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Cited by 4Pelvic floor disorders treatmentsUterine Myomas and TreatmentsAnesthesia and Pain Management

The Impact of Preoperative Pain on Outcomes After Vaginal Reconstructive Surgery and Perioperative Pelvic Floor Muscle Training

Wang, Rui, Tulikangas, Paul K., Sappenfield, Elisabeth C.·2023·Urogynecology
DOI 10.1097/spv.0000000000001361
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Abstract

IMPORTANCE: The impact of preoperative pain on outcomes can guide counseling. OBJECTIVE: The objective of this study was to compare outcomes after vaginal reconstructive surgery and pelvic muscle training between women with and without preoperative pain. STUDY DESIGN: This is a secondary analysis of the Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial, which randomized patients to a surgical intervention (sacrospinous ligament fixation versus uterosacral vaginal vault suspension) and a perioperative behavioral intervention (pelvic floor muscle training vs usual care). Preoperative pain was defined as a response of "5" or greater on the pain scale or answering "moderately" or "quite a bit" on the Pelvic Floor Distress Inventory question "Do you usually experience pain in the lower abdomen or genital area?" RESULTS: The OPTIMAL trial included 109 women with preoperative pain and 259 without pain. Although women with pain had worse pain scores and pelvic floor symptoms at baseline and postoperatively, they had greater improvement on pain scores (-2.3 ± 2.4 vs -0.2 ± 1.4, P < 0.001), as well as Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire scores. Among women with pain who underwent a sacrospinous ligament fixation, those who received pelvic floor muscle training had a greater reduction in pain compared with those in the usual care group (-3.0 ± 2.3 vs -1.3 ± 2.1, P = 0.008). Persistent or worsening pain was present at 24 months in 5 (16%) women with preoperative pain. CONCLUSIONS: Women with preoperative pain experience significant improvements in pain and pelvic floor symptoms with vaginal reconstructive surgery. Pelvic floor muscle training perioperatively may be beneficial for select patients.

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Crossref · 10.1097/spv.0000000000001361

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Authors
Wang, R., Tulikangas, P. K., & Sappenfield, E. C.
Affiliations
Hartford Hospital (US)
Corresponding author
  • Wang, Rui
  • Tulikangas, Paul K.
  • Sappenfield, Elisabeth C.
ORCID
Sappenfield, Elisabeth C.
Venue
Urogynecology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2023-04-26
Volume
29
Issue
12
Pages
930-937
ISSN
  • 2151-8378 (ISSN-L)
  • 2771-1897
DOI
10.1097/spv.0000000000001361
OpenAlex
W4376872642
Cited by
4
References
31
Citations by year
2026: 3 · 2025: 1
FWCI
0.84
Type
journal article
Language
en
Open access
closed
Locations
  • Urogynecology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
  • Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
Keywords
preoperative pain, vaginal reconstruction, pelvic floor muscle training, sacrospinous ligament fixation, pelvic organ prolapse, pelvic floor symptoms, postoperative pain, OPTIMAL trial
MeSH terms
Female, Humans, Ligaments, Articular, Pain, Surgery, Plastic, Vagina, Randomized Controlled Trials as Topic, Pelvic Floor

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