Pelvic organ prolapse, self-image and acceptance

Rationale: Pelvic organ prolapse (POP) is a very common disorder among women. Studies show that patients with POP report sexual dysfunction. A study shows that genital self-image is associated with sexual dysfunction. POP directly involves the female genitals and is likely to affect sexual identity. This may become a threat to the sense of the self-concept, which may explain women’s fear and negative experiences in sex. Despite its heuristic and clinical significance, the sexual self-concept has received little research attention so far. It is plausible to assume that not only POP, but also other chronic disease influence the self-image and sexual functioning, therefore we want to determine whether the sexual self-concept in relation to sexual function and sexual experiences is specific to POP, or rather determined by general factors related to being chronically ill. It is known that men with diabetes Mellitus (DM) suffer from sexual dysfunction, the sexual function of women with DM on the other hand is less known. The aim of this study is to determine whether and to which extent the pelvic organ prolapse is associated with poor sexual function in heterosexual couples and assess if it is comparable to patients with diabetes mellitus when compared to healthy controls.
Method: This is a cross-sectional, observational study in patients with POP-Q stadium 2 and their partners, women with diabetes mellitus type 2 and their partners, and healthy controls and their partners. Eligible patients are recruited from 3 hospitals in the Netherlands. A total of 63 couples in each arm of the study (prolapse, DM and healty controls) are included. Patients and their partners are asked to fill in questionnaires separately (for female: Female Sexual Function index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Body Image Scale, Rosenberg Self-Esteem Scale, Female genital self-image scale, Sexual Self-concept, Hospital Anxiety and Depression Scale (HADS), and SF-36. For men: International Index of Erectile Function, Rosenberg Self-Esteem Scale, Female genital self-image scale, Sexual Self-concept, HADS, and SF-36).
Main study parameters/endpoints: The main study endpoint is the score on the FSFI, for women in the POP group, the DM type 2 group, and the control group. Sexual function in men with the international index of erectile function (IIEF), body image using the Body Image Scale and genital body image using the female genital self-image scale (FGSIS), sexual distress with the Female Sexual Distress Scale (FSDS-R), sexual self-concept measured using an adapted version of the Sexual Self Scale of Snell, self-esteem using the Rosenberg Self-Esteem Scale, Anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), and Quality of Life (QoL) measured using the SF-36.

We hypothesize that patients with pelvic organ prolapse have a lower score on the general and sexual well-being than a healthy control group, but also compared to patients with diabetes mellitus. Furthermore, we hypothesize that sexual self-concept is an important determinant of sexual function and behaviour. In addition, we hypothesize that a discrepancy of the patient’s self-image in comparison to the image of the patient by the partner does exist and can be determinative for the sexual behaviour and functioning.

September 2019 start inclusion

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