Sexual function in women with uterovaginal prolapse and urinary incontinence
Objective
To compare sexual function in women with and without uterovaginal prolapse and urinary incontinence.
Methods
Eighty women with prolapse and with or without incontinence and 30 continent women without prolapse completed questionnaires assessing sexual function and underwent a physical examination.
Results
Women with prolapse were older than those without prolapse (mean age ± standard deviation 58.2 ± 13.0 versus 49.2 ± 8.4 years, respectively; P <.001). The proportions of sexually active women were similar in both groups (56 and 57% for those with and those without prolapse, respectively). Measures of sexual function were not significantly different between the two groups. The mean global sexual function score was 0.58 ± 0.15 in the prolapse group and 0.55 ± 0.14 in the comparison group, a nonsignificant difference. The proportion of women with vaginal dryness or dyspareunia did not differ significantly between the two groups. Interest in sexual activity was unchanged in 70% of sexually active women with prolapse and incontinence, and 84% reported satisfaction with their sexual relationship. Twenty of 45 (44%) sexually active women with prolapse reported incontinence during sexual activity, and 14 (31%) reported that incontinence or prolapse interfered with sexual activity. After multivariate analysis, increasing age was the only significant factor predictive of a higher global sexual function score (P =.02), indicating worse sexual function. Increasing grade of prolapse predicted interference with sexual activity (P =.05), although this did not affect frequencyof intercourse or description of satisfaction with the sexual relationship.
Conclusion
Women with prolapse and urinary incontinence do not differ from continent women without prolapse in measures of sexual function; age is the most important predictor of sexual function.
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Cited by (157)
Sexual Function Following Treatment for Stress Urinary Incontinence With Bulk Injection Therapy and Mid-Urethral Sling Surgery
2022, Journal of Sexual MedicinePeri-urethral bulking injections (PBI) gain popularity for the treatment of stress urinary incontinence (SUI), but – in contrast to mid-urethral sling (MUS) surgery – little is known about its impact on sexual function.
This was a secondary analysis of a prospective cohort study that included patients with moderate to severe SUI undergoing either MUS surgery or PBI with polydimethylsiloxane Urolastic (PDMS-U). The validated Dutch and English version of the ‘Pelvic Organ Prolapse and/or Urinary Incontinence Sexual Function Questionnaire – IUGA Revised’ (PISQ-IR) was used to assess sexual function at baseline, at 6 and 12 months of follow-up. For between-group analysis, differences in baseline characteristics were corrected using multivariate analysis of covariance.
The primary outcome was the PISQ-IR single summary score of sexually active (SA) women following both procedures, calculated by mean calculation. Secondary outcomes were the PISQ-IR subscale scores of SA and non-sexually active (NSA) women, the proportions of sexual activity and subjective improvement (‘Patient Global Impression of Improvement’ (PGI-I)).
A total of 259 women (MUS: n = 146, PBI: n = 113) were included in this study. The PISQ-IR single summary score of SA women improved following both interventions (in the MUS group from 3.2 to 3.4 and in the PBI group from 3.0 to 3.3 after 12 months). After correcting for differences in baseline characteristics, the PISQ-IR summary score at 6 and 12 months was similar for both treatment groups. For SA women, condition-specific and condition-impact subscale scores significantly improved following both procedures.
In treating SUI, PBI is inferior to MUS surgery. However, there is a need for less invasive strategies, especially for women who are unfit for surgery or have contraindications. Sexual function improves after PBI using PDMS-U, which is relevant for the counselling of women with SUI about available treatment options.
Strength: until this study, there was a lack of knowledge about the effects of PBI on sexual function. Limitation: there may be indication bias as we did not perform a randomized controlled trial.
PBI using PMDS-U and MUS surgery for the treatment of SUI improve sexual function equally in SA women, mainly by decreasing the condition's impact on sexual activity and quality.
Latul YP, Casteleijn FM, Zwolsman SE, et al. Sexual Function Following Treatment for Stress Urinary Incontinence With Bulk Injection Therapy and Mid-Urethral Sling Surgery. J Sex Med 2022;19:1116–1123.
The Lost Penis Syndrome: A New Clinical Entity in Sexual Medicine
2022, Sexual Medicine ReviewsThe “lost penis syndrome” (LPS) is a term often used in non-clinical settings to describe the subjective perception of the loss of cutaneous and proprioceptive feelings of the male organ during vaginal penetration. Although deserving clinical attention, this syndrome did not receive any consideration in the medical literature. Notwithstanding, it represents a relatively unexceptional condition among patients in sexual medicine clinics, and it is often reported together with other sexual dysfunctions, especially delayed ejaculation, anejaculation, male anorgasmia and inability to maintain a full erection.
To draft a new conceptual characterization of the LPS, defined as a lack of penile somesthetic sensations during sexual penetration due to various causes and leading to several sexual consequences in both partners.
Based on an extensive literature review and physiological assumptions, the mechanisms contributing to friction during penovaginal intercourse, and their correlation to LPS, have been explored, as well as other nonanatomical factors possibly contributing to the loss of penile sensations.
