Skip to main content

Advertisement

SpringerLink
Log in

Pelvic floor symptoms among premenopausal women with pelvic organ prolapse in the Democratic Republic of the Congo

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Most of the literature on pelvic organ prolapse (POP) has been generated from postmenopausal patients in high-income countries. In the Democratic Republic of the Congo (DRC), a significant proportion of patients who present for surgical management of POP are premenopausal. Little is known about the impact of POP on pelvic floor symptoms in this population. The objective was to describe pelvic floor symptoms and sexual function among premenopausal patients presenting for POP surgery in DRC.

Methods

We performed a prospective cohort study of symptomatic premenopausal patients undergoing fertility-sparing POP surgery at a large referral hospital in the DRC. Pelvic floor symptoms were evaluated with the Pelvic Floor Distress Inventory Questionnaire and sexual function with the Pelvic organ prolapse/urinary Incontinence Sexual Questionnaire. Data are presented as means with standard deviations or counts with percentages.

Results

A total of 107 patients were recruited between April 2019 and December 2021. All had either stage III (95.3%) or stage IV (4.7%) prolapse. Ages were 34.2 ± 6.7 years; 78.5% were married. A majority of patients experienced low abdominal pain (82.2%), heaviness or dullness (95.3%), and bulging or protrusion of the prolapse (92.5%). Almost two-thirds of patients reported no longer being sexually active, and 80% stated that they were not sexually active because of POP. Of the 37 sexually active patients (34.6%), nearly all reported significant sexual impairment because of the prolapse, with only 4 reporting no sexual impairment.

Conclusions

This study represents one of the largest prospective series of patients with premenopausal POP. Our results highlight the severity of pelvic floor symptoms and the negative effects on sexual function among this patient population with POP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data Availability

 The data that support the findings of this study are available from the corresponding author, AW, upon reasonable request.

References

  1. Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186:1160–1166. https://doi.org/10.1067/mob.2002.123819.

    Article  PubMed  Google Scholar 

  2. Nygaard I, Bradley C, Brandt D. Pelvic organ prolapse in older women: prevalence and risk factors. Obstet Gynecol. 2004;104:489–97. https://doi.org/10.1097/01.AOG.0000136100.10818.d8.

    Article  PubMed  Google Scholar 

  3. Walker GJA, Gunasekera P. Pelvic organ prolapse and incontinence in developing countries: review of prevalence and risk factors. Int Urogynecol J. 2011;22:127–35. https://doi.org/10.1007/s00192-010-1215-0.

    Article  PubMed  Google Scholar 

  4. Scherf C, Morison L, Fiander A, Ekpo G, Walraven G. Epidemiology of pelvic organ prolapse in rural Gambia, West Africa. BJOG. 2002;109:431–6. https://doi.org/10.1111/j.1471-0528.2002.01109.x.

    Article  PubMed  Google Scholar 

  5. Brækken IH, Majida M, Ellström Engh M, Holme IM, Bø K. Pelvic floor function is independently associated with pelvic organ prolapse. BJOG. 2009;116:1706–14. https://doi.org/10.1111/j.1471-0528.2009.02379.x.

    Article  PubMed  Google Scholar 

  6. Woodman PJ, Swift SE, O’Boyle AL, et al. Prevalence of severe pelvic organ prolapse in relation to job description and socioeconomic status: a multicenter cross-sectional study. Int Urogynecol J. 2006;17:340–5. https://doi.org/10.1007/s00192-005-0009-2.

    Article  Google Scholar 

  7. Nygaard IE, Shaw JM. Physical activity and the pelvic floor. Am J Obstet Gynecol. 2016;214:164–71. https://doi.org/10.1016/j.ajog.2015.08.067.

    Article  PubMed  Google Scholar 

  8. Belayneh T, Gebeyehu A, Adefris M, Rortveit G, Awoke T. Pelvic organ prolapse in Northwest Ethiopia: a population-based study. Int Urogynecol J. 2020;31:1873–81. https://doi.org/10.1007/s00192-019-04196-1.

