Cross-Sectional Ancillary Study Links Midurethral Sling to Reduced Clitoral Dimensions and Sexual Function Scores

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medRxiv Published April 21, 2026 Medically reviewed April 25, 2026 Study authors: Bowen, S. T.; Moalli, P. A.; Rogers, R. G.; Corton, M. M.; Andy, U. U.; Rardin, C. R.; Hahn, M. E.; … DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Note that MUS use was associated with smaller clitoral dimensions and poorer sexual function scores in this cross-sectional analysis.

This cross-sectional ancillary study analyzed data from 88 women analyzed (82 analyzed in results; 45 MUS, 37 No-MUS) with uterovaginal prolapse across eight clinical sites in the US Pelvic Floor Disorders Network. Participants underwent vaginal mesh hysteropexy or vaginal hysterectomy with uterosacral ligament suspension with or without midurethral sling (MUS). Follow-up occurred at 24-48-month follow-up for sexual activity and function, with MRI 30-42 months after surgery (or earlier if reoperation was desired).

Postoperatively, 25 MUS, 12 No-MUS, 20 hysteropexy, and 17 hysterectomy patients were sexually active. Regarding function, the MUS group had a poorer PISQ-IR arousal/orgasm score than the No-MUS group, with a median 3.5 vs 4.3 (P=.02). The hysteropexy group had less improvement than the hysterectomy group, showing a median 0.0 vs 0.3 (P=.01).

Anatomical findings showed women with MUS had a smaller clitoral glans thickness than without MUS, with a median 9.0 mm vs 10.0 mm (P=.008). Similarly, women with MUS had a smaller clitoral body volume, with a median 2783.5 mm3 vs 3587.4 mm3 (P=.01). Safety data including adverse events and discontinuations were not reported.

Authors note that future studies should explore surgery-induced changes in clitoral anatomy and sexual function. Practice relevance suggests women with MUS or hysteropexy experienced poorer postoperative sexual function. The observational design precludes inferring causation from these associations. Funding or conflicts were not reported.

Study Details

Sample sizen = 2,018

EvidenceLevel 5

PublishedApr 2026

View Original Abstract ↓

Importance: Sexual dysfunction can occur after midurethral sling (MUS) and transvaginal prolapse surgery. It remains unclear whether these procedures impact the clitoris, despite its role in sexual function and proximity to the MUS and vagina. Objectives: To compare postoperative sexual function and clitoral features by MUS and vaginal surgery approach after transvaginal prolapse repair with/without concomitant MUS. Design: Cross-sectional ancillary study of magnetic resonance imaging (MRI) and sexual function data from the Defining Mechanisms of Anterior Vaginal Wall Descent study. Setting: Eight clinical sites in the US Pelvic Floor Disorders Network. Participants: 88 women with uterovaginal prolapse who underwent vaginal mesh hysteropexy or vaginal hysterectomy with uterosacral ligament suspension with/without MUS between 2013-2015. Data were analyzed between September 2021-June 2023. Exposures: Between June 2014-May 2018, participants underwent pelvic MRI 30-42 months after surgery, or earlier if reoperation was desired. Sexual activity and function at baseline and 24-48-month follow-up were evaluated using the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Clitoral features were obtained from postoperative MRI-based 3-dimensional models. Main Outcomes and Measures: PISQ-IR scores and clitoral features (size, position). Results: Eighty-two women (median [range] age, 65 [47-79] years) were analyzed: 45 MUS (22 hysteropexy, 23 hysterectomy) and 37 No-MUS (19 hysteropexy, 18 hysterectomy). Postoperatively, 25 MUS, 12 No-MUS, 20 hysteropexy, and 17 hysterectomy patients were sexually active (SA). Overall, within the MUS and vaginal surgery groups, sexual function remained unchanged or improved (most PISQ-IR change from baseline scores were [≥]0) among SA and NSA women. Among SA women after surgery, the MUS group (vs No-MUS) had a poorer PISQ-IR arousal/orgasm (SA-AO) score (median, 3.5 vs 4.3; P=.02). The hysteropexy group (vs hysterectomy) had less improvement in PISQ-IR SA-AO score (median, 0.0 vs 0.3; P=.01). Women with MUS (vs without) had a smaller clitoral glans thickness (median, 9.0 mm vs 10.0 mm; P=.008) and clitoral body volume (median, 2783.5 mm3 vs 3587.4 mm3; P=.01). Conclusions and Relevance: SA women with MUS (vs without) or hysteropexy (vs hysterectomy) experienced poorer postoperative sexual function. MUS was linked to a smaller clitoris. Future studies should explore surgery-induced changes in clitoral anatomy and sexual function.

Cross-Sectional Ancillary Study Links Midurethral Sling to Reduced Clitoral Dimensions and Sexual Function Scores

Study Details

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Cross-Sectional Ancillary Study Links Midurethral Sling to Reduced Clitoral Dimensions and Sexual Function Scores

Study Details

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Ultrasound scans did not change breast cancer surgery outcomes in this large study

Clinical research that matters. Delivered to your inbox.

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