Efficient penile erection and sensitivity, optimal vaginal lubrication and trophism contribute to penovaginal friction. Whenever one of these processes does not occur, loss of penile sensation defined as LPS can occur. Sociocultural, psychopathological and age-related (ie, couplepause) factors are also implicated in the etiology. Four types of LPS emerged from the literature review: anatomical and/or functional, behavioral, psychopathological and iatrogenic. According to the subtype, a wide variety of treatments can be employed, including PDE5i, testosterone replacement therapy and vaginal cosmetic surgery, as well as targeted therapy for concomitant sexual comorbidity.
We held up the mirror on LPS as a clinically existing multifactorial entity and provided medical features and hypotheses contributing to or causing the occurrence of LPS. In the light of a sociocultural and scientific perspective, we proposed a description and categorization of this syndrome hypothesizing its usefulness in daily clinical practice.
Colonnello E, Limoncin E, Ciocca G, et al. The Lost Penis Syndrome: A New Clinical Entity in Sexual Medicine. Sex Med Rev 2022;10:113–129.
Évaluer l’impact de l’incontinence urinaire sur la fonction sexuelle des femmes marocaines en utilisant le questionnaire Pelvic Organ Prolapse and/or Urinary Incontinence Sexual Questionnaire (PISQ-12) validé en arabe.
Nous avons réalisé une enquête, sur une période de 6 mois, entre septembre 2018 et mars 2019, auprès de 50 femmes souffrant d’incontinence urinaire. Nous avons comparé les caractéristiques socio-démographiques entre les femmes avec et sans activité sexuelle puis on a comparé le score PISQ-12 entre les différents types d’incontinence urinaire. Une valeur p inférieure à 0,05 a été considérée comme significative.
Notre population d’étude se caractérisait par une moyenne d’âge de 53 ans, une nette prédominance de femmes mariées et en période d’activité génitale, très souvent multipares. L’incontinence urinaire la plus fréquente chez nos patientes est de type urgenturie IUU, suivie de celle à l’effort IUE et de l’incontinence urinaire mixte IUM. Les prolapsus des organes pelviens étaient présents chez 52 % de nos patientes. L’impact négatif de l’incontinence urinaire sur la fonction sexuelle a été mis en évidence par le bas score moyen PISQ-12 de 28,45. Le score moyen était plus bas chez les patientes présentant un prolapsus des organes pelviens (p < 0,05). Les femmes ménopausées avec une IUU avaient une meilleure fonction sexuelle que celles avec une IUE ou IUM (p = 0,038).
La qualité de vie sexuelle est altérée chez les femmes présentant une incontinence urinaire. Il n’existe pas de corrélation entre les différents types d’incontinence urinaire et le score total PISQ-12. L’association prolapsus et incontinence urinaire était plus délétère sur la sexualité.
Assess the impact of urinary incontinence on the sexual function of Moroccan women using the Pelvic Organ Prolapse and/or Urinary Incontinence Sexual Questionnaire (PISQ-12) validated in Arabic.
We conducted a survey, on a 6 months period, between September 2018 and March 2019, with 50 women suffering from urinary incontinence. First, we compared socio-demographic characteristics between women with and without sexual activity. Afterwards, we compared the PISQ-12 score between the different types of urinary incontinence. A P-value less than 0.05 was considered significant.
Our study population was characterized by an average age of 53 years, a clear predominance of married women, in their genitally active period, very often multiparous. The most common urinary incontinence in our patients is urge urinary incontinence UUI followed by stress urinary incontinence SUI and mixed urinary incontinence MUI. Pelvic organ prolapse was found in 52% of our patients. The negative impact of urinary incontinence on sexual function was brought to light by the low mean PISQ-12 score of 28.45 of our patients. The PISQ-12 score was lower in patients with pelvic organ prolapse (P < 0.05). Postmenopausal women with UUI had a better sexual function than women with SUI or MUI (P = 0.038).
The quality of sexual life is impaired in women with urinary incontinence. There is no correlation between the different types of urinary incontinence and the total PISQ-12 score. The association prolapse and urinary incontinence was more deleterious on sexuality.
Retrospective Analysis of Sexual Function After Transvaginal Mesh Surgery
2021, Sexual MedicineDespite ample research regarding the impact of reconstructive surgery on anatomic/functional outcomes of pelvic organ prolapse (POP), including incidence of dyspareunia, evidence regarding sexual outcomes is equivocal.
To assess changes in sexual function in women followed up for at least 12 months after transvaginal mesh surgery for POP.
We conducted a retrospective review of women who underwent surgery for POP using different mesh products between 2008 and 2019. Baseline demographics were compiled along with intraoperative and postoperative information. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12) was used to assess sexual function.
Women sexually active before and after surgery were assessed to determine changes in overall and question-specific PISQ-12 responses and potential factors to explain sexual function after surgery.
