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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 蒙恩 | 陰道脫垂手術對陰道壁敏感性，陰道血管充血及性功能的影響：前瞻性單一醫學中心之研究 | 2015/2/26 下午 08:00:35 | 0 |
| 原 文 | 題 目 | The Effects of Prolapse Surgery on Vaginal Wall Sensibility, Vaginal vasocongestion, and Sexual Function: A Prospective Single Centre Studyrs |
| 作 者 | Marielle M. E. Lakeman, Ellen Laan, and Jan-Paul W. R. Roovers | |
| 出 處 | Neurourology and Urodynamics (2014) 33, 1217-1224. | |
| 出版日期 | Nov, 2014 | |
| 評 論 |
經陰道骨盆器官脫垂手術可以有效改善身體形像(Body image)，也可以減輕骨盆底的症狀，並改善性功能。但是手術本身造成的創傷卻可能會破壞陰道神經支配和血管的完整，進而不利於性功能。本研究的目的是評估陰道脫垂手術對陰道血管充血，陰道壁敏感性，和病人主觀性功能的影響。 這是一個針對預定接受陰道脫垂手術患者進行的前瞻性研究。參與者在手術前和術後6個月給予非色情和色情的視覺刺激並接受評量。評量乃是使用特殊的陰道探頭來進行，探頭裡面包括陰道光電容積描記器(photoplethysmography)用來評估陰道脈衝振幅（VPA）（表示陰道血管充血量），和有四個脈衝電極來測量陰道壁敏感性（表示陰道神經支配）。並使用經過驗證的性功能問卷(FSFI, FSDS-R, SSAQ)來進行評估病人主觀的性功能。 共有二十九的女性參與評估，其中24（83％）人完成6個月追蹤。VPA分析顯示手術後於性刺激期間陰道血管充血顯著減少（術前2.4mV（SD2.5）與術後1.7mV（SD2.4），P= 0.05）。陰道上後壁(cranial posterior vaginal wall)的陰道壁敏感性在手術後顯著減少（術前13.3毫安與術後17.5毫安，P <0.05）。其他位置的陰道壁敏感性並沒有受到手術影響。病人主觀的性功能評估與調查問卷，在手術前後並沒有顯著差異。 這篇研究告訴我們，骨盆腔脫垂手術會減少在色情刺激期間陰道上後壁的敏感性及陰道血管充血量。但病人主觀的性功能評估並未受影響。未來還需要更多的研究來弄清楚這些生理的變化是否與主觀的性功能有關。 |
|
| abstract |
Context Aims: Prolapse surgery has been shown to positively alter body image and decrease pelvic floor symptoms, hereby possibly improving sexual function. However, the surgical trauma itself may adversely affect sexual function, by damaging vaginal innervation and vascularization. The aim of this study is to evaluate the effects of vaginal prolapse surgery on vaginal vasocongestion, vaginal wall sensibility, and sexual function. Methods: A prospective study was performed, including patients scheduled for vaginal prolapse surgery. Participants underwent measurements before and 6 months after surgery, during non-erotic and erotic visual stimuli. Measurements were performed using a vaginal combiprobe which includes vaginal photoplethysmography to assess vaginal pulse amplitude (VPA) (representing vaginal vasoconestion), and four pulse-generating electrodes to measure vaginal wall sensibility (representing vaginal innervation). Sexual function was assessed using validated questionnaires (FSFI, FSDS-R, SSAQ). Results: Twentynine women were included, 24 (83%) completed the 6 months follow-up. VPA analysis showed a significant reduction in vaginal vasocongestion during sexual stimulation post-operatively (pre-op 2.4mV (SD 2.5) vs. post-op 1.7mV (SD 2.4), P=0.05). Vaginal wall sensibility in the cranial posterior vaginal wall was significantly reduced after surgery (pre-op 13.3mA vs. post-op 17.5 mA, P<0.05). Vaginal wall sensibility in the other three locations was not affected by surgery. Sexual function as assessed with questionnaires, was not significantly affected. Conclusion: Prolapse surgery negatively impacted levels of vaginal vasocongestion during erotic stimuli as well as vaginal wall sensibility in the cranial posterior wall. Future studies are needed to tease out if these changes in physiological factors are relevant for subjective sexual function. |
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