{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:15:59Z","timestamp":1792282559841,"version":"4.4.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2018,7,19]],"date-time":"2018-07-19T00:00:00Z","timestamp":1531958400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2018,7,19]],"date-time":"2018-07-19T00:00:00Z","timestamp":1531958400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["jsm.jsexmed.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Women with vesicovaginal fistulas often experience a disruption in their normal lives, including sexual relationships, because of urinary incontinence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>Although surgery repairs the urinary leakage, it is not known how surgery might affect sexual function positively or negatively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>119 women were enrolled before surgery and interviewed including a revised Female Sexual Distress Scale (FSDS-R) score and examined for vaginal length, caliber, and pelvic floor strength.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main Outcome Measures<\/jats:title>\n                  <jats:p>Approximately one third of women return to normal sexual function after repair, although a minority experience de novo dysfunction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>115 women completed follow-up 6 to 12 months after surgery. Approximately one third (35.6%, n\u00a0=\u00a041) stated that intercourse had returned to the way it was before a fistula. Forty-four women (40%) report sexual problems after the fistula developed; 15% due to incontinence and 23.5% due to pain. Fourteen women (12.2%) stated that they experienced problems with intercourse since surgery; 50% due to incontinence during intercourse and 50% due to pain. Nineteen of the participants (16.5%) scored in the range of dysfunction as assessed by the FSDS-R tool after surgery. Fibrosis did not significantly change and was not found to be associated with sexual function. Vaginal length was found to decrease on average by 5 mm. Of the variables examined, the factors statistically significantly associated with dysfunction included a larger-size fistula as determined by the Goh classification (&amp;gt; 3 cm diameter) and decreased vaginal caliber. FSDS-R scores drastically decreased from before to after surgery and the reason for problems with intercourse changed from leaking urine before surgery to lack of partner and concern for HIV infection.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Implications<\/jats:title>\n                  <jats:p>Women with large fistulas and decreased vaginal calibers are at high risk for sexual dysfunction and should be counseled appropriately preoperatively and offered surgical and medical interventions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Strengths &amp; Limitations<\/jats:title>\n                  <jats:p>Physical parameters were combined with qualitative interviews and FSDS-R scores to contextualize sexual health before and after surgery. Limitation is the brief follow-up of 6-12 months after surgery as many women were still abstaining from sexual activity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Sexual dysfunction is a complex issue for women with obstetric fistulas; although many women do not continue to experience problems, several need ongoing counseling and treatment.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1016\/j.jsxm.2018.06.006","type":"journal-article","created":{"date-parts":[[2018,7,20]],"date-time":"2018-07-20T18:09:50Z","timestamp":1532110190000},"page":"1125-1132","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":27,"title":["Sexual Function Before and After Vesicovaginal Fistula Repair"],"prefix":"10.1093","volume":"15","author":[{"given":"Rachel","family":"Pope","sequence":"first","affiliation":[{"name":"Baylor College of Medicine, Department of Obstetrics and Gynecology, Division of Global Women\u2019s Health , Houston, TX , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakash","family":"Ganesh","sequence":"additional","affiliation":[{"name":"International Training and Education Center for Health (I-TECH), University of Washington , Seattle, WA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chisomo","family":"Chalamanda","sequence":"additional","affiliation":[{"name":"Fistula Care Center , Lilongwe , Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Nundwe","sequence":"additional","affiliation":[{"name":"Fistula Care Center , Lilongwe , Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine, Department of Obstetrics and Gynecology, Division of Global Women\u2019s Health , Houston, TX , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,7,19]]},"reference":[{"key":"2023012309405596900_bib1","first-page":"2304","article-title":"Urogenital complaints and female sexual dysfunction, part 2","volume":"7","author":"Wehbe","year":"2010","journal-title":"J\u00a0Sex Med"},{"key":"2023012309405596900_bib2","author":"Fistula care; Meeting the needs of women with fistula deemed incurable: Creating a culture of possibility. 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