Sling Surgery

Content written by Irwin Goldstein MD

Suburethral sling procedures are a very common treatment for stress urinary incontinence (incontinence with sneezing, coughing, lifting). The latest generation of slings involve placement of synthetic mesh at the mid-urethra via a minimally invasive approach. These procedures are fast becoming the treatment of choice for stress incontinence in women due to their minimal risk and morbidity, as well as excellent success rates. While several modifications of these sling surgeries exist, the available information on each technique with respect to sexual function is limited. On that basis, in this document all sling procedures will be discussed together.

Women with stress urinary incontinence often suffer from sexual function alterations due to loss of spontaneity, irritation of the vulva, depression, and low body image. Surgical treatment with a suburethral sling is extremely successful at curing stress incontinence; this may result in improvements in sexual function. However, minor deteriorations have also been noted. Potential reasons for negative effects include disruption of the nerve supply to the female sexual organs, alteration in the vaginal axis or vaginal girth, scar tissue formation at incision lines, and complications related to the mesh itself, such as extrusion, partner discomfort, vaginal discharge and vaginal bleeding.

The majority of studies addressing this issue show marked improvements in sexual function as symptoms of urinary incontinence lessen. However, a few authors report deteriorations in women’s orgasm and satisfaction, as well as increased pain after the surgery. While these subjects are the minority in all studies, it still must be noted. Providers should be aware of the potential for alterations and counsel women about risks and expectations prior to any surgical intervention. Women who experience problems following surgery must have these addressed early in the postoperative period in order to alleviate any long-term impact on their quality of life.