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Poster 11: Distribution of Nerve Bundles in the Human Vagina and Correlation with Female Sexual Function

Pauls, R N.; Mutema, G K.; Segal, J L.; Silva, W A.; Kleeman, S D.; Karram, M M.

Journal of Pelvic Medicine and Surgery: 2005 - Volume 11 - Issue - p S30-S31
doi: 10.1097/01.spv.0000178867.20559.8e
Poster Presentations: AUGS Abstracts: 2005 26th Annual Scientific Meeting of The American Urogynecologic Society

Good Samaritan Hospital, Cincinnati, OH

Disclosure – Grant/Research Support: AMS: M.M. Karram; Gynecare: M.M. Karram; Pfizer: M.M. Karram; Yamanouchi: M.M. Karram; Consultant: Gynecare: M.M. Karram; Indevus: M.M. Karram; Ortho-MacNeil: M.M. Karram; Watson: M.M. Karram; AMS: S.D. Kleeman; Boston Scientific: S.D. Kleeman; Cooper Surgical: S.D. Kleeman; Mentor: S.D. Kleeman; Speaker's Bureau: Eli Lilly: M.M. Karram; Gynecare: M.M. Karram; Indevus: M.M. Karram; Ortho-MacNeil: M.M. Karram; Watson: M.M. Karram; Pfizer: S.D. Kleeman

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The objectives of this study were to quantify nerve bundle distribution by location in the female vagina and to evaluate whether innervation affects female sexual function.

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This is a prospective study of patients undergoing surgical repair of prolapse and incontinence. A POP-Q examination and questionnaire of sexual function were completed before surgery (FSFI). All patients underwent a preoperative vaginal smear for maturation index. Full-thickness vaginal biopsies of the anterior vaginal wall (proximal and distal), posterior vaginal wall (proximal and distal), cuff, and cervix, where applicable, were obtained during surgery. Specimens were prepared with hematoxylin & eosin and S100 protein immunoperoxidase. The total number of large and small nerves in each specimen were counted and then averaged. Student t test was used to compare the groups (subjects with dysfunction vs subjects without dysfunction).

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Twenty-one subjects were enrolled. The mean age was 50 (range, 22–76). All subjects were white. Eleven were postmenopausal with the majority on hormone replacement. All subjects were parous. Ten subjects had undergone previous vaginal surgery, 9 with hysterectomy. The mean prolapse stage of anterior and posterior compartments was II, vaginal cuff I.

There was no site in the vagina that consistently demonstrated the highest innervation. There was a trend for anterior and posterior walls to be more innervated than the vaginal cuff (see Table 1). There were no differences in total nerves based on age (>50 or <50), maturation index, previous hysterectomy, or number of vaginal deliveries (>3 or <3).



Fifty-two percent of subjects had female sexual dysfunction in one or more domains of the FSFI. The domains and the percentage of dysfunction were as follows: desire (48%), arousal (33%), lubrication (24%), orgasm (29%), satisfaction (24%), and pain (38%). There were no significant differences in total or site-specific nerves in patients with disorders in any of the domains.

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In this group of patients, there is no correlation between vaginal innervation and sexual dysfunction, and there is not one site of greater nerve density. There is a trend for anterior and posterior walls to have more nerves than the vaginal cuff, but the clinical significance of this is unclear. Prior hysterectomy does not appear to result in decreased vaginal innervation.

© 2005 Lippincott Williams & Wilkins, Inc.