    Article  PubMed  Google Scholar 

  9. World Fertility Patterns 2015 – Data Booklet (ST/ESA/ SER. A/370). United Nations, Department of Economic and Social Affairs, Population Division. 2015.

  10. Islam RM, Oldroyd J, Rana J, Romero L, Karim MN. Prevalence of symptomatic pelvic floor disorders in community-dwelling women in low and middle-income countries: a systematic review and meta-analysis. Int Urogynecol J. 2019;30:2001–11. https://doi.org/10.1007/s00192-019-03992-z.

    Article  PubMed  Google Scholar 

  11. Ntakwinja M, Borazjani A, Vodusek Z, Tambwe AM, Mukwege D. Surgical management of pelvic organ prolapse in a high-volume resource-limited setting. Int J Gynecol Obstet. 2022;156:145–50. https://doi.org/10.1002/ijgo.13684.

    Article  Google Scholar 

  12. Fatton B, Letouzey V, Lagrange E, Mares P, Jacquetin B, de Tayrac R. Validation linguistique en français de la version courte du questionnaire sur la sexualité (PISQ-12) chez les patientes présentant un prolapsus génital et/ou une incontinence urinaire. J Gynecol Obstet Biol Reprod. 2009;38:662–7. https://doi.org/10.1016/j.jgyn.2009.02.008.

    Article  CAS  Google Scholar 

  13. De Tayrac R, Deval B, Fernandez H, Marès P. Development of a linguistically validated French version of two short-form, condition-specific quality of life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). J Gynecol Obstet Biol Reprod. 2007;36:738–48. https://doi.org/10.1016/j.jgyn.2007.08.002.

    Article  Google Scholar 

  14. Rogers RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C. A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J. 2003;14:164–8. https://doi.org/10.1007/s00192-003-1063-2.

    Article  Google Scholar 

  15. Rogers RG, Kammerer-Doak D, Villarreal A, Coates K, Qualls C. A new instrument to measure sexual function in women with urinary incontinence or pelvic organ prolapse. Am J Obstet Gynecol. 2001;184:552–8. https://doi.org/10.1067/mob.2001.111100.

    Article  CAS  PubMed  Google Scholar 

  16. Johnson K, Scott J, Rughita B, et al. Association of sexual violence and human rights violations with physical and mental health in territories of the Eastern Democratic Republic of the Congo. JAMA. 2010;304:553–62. https://doi.org/10.1001/jama.2010.1086.

    Article  CAS  PubMed  Google Scholar 

  17. Larsudd-Kåverud J, Gyhagen J, Åkervall S, Molin M, Milsom I, Wagg A, Gyhagen M. The influence of pregnancy, parity, and mode of delivery on urinary incontinence and prolapse surgery—a national register study. Am J Obstet Gynecol. 2023;228:61.e1–e13. https://doi.org/10.1016/j.ajog.2022.07.035.

    Article  PubMed  Google Scholar 

  18. Gjerde JL, Rortveit G, Adefris M, Mekonnen H, Belayneh T, Blystad A. The lucky ones get cured: health care seeking among women with pelvic organ prolapse in Amhara Region, Ethiopia. PLoS One 2018;13:e0207651. https://doi.org/10.1371/journal.pone.0207651.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Gjerde JL, Rortveit G, Muleta M, Adefris M, Blystad A. Living with pelvic organ prolapse: voices of women from Amhara region, Ethiopia. Int Urogynecol J. 2017;28:361–6. https://doi.org/10.1007/s00192-016-3077-6.

    Article  PubMed  Google Scholar 

  20. Wusu-Ansah OK, Opare-Addo HS. Pelvic organ prolapse in rural Ghana. Int J Gynecol Obstet. 2008;103:121–4. https://doi.org/10.1016/j.ijgo.2008.06.014.

    Article  Google Scholar 

  21. Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol. 2001;185:1332–8. https://doi.org/10.1067/mob.2001.119078.

    Article  CAS  PubMed  Google Scholar 

  22. Barber MD, Visco AG, Wyman JF, Fantl JA, Bump RC. Sexual function in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol. 2002;99:281–9. https://doi.org/10.1016/S0029-7844(01)01727-6.

