preparedness to return to sexual activity (adj OR 2.42, 95% CI 1.03–5.55), lower likelihood of experiencing dyspareunia (adj OR 0.27, 95% CI 0.09–0.86), and earlier return to sexual activity (adj HR 1.46, 95% CI 1.06–2.01) (Table 1) (Figure 1). Prior to the intervention, 57 (33.5%) patients returned to sexual activity; 123 women were included in the per-protocol analyses. In per-protocol analyses, standardized counseling remained associated with greater preparedness at 6–8 weeks postoperative (81 vs. 57%; adj OR 4.8, 95% CI 1.66–13.99) (Table 2). CONCLUSIONS: Standardized counseling regarding return to sexual activity following surgery for POP and UI improves patient preparedness to return to sexual activity compared to routine counseling. Surprisingly, nearly a third of women returned to sexual activity before 6–8 weeks postoperatively.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.010 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.004 | 0.004 |
| Insufficient payload (model declined to judge) | 0.017 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".