The role of pelvic floor innervation disorders associated with neural tube pathology in the development of genital prolapse and sexual dysfunction in women aged 35–45 years

Abstract

DOI: 10.52705/2788-6190-2025-4-06
УДК: 616.61-007.43-055.2:616.831-007.253-053.8

Genital prolapse in middle-aged women is a multifactorial condition involving mechanical, anatomical, and neuromuscular disturbances. However, the contribution of occult neural tube anomalies—particularly spina bifida occulta – to the early development of prolapse and sexual dysfunction remains insufficiently explored. In women aged 35–45 years, the clinical presentation often includes a combination of mild or moderate prolapse, chronic pelvic pain, sexual disorders, and psych emotional symptoms, which may be associated with impaired pelvic floor innervation.
The objective: to evaluate the role of neurogenic disorders related to neural tube pathology in the development of genital prolapse and sexual dysfunction in women aged 35–45 years.
Materials and methods. A total of 55 women were examined and divided into three groups: 20 patients with radiologically confirmed spina bifida occulta and stage I prolapse; 15 women with stage II prolapse without neural tube anomalies; 20 women as the control group. All participants underwent clinical examination, perineal 2D/3D ultrasound, electromyography, manometry, psychosexual assessment (FSFI, PHQ-9, GAD-7), and L5–S2 radiography. Statistical analysis included the t-test, χ2-test, and ANOVA.
Results. Radiological signs of spina bifida occulta were identified in 100% of Group 1 patients and were accompanied by marked neurofunctional deficits, including reduced M-response amplitude (82 ± 12 μV vs. 157 ± 11 μV in controls), prolonged motor conduction time (7.3 ± 0.9 ms), and decreased pelvic floor contraction strength according to manometry (18.7 ± 3.2 cm H2
O). Despite only minimal prolapse severity (POP-Q I), these women exhibited the most pronounced sexual
dysfunction: FSFI reduction to 18.4 ± 4.7, high rates of dyspareunia (65%), hypolibidemia (50%), and anorgasmia (35%). Psych emotional status was also poorest in this group: mean PHQ-9 was 11.2 ± 3.5, and GAD7 was 10.6 ± 3.1, demonstrating a significant correlation between neurogenic impairment and psychological maladaptation (r = 0.61; p < 0.05). In Group 2, anatomical injuries predominated, including levator avulsion (60%), enlargement of the levator hiatus to 29.3 ± 3.8 cm2, and reduced pelvic floor contraction strength (15.1 ± 2.7 cm H2O). Sexual dysfunction was present but had a predominantly mechanical-pain etiology and was less severe than in Group 1 (FSFI – 22.1 ± 4.3). All parameters in the control group remained within normal ranges.
Conclusions. Occult neural tube defects represent a significant risk factor for the early development of prolapse and sexual dysfunction. The findings support the inclusion of radiography and neurofunctional assessment in the early diagnostic algorithm for women with minimal prolapse symptoms. An individualized therapeutic approach should incorporate neurorehabilitation, physiotherapy, correction of sexual dysfunction, and psych emotional support.