    Article  PubMed  Google Scholar 

  23. Handa VL, Cundiff G, Chang HH, Helzlsouer KJ. Female sexual function and pelvic floor disorders. Obstet Gynecol. 2008;111:1045–52. https://doi.org/10.1097/AOG.0b013e31816bbe85.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Weber AM, Walters MD, Schover LR, Mitchinson A. Sexual function in women with uterovaginal prolapse and urinary incontinence. Obstet Gynecol. 1995;85:483–7. https://doi.org/10.1016/0029-7844(94)00434-F.

    Article  CAS  PubMed  Google Scholar 

  25. Rogers GR, Villarreal A, Kammerer-Doak D, Qualls C. Sexual function in women with and without urinary incontinence and/or pelvic organ prolapse. Int Urogynecol J. 2001;12:361–5. https://doi.org/10.1007/s001920170012.

    Article  CAS  Google Scholar 

  26. Özel B, White T, Urwitz-Lane R, Minaglia S. The impact of pelvic organ prolapse on sexual function in women with urinary incontinence. Int Urogynecol J. 2006;17:14–7. https://doi.org/10.1007/s00192-005-1327-0.

    Article  Google Scholar 

  27. Shrestha B, Onta S, Choulagai B, et al. Women’s experiences and health care-seeking practices in relation to uterine prolapse in a hill district of Nepal. BMC Womens Health 2014;14:20. https://doi.org/10.1186/1472-6874-14-20.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Rahman A, Toubia N. Female genital mutilation: a guide to laws and policies worldwide. Zed Books, London; 2000.

  29. Goba GK, Legesse AY, Zelelow YB, et al. Reliability and validity of the Tigrigna version of the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-7 (PFIQ-7). Int Urogynecol J. 2019;30:65–70. https://doi.org/10.1007/s00192-018-3583-9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo

    Mukanire Ntakwinja & Denis Mukwege

  2. Evangelical University in Africa, Bukavu, Democratic Republic of the Congo

    Mukanire Ntakwinja & Denis Mukwege

  3. Global Innovations for Reproductive Health & Life, Chicago, IL, USA

    Adrienne Werth & Ali Borazjani

  4. Hartford Healthcare, Hartford, CT, USA

    Adrienne Werth

  5. Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Ali Borazjani

  6. Departments of Obstetrics & Gynecology and Urology, MedStar Heath, Georgetown University School of Medicine, Washington, DC, USA

    Cheryl Iglesia

  7. Temple University School of Medicine, Philadelphia, PA, USA

    Kevin Jon Williams

Authors
  1. Mukanire Ntakwinja
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adrienne Werth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ali Borazjani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cheryl Iglesia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kevin Jon Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Denis Mukwege
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

M. Ntakwinja: project development, data collection, manuscript writing; A. Werth: data analysis, manuscript writing; A. Borazjani: data analysis, manuscript writing; C. Iglesia: manuscript writing; K.J. Williams: manuscript writing; D. Mukwege: project development, manuscript editing.

Corresponding author

Correspondence to Adrienne Werth.

Ethics declarations

Conflicts of interest

M. Ntakwinja: none; A. Werth: none; A. Borazjani: patents related to treatments and diagnostics for pelvic floor disorders, consultant and equity shareholder in Cosm Medical Corp; C. Iglesia: SGS executive board, NICHD PFDN pelvic floor disorders network advisory board chair, US FDA OBGYN Devices Panel special government employee, medical advisory board member for the Patty Brisben Foundation, Editorial board for Urogynecology journal and OBGManagement journal; K. Williams: none; D. Mukwege: none.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ntakwinja, M., Werth, A., Borazjani, A. et al. Pelvic floor symptoms among premenopausal women with pelvic organ prolapse in the Democratic Republic of the Congo. Int Urogynecol J 35, 103–108 (2024). https://doi.org/10.1007/s00192-023-05670-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-023-05670-7

Keywords

Search

Navigation