How often does midurethral sling surgery cause new sexual pain or dyspareunia?
Executive summary
Midurethral sling (MUS) surgery can cause new-onset sexual pain (de novo dyspareunia) in a measurable minority of patients: randomized and cohort studies report rates commonly around 4–9%, though reported estimates vary widely across studies from near 0% up to about 30% depending on definition, population and procedure type [1] [2] [3]. Overall sexual function several studies show improves for many women after MUS, but a distinct subgroup develops persistent or neuropathic pain that may lead to revision or removal [4] [5] [6].
1. What the literature actually measures: disparate definitions and baselines
Studies do not use a single metric for “new sexual pain,” and baseline rates of dyspareunia before surgery can be high, which complicates estimating true de novo incidence; for example, one prospective series showed dyspareunia falling from 57% at baseline to 43% at 12 months, implying many had preexisting pain rather than new pain attributed to the sling [5]. Randomized trials reporting direct questions on dyspareunia found lower de novo rates — one trial reported 4.8% dyspareunia after conventional midurethral slings vs 11.7% with mini-slings [7] — while other cohort analyses report de novo dyspareunia near 9% (21/238 patients) [2], illustrating how choice of comparator, sling type and outcome instrument matter [1] [2].
2. Typical range: most evidence centers on single‑digit to low‑double‑digit percentages
When pooled conceptually across published series, de novo dyspareunia after MUS most often falls in the single digits to low teens: several well-cited cohort and trial reports document figures around 4–9% for conventional midurethral slings [7] [2]. At the extreme, reviews and editorials cite a broader interval (0–30%) reflecting heterogeneity in follow‑up duration, measurement and inclusion of neuropathic pain versus transient postoperative discomfort [3].
3. Who is at higher risk and how often pain drives reoperation
Patients with preexisting chronic pelvic pain conditions or overlapping pain diagnoses have higher rates of subsequent sling revision or removal: a market‑claims analysis found a 12.7% cumulative incidence of sling revision/removal in those with co‑occurring dyspareunia and interstitial cystitis or pelvic/perineal pain, and chronic pain diagnoses increased revision risk (hazard ratio 2.40) [6] [8]. In surgical series of revisions, vaginal pain/dyspareunia accounted for about 7.9% of revision indications [9], and small case series show persistent pelvic pain may not fully resolve after sling division in some patients [10].
4. Mechanisms and variations by procedure type
Transobturator approaches are linked in some reports with higher rates of neuropathic complications (including groin, thigh pain and possible neuralgia) with reported postoperative peripheral neuropathy rates around 9.4%, which can manifest as dyspareunia or altered genital sensation; mesh material, scarring/retraction and positioning are hypothesized contributors [11] [3]. Comparisons between retropubic and transobturator slings show mixed results: some studies report similar sexual‑function outcomes overall but procedural differences in specific pain patterns and coital incontinence outcomes [2] [4].
5. Treatment outcomes and clinical context
When dyspareunia is linked to sling mechanics or exposure, surgical revision, incision or removal often improves pain for many patients—studies of sling incision report dyspareunia cure rates around 60–94% depending on indication and selection, though sling incision can result in recurrent stress incontinence in a majority of cases [12]. Other literature cautions that while many complications are “infrequent and usually easily managed,” a small group have persistent, difficult‑to‑treat neuropathic pain that may require specialized pain management and sometimes explantation [3] [13].
6. Bottom line and limits of the evidence
Best available evidence places de novo dyspareunia after standard midurethral sling surgery most commonly in the single digits (roughly ~4–9% in multiple reports), with wider reported ranges up to ~30% in heterogeneous series; certain subgroups—those with prior pelvic pain or specific procedural approaches—face substantially higher risk and an elevated likelihood of revision [7] [2] [3] [6]. These numbers must be interpreted alongside study differences in baseline pain, outcome definitions and follow‑up; the literature supports counseling patients about a real but not predominant risk of new sexual pain and about treatment options including sling revision or specialist pain care when needed [12] [14].