A comparison of genital sensory and motor innervation in women with pelvic organ prolapse and normal controls including a pilot study on the effect of vaginal prolapse surgery on genital sensation: A prospective study

Warrell Unit, St Mary's Hospital, Manchester, UK.
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.45). 01/2013; 120(2):193-9. DOI: 10.1111/1471-0528.12083
Source: PubMed


To study genital sensory and motor innervation in women with pelvic organ prolapse and to determine the effect of vaginal prolapse surgery on genital sensation.
A prospective observational study.
A tertiary referral unit in northwest England.
Twenty women complaining of prolapse symptoms (including seven undergoing vaginal prolapse repair) and a control group of ten healthy women.
Women attended a research clinic where genital sensory thresholds were determined by quantitative sensory testing and motor innervation was assessed by concentric needle electromyography (EMG) of the pelvic floor muscles. Women undergoing surgery were assessed preoperatively and postoperatively at 6 months.
Primary outcome measure was change in genital vibration threshold and the percentage of polyphasic potentials on EMG.
Healthy control women had normal vibration detection thresholds at the vagina and clitoris. Thresholds in the majority of women with prolapse were abnormal and in all women with prolapse over the age of 50 years. Women with prolapse had a significantly larger percentage of polyphasic potentials of the left pubococcygeus but not the right. There was no significant change in genital sensory thresholds at 6 months postoperatively following vaginal repair.
The majority of women with prolapse have abnormal genital vibration detection, which is particularly evident after the age of 50 years. Impaired sensory function does not correlate with EMG markers of partial motor denervation. In women with abnormal sensory thresholds, no additional effect was detected following vaginal prolapse repair.

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    ABSTRACT: The objective was to compare vaginal and clitoral sensory thresholds in women with pelvic organ prolapse and women with normal pelvic anatomy. Quantitative sensory thresholds for warm, cold, and vibratory sensations were measured at the vagina and clitoral area of women with pelvic organ prolapse, pelvic organ prolapse quantification (POP-Q) stage II or higher (study group) and of women without prolapse, POP-Q stage ≤ I (control group). The quantitative sensory tests were performed with a thermal and vibration Genito-Sensory Analyzer, at the distal third of the anterior and posterior vaginal wall and at the clitoral area. Warm stimuli were used to evaluate unmyelinated C-fibers; cold stimuli for thinly myelinated A-delta; and vibratory stimuli for large A-beta fibers. Independent Student's t test and Chi-squared test of association were used for analysis of continuous and categorical parameters respectively. Overall, 66 women, 22 with median POP-Q stage III (range: II-IV) and 44 with POP-Q stage I (range: 0-I), participated in the study. There were no statistically significant differences between the two groups regarding the characteristics examined (health status, medical history, and age). In all regions examined, mean thresholds for vibratory and warm stimuli were significantly higher and mean thresholds for cold stimuli significantly lower in the group with prolapse. Women with pelvic organ prolapse exhibited lower sensitivity in the genital area to vibratory and thermal stimuli than did women without prolapse. Our findings suggest that a neuropathic sensory deficit in the area of the genitalia might be associated with prolapse.
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