Impact of surgical treatment on pelvic floor symptoms and sexual function in Ghanaian women with pelvic organ prolapse: a prospective study

Abstract

Background: Pelvic organ prolapse (POP) is a major contributor to gynecological morbidity worldwide, including Ghana, with an estimated global prevalence of 30.9%. Surgery remains the definitive treatment for anatomical correction, but evidence on its functional outcomes in sub-Saharan Africa is limited. Objectives: This study evaluated the impact of surgical repair on pelvic floor symptoms and sexual function among Ghanaian women. Design: A prospective, hospital-based before-and-after study was conducted in Ghana between July 2018 and December 2019. Methods: Women with stage II or higher POP ( n = 96) were assessed preoperatively and 3 months postoperatively via the validated Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (IUGA-Revised (PISQ-IR)) tools. Pre- and postoperative mean scores for the urinary, anorectal, mechanical, and sexual function domains were compared via paired t tests. Statistical significance was defined as p < 0.05. Results: Surgical repair appeared to be linked to improvements across all PFDI-20 subscales: POPDI-6 (28.47–1.91, p < 0.001), UDI-6 (17.14–3.26, p < 0.001), and CRADI-8 (5.01–2.15, p < 0.001). Nearly 87% of the participants were sexually inactive, and among these, the PISQ-IR demonstrated marked gains in condition-specific and condition-impact domains ( p < 0.001), although no significant changes were observed in partner-related or global quality domains. The incidence of perioperative complications was minimal and was limited to urinary retention in 4.2% of the patients. Conclusion: Surgical management of POP among Ghanaian women was associated with substantial improvements in bulge, urinary, and bowel symptoms, with additional benefits in selected aspects of sexual health. These findings reflect initial symptom relief and quality of life improvements and should not be interpreted as long-term efficacy. These findings provide essential local data to fill knowledge gaps and inform preoperative counseling, guide decision-making, and shape postoperative expectations in similar resource-limited contexts.