Sexual life after gynaecological operations--II.

In a review of the effect of gynecological operations on sexual function, difficulties resulting from operative technique and from psychological side effects were discussed. In repair of prolapse of the vagina, operative technique has been considered of crucial importance in influencing the sexual life of the patient. Preoperative clinical assessment rarely gives an accurate picture but can prepare the operator for some unforeseen difficulties. Patients with recurrent prolapse may have to sacrifice a functional vagina in the interest of surgical cure. However, the patient's views on coitus must be sought before surgery. Vaginal hysterectomy as an alternative to abdominal surgery can result in a rapid return to normal sexual function. Anterior colporrhaphy, the most commonly performed prolapse repair, may narrow the vagina from a too wide excision of vaginal epithelium. Some degree of shortening was thought to be almost invariable. Posterior colpoperineorrhaphy has been the major cause of vaginal stenosis after prolapse repair. The operation should be avoided but a technique by Simmons avoids the useless skin bridge, the main cause of postoperative dyspareunia. In anticipation of continuing postmenopausal atrophy, undue tightening of the vagina should be avoided. Sexual difficulties resulting from episiotomy frequently result from inaccuracy of siting and repair in favor of speed and dispatch. However, some postpartum difficulties in return to sexual function can result from emotional factors. Relief from postoperative contracture after vaginal operations may be obtained by several means including William's operation for vaginal atresia. Other gynecological procedures were considered outside the scope of this article. Therapeutic abortion and sterilization represent a different kind of operation because of emotional impact. However, it is suggested that many sexual problems are the result of poor preoperative explanation and postoperative instructions.