Objective: To compare patients undergoing laparoscopic sacrocolpopexy for pelvic organ prolapse POP, in terms of sexual function and surgical anatomical outcomes more than 5-years follow up period. Design: This is a cohort study of prospectively collected data that includes all women who underwent LSC between July 2005 and December 2021 at a tertiary care center. Setting: Improvement in sexual function is an acknowledged goal for women undergoing pelvic organ prolapse repair. The impact of POP surgeries on sexual activity and function is very controversial, with some studies showing improvement, while others showed no differences or worsening in sexuality after the surgery Population: 228 women were enrolled in this study. Methods: Patients completed the validated quality of life questionnaires and were evaluated using the POP-Q, the PFDI-20, PFIQ-7 and the PISQ-12 scores. Patients were divided preoperatively according to their sexual activity and postoperatively according to the sexual improvement after POP surgery. Main Outcomes: To compare the PISQ-12 score pre and postoperatively and to assess anatomical and sexual improvement after surgery. Results: There was a statistically significant improvement in the PFDI, PFIQ and POPQ-score score. There was no significant improvement in the PISQ-12 score with more than 5 years follow-up. 76.1% of patients who were not sexually active preoperatively resumed their sexual activity after the surgery. Conclusions: The anatomical correction of a pelvic organ prolapses and pelvic floor disorders by laparoscopic sacrocolpopexy may improve sexual function but did not change significantly the sexuality score. Funding: No funding. Keywords: prolapse, sacrocolpopexy, laparoscopy, sexuality.

Background: There is variation in the reported incidence of levator avulsion (LA). Objective: Explore incidence of LA by mode of birth, imaging modality, timing of diagnosis and laterality of avulsion. Search strategy: We searched MEDLINE, EMBASE, CINAHL, AMED and MIDIRS with no language restriction from inception to April 2019. Study eligibility criteria: A study was included if LA was assessed by an imaging modality after the first vaginal birth or if only delivered by caesarean section. Case series and reports were not included. Data collection and analysis: RevMan v5.3 was used for the meta-analyses and SW SAS and STATISTICA packages for type and timing of imaging analyses. . Results: We included 37 primary non-randomized studies from 17 countries and involving 5594 women. Incidence of LA was 1%, 15%, 21%, 38.5% and 52% following caesarean, spontaneous, vacuum, spatula and forceps births respectively, with no differences by imaging modality. OR of LA following spontaneous birth vs. caesarean was 10.69. While the OR for LA following vacuum and forceps compared to the spontaneous birth were 1.66 and 6.32 respectively. LA was more likely to occur on the right side following spontaneous birth (p = 0.02) and unilaterally vs. bilaterally following spontaneous (P < .0001) and vacuum-assisted births (P = 0.0103) only. Incidence was higher if assessment was performed in the first 4 weeks postpartum. Conclusions: Forceps significantly increases incidence and severity of LA. Ultrasound and MRI are comparable diagnostic tools but early postpartum imaging may lead to over diagnosis of LA.