{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:30:07Z","timestamp":1788827407058,"version":"build-2803163510"},"posted":{"date-parts":[[2026,4,21]]},"group-title":"Obstetrics and Gynecology","reference-count":32,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,4,21]]},"abstract":"<jats:title>STRUCTURED ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Importance<\/jats:title>\n                  <jats:p>Sexual dysfunction can occur after midurethral sling (MUS) and transvaginal prolapse surgery. It remains unclear whether these procedures impact the clitoris, despite its role in sexual function and proximity to the MUS and vagina.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To compare postoperative sexual function and clitoral features by MUS and vaginal surgery approach after transvaginal prolapse repair with\/without concomitant MUS.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Cross-sectional ancillary study of magnetic resonance imaging (MRI) and sexual function data from the Defining Mechanisms of Anterior Vaginal Wall Descent study.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Eight clinical sites in the US Pelvic Floor Disorders Network.<\/jats:p>\n                  <jats:p>Participants: 88 women with uterovaginal prolapse who underwent vaginal mesh hysteropexy or vaginal hysterectomy with uterosacral ligament suspension with\/without MUS between 2013-2015. Data were analyzed between September 2021-June 2023.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Exposures<\/jats:title>\n                  <jats:p>Between June 2014-May 2018, participants underwent pelvic MRI 30-42 months after surgery, or earlier if reoperation was desired. Sexual activity and function at baseline and 24-48-month follow-up were evaluated using the Pelvic Organ Prolapse\/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Clitoral features were obtained from postoperative MRI-based 3-dimensional models.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Main Outcomes and Measures<\/jats:title>\n                  <jats:p>PISQ-IR scores and clitoral features (size, position).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Eighty-two women (median [range] age, 65 [47-79] years) were analyzed: 45 MUS (22 hysteropexy, 23 hysterectomy) and 37 No-MUS (19 hysteropexy, 18 hysterectomy).<\/jats:p>\n                  <jats:p>\n                    Postoperatively, 25 MUS, 12 No-MUS, 20 hysteropexy, and 17 hysterectomy patients were sexually active (SA). Overall, within the MUS and vaginal surgery groups, sexual function remained unchanged or improved (most PISQ-IR change from baseline scores were \u22650) among SA and NSA women. Among SA women after surgery, the MUS group (vs No-MUS) had a poorer PISQ-IR arousal\/orgasm (SA-AO) score (median, 3.5 vs 4.3; P=.02). The hysteropexy group (vs hysterectomy) had less improvement in PISQ-IR SA-AO score (median, 0.0 vs 0.3; P=.01). Women with MUS (vs without) had a smaller clitoral glans thickness (median, 9.0 mm vs 10.0 mm; P=.008) and clitoral body volume (median, 2783.5 mm\n                    <jats:sup>3<\/jats:sup>\n                    vs 3587.4 mm\n                    <jats:sup>3<\/jats:sup>\n                    ; P=.01).\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions and Relevance<\/jats:title>\n                  <jats:p>SA women with MUS (vs without) or hysteropexy (vs hysterectomy) experienced poorer postoperative sexual function. MUS was linked to a smaller clitoris. Future studies should explore surgery-induced changes in clitoral anatomy and sexual function.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>KEY POINTS<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Question<\/jats:title>\n                    <jats:p>How do sexual function and clitoral anatomy differ by midurethral sling placement and vaginal surgery approach?<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>This cross-sectional study compared patient-reported sexual function outcomes and 30-42-month postoperative magnetic resonance imaging-based 3-dimensional clitoral models of 82 women after vaginal prolapse surgery with or without concomitant midurethral sling. Midurethral sling (vs no sling) and vaginal mesh hysteropexy (vs vaginal hysterectomy) were associated with poorer postoperative sexual function outcomes. Additionally, midurethral sling was associated with a smaller clitoral glans and body.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Meaning<\/jats:title>\n                    <jats:p>Midurethral sling and vaginal mesh hysteropexy were associated with, and may adversely alter, postoperative sexual function and\/or clitoral anatomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>VISUAL ABSTRACT\/PROMOTIONAL IMAGE<\/jats:title>\n                    <jats:fig id=\"ufig1\" position=\"float\" orientation=\"portrait\" fig-type=\"figure\">\n                      <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"26351291v1_ufig1\" position=\"float\" orientation=\"portrait\"\/>\n                    <\/jats:fig>\n                  <\/jats:sec>\n                <\/jats:sec>","DOI":"10.64898\/2026.04.20.26351291","type":"posted-content","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T22:50:14Z","timestamp":1776811814000},"source":"Crossref","is-referenced-by-count":1,"title":["Sexual Function and Clitoral Anatomy after Vaginal Surgery with and without Midurethral Sling"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4410-8481","authenticated-orcid":false,"given":"Shaniel T.","family":"Bowen","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA"},{"name":"Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9689-3824","authenticated-orcid":false,"given":"Pamela A.","family":"Moalli","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA"},{"name":"Division of Urogynecology and Reconstructive Pelvic Surgery, Magee-Womens Hospital of the University of Pittsburgh, Pittsburgh, PA"},{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca G.","family":"Rogers","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1469-9062","authenticated-orcid":false,"given":"Marlene