Impact of Midline Rectovaginal Fascia Plication on Female Sexual Function and Surgical Outcomes: A Retrospective Study

Objective: Rectocele is a common posterior compartment defect that may cause defecatory dysfunction and impaired sexual function, adversely affecting quality of life. Although midline rectovaginal fascia plication (MFP) is associated with favorable anatomical outcomes, its effects on female sexual function remain insufficiently explored. This study aimed to evaluate surgical outcomes and changes in female sexual function following MFP in women with symptomatic rectocele. Methods: This retrospective study included 100 women who underwent MFP for symptomatic rectocele between January 2023 and December 2024. Objective and subjective success rates were assessed using POP-Q findings and symptom resolution. Sexual function was evaluated preoperatively and at 12 months postoperatively using the Female Sexual Function Index (FSFI). Postoperative pain was assessed using the Visual Analog Scale (VAS). Results: The mean age was 45.96 ± 10.12 years, and the mean follow-up period was 14.42 ± 3.57 months. Objective success based on POP-Q findings and subjective success based on symptom improvement were 92% and 89%, respectively. Postoperative pain decreased significantly within the first postoperative week (p < 0.001). Significant improvement was observed across all FSFI domains. The mean total FSFI score increased from 10.40 ± 4.26 preoperatively to 23.60 ± 3.46 postoperatively (p < 0.0001). Conclusions: Midline rectovaginal fascia plication is a safe and effective surgical option for symptomatic rectocele, providing high anatomical success and significant improvements in female sexual function, with minimal morbidity and rapid recovery.