We want to thank you for your very thoughtful letter in response to our article, “Consistently inconsistent, the posterior vaginal wall.” You point out a very important concern, sexual function and body image, as part of the management of not only posterior wall prolapse but also of all pelvic floor disorders. Unfortunately, this article was directed at defecatory dysfunction and correlates of posterior compartment anatomy. We did address some concerns of sexual dysfunction as related to surgical treatment, specifically dyspareunia, following levator myorrhaphy.

We agree with your recommendations and suggestions. Assessment of sexual function and body image are key areas to address in the patient’s evaluation, therapeutic options, and goals for successful treatment. The impact of colpoperineorrhaphy on sexual function has shown improvement in several series, despite increased dyspareunia. This is thought to be secondary to improvement in body image and desire. When caring for women with posterior compartment prolapse, the impact this has on her sexual function and body image should be discussed. Whereas the focus of this article was the correction of bowel dysfunction with surgical management of women with posterior prolapse, we again thank you for calling out this important consideration.