M.","family":"Corton","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1213-6912","authenticated-orcid":false,"given":"Uduak U.","family":"Andy","sequence":"additional","affiliation":[{"name":"Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles R.","family":"Rardin","sequence":"additional","affiliation":[{"name":"Division of Urogynecology, Alpert Medical School of Brown University, Providence, RI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8323-8174","authenticated-orcid":false,"given":"Michael E.","family":"Hahn","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of California, San Diego, La Jolla, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3859-1494","authenticated-orcid":false,"given":"Alison C.","family":"Weidner","sequence":"additional","affiliation":[{"name":"Division of Urogynecology, Department of Obstetrics & Gynecology, Duke University, Durham, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5888-5129","authenticated-orcid":false,"given":"David R.","family":"Ellington","sequence":"additional","affiliation":[{"name":"Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, Birmingham, AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9562-4083","authenticated-orcid":false,"given":"Donna","family":"Mazloomdoost","sequence":"additional","affiliation":[{"name":"Gynecologic Health and Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7216-7713","authenticated-orcid":false,"given":"Amaanti","family":"Sridhar","sequence":"additional","affiliation":[{"name":"RTI International, Research Triangle Park, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8528-0184","authenticated-orcid":false,"given":"Marie G.","family":"Gantz","sequence":"additional","affiliation":[{"name":"RTI International, Research Triangle Park, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the NICHD Pelvic Floor Disorders Network","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026042403550835000_2026.04.20.26351291v1.1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003992"},{"key":"2026042403550835000_2026.04.20.26351291v1.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2018.10.033"},{"key":"2026042403550835000_2026.04.20.26351291v1.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.05.042"},{"key":"2026042403550835000_2026.04.20.26351291v1.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2020.07.003"},{"key":"2026042403550835000_2026.04.20.26351291v1.5","doi-asserted-by":"publisher","DOI":"10.1016\/J.ESXM.2016.12.001"},{"key":"2026042403550835000_2026.04.20.26351291v1.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2019.02.016"},{"key":"2026042403550835000_2026.04.20.26351291v1.7","doi-asserted-by":"publisher","DOI":"10.1002\/nau.20988"},{"key":"2026042403550835000_2026.04.20.26351291v1.8","doi-asserted-by":"publisher","DOI":"10.1007\/S00261-020-02404-X"},{"key":"2026042403550835000_2026.04.20.26351291v1.9","doi-asserted-by":"publisher","DOI":"10.1111\/jsm.12450"},{"key":"2026042403550835000_2026.04.20.26351291v1.10","doi-asserted-by":"publisher","DOI":"10.1001\/JAMASURG.2024.6922"},{"key":"2026042403550835000_2026.04.20.26351291v1.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2015.12.023"},{"key":"2026042403550835000_2026.04.20.26351291v1.12","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-020-04511-1"},{"key":"2026042403550835000_2026.04.20.26351291v1.13","doi-asserted-by":"publisher","DOI":"10.1016\/J.AJOG.2021.05.041"},{"key":"2026042403550835000_2026.04.20.26351291v1.14","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.12812"},{"key":"2026042403550835000_2026.04.20.26351291v1.15","doi-asserted-by":"publisher","DOI":"10.1007\/S00192-012-2020-8"},{"key":"2026042403550835000_2026.04.20.26351291v1.16","doi-asserted-by":"publisher","DOI":"10.1007\/S00192-017-3373-9"},{"key":"2026042403550835000_2026.04.20.26351291v1.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.mri.2012.05.001"},{"key":"2026042403550835000_2026.04.20.26351291v1.18","doi-asserted-by":"publisher","DOI":"10.1016\/J.CMPB.2021.106175"},{"key":"2026042403550835000_2026.04.20.26351291v1.19","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-022-05172-y"},{"key":"2026042403550835000_2026.04.20.26351291v1.20","doi-asserted-by":"publisher","DOI":"10.22541\/AU.167423421.16369342\/V1"},{"key":"2026042403550835000_2026.04.20.26351291v1.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2023.09.009"},{"key":"2026042403550835000_2026.04.20.26351291v1.22","doi-asserted-by":"publisher","DOI":"10.1111\/JSM.12230"},{"key":"2026042403550835000_2026.04.20.26351291v1.23","doi-asserted-by":"publisher","DOI":"10.1016\/J.JSXM.2021.05.002"},{"key":"2026042403550835000_2026.04.20.26351291v1.24","doi-asserted-by":"publisher","DOI":"10.1007\/S00192-005-0004-7"},{"key":"2026042403550835000_2026.04.20.26351291v1.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.07.009"},{"key":"2026042403550835000_2026.04.20.26351291v1.26","doi-asserted-by":"publisher","DOI":"10.1093\/JSXMED\/QDAC046"},{"key":"2026042403550835000_2026.04.20.26351291v1.27","doi-asserted-by":"publisher","DOI":"10.1111\/J.1743-6109.2012.02711.X"},{"key":"2026042403550835000_2026.04.20.26351291v1.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.12.027"},{"key":"2026042403550835000_2026.04.20.26351291v1.29","doi-asserted-by":"publisher","DOI":"10.1002\/sm2.95"},{"key":"2026042403550835000_2026.04.20.26351291v1.30","doi-asserted-by":"publisher","DOI":"10.18926\/AMO\/56455"},{"key":"2026042403550835000_2026.04.20.26351291v1.31","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13506"},{"key":"2026042403550835000_2026.04.20.26351291v1.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsxm.2016.01.006"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.04.20.26351291","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T10:55:15Z","timestamp":1777028115000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.04.20.26351291"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":32,"URL":"https:\/\/doi.org\/10.64898\/2026.04.20.26351291","relation":{},"subject":[],"published":{"date-parts":[[2026,4,21]]},"subtype":"preprint"}}