622 women underwent surgery using mesh at our center. 360 (58%) attended at least one visit at a median of 12 months (IQR 11–23 months), with 113 (31%) sexually active at baseline and 247 (69%) sexually inactive. 97 had complete PISQ-12 responses before and after surgery. There was an overall improvement in the median PISQ-12 scores of 2 points (P < .001); improvements persisted when scores were stratified by various factors. Specific improvements were noted in climax (P = .046) and orgasm intensity (P = .002), fear (P < .001) or actual incontinence during intercourse (P = .004), avoidance of intercourse due to prolapse (P < .001), and negative emotions (P < .001). There was a slight positive effect of the baseline PISQ-12 score on the postoperative PISQ-12 score (regression coefficient 0.24, 95% CI: 0.09-0.39), and a stronger negative effect of having a concomitant anal sphincteroplasty (−4.84, 95% CI: −8.42 to −1.25). Preoperative prolapse stage was not associated with postoperative sexual outcomes. There was a weak negative association between the postoperative PISQ-12 and Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) scores [rs(95) = −0.27, P = .008] and a moderate negative association between postoperative PISQ-12 and total Pelvic Floor Distress Inventory short form [rs(94) = −0.42, P < .001].
Transvaginal mesh surgery appears to positively impact sexual function, and improvements were independent of mesh or baseline prolapse severity.
Khandwala S, Cruff J, Williams C. Retrospective Analysis of Sexual Function After Transvaginal Mesh Surgery. Sex Med 2021;9:100281.
Pelvic Floor Dysfunction And Its Effect On Quality Of Sexual Life
2019, Sexual Medicine ReviewsPelvic floor disorders (PFD) are extremely common; 1 in 3 parous women will experience urinary incontinence, 1 in 2 will develop pelvic organ prolapse, whereas 1 in 10 experience fecal incontinence. PFD are often associated with a significant reduction in women’s psychological, social, and sexual well-being.
To review the current literature on sexual dysfunction related to PFD.
A literature search was conducted using PubMed and key words including sexual dysfunction, prolapse, incontinence, pelvic floor dysfunction, and surgical repair.
The outcome was to identify the nature and severity of sexual dysfunction in women with PFD.
The prevalence of sexual dysfunction is estimated to be around 30–50% in the general population, whereas in women with PFD, the reported incidence rises to 50–83%. The leading factors cited for the reduction in a woman’s sexual experience included worries about the image of their vagina for women with pelvic organ prolapse, dyspareunia and coital incontinence in women with urinary incontinence, and fear of soiling when dealing with anal incontinence. Pelvic floor muscle training has been associated with an improvement in sexual function. 11% of parous women will have surgery for pelvic organ prolapse, yet limited data are available on the impact of surgical intervention on sexual function. Native tissue repair of pelvic organ prolapse is associated with an improvement in sexual function, whereas posterior repair with levatorplasty and vaginal mesh repair can increase the risk of postsurgical dyspareunia. Subtotal hysterectomy is not associated with improved sexual function compared with traditional total hysterectomy.
It is clear there is an urgent need for further research on the effects of surgery for PFD on sexual function. To date, most studies have focused on anatomic rather than functional outcomes.
Verbeek M, Hayward L. Pelvic Floor Dysfunction and Its Effect on Quality of Sexual Life. Sex Med Rev 2019;7:559–564.
Assessment of Body Image, Sexual Function, and Attractiveness in Women With Genital Prolapse: A Cross-Sectional Study With Validation of the Body Image in the Pelvic Organ Prolapse (BIPOP) Questionnaire
2019, Journal of Sexual MedicineCitation Excerpt :When advanced, POP also may cause pain associated with penetration or may be associated with fear of some form of lesion during intercourse.6 However, some previous studies assessing sexual function of women with prolapse did not demonstrate a consistent negative impact of the condition on sexual functioning.4,7 A literature review found that in most of these studies assessment was focused on measurements of sexual function, POP-related symptoms, and response to surgical treatment of prolapse.8–12
Women’s sense of attractiveness and body image, and the impact of pelvic organ prolapse (POP) over these constructs, are likely influenced by social and cultural background.
To evaluate sexual function and body image in women with POP, to compare the sense of attractiveness between women with and without POP, and to translate the Body Image in the Pelvic Organ Prolapse (BIPOP) questionnaire into Brazilian Portuguese and validate it in this population.
In this cross-sectional study of 105 Brazilian women with POP, we administered the BIPOP (scored from 1 to 5, with higher scores indicating worse body image), the Female Sexual Function Inventory (FSFI) (scored from 2 to 36, with higher scores indicating lower risk for sexual dysfunction), and the Attractiveness subscale of the Body Attitudes Scale questionnaire (BAQ) (scored from 5 to 35, with higher score indicating better body image). We also included 100 control women who completed the BAQ Attractiveness subscale questionnaire.
The main outcome measure included BIPOP, FSFI, and BAQ Attractiveness scores.
Mean BIPOP scores were 3.09 ± 1.08 in women with any POP, 3.05 ± 1.00 in those with lesser-stage POP (1 or 2), and 3.13 ± 1.15 in those with advanced-stage POP (3 or 4). There were no significant differences in score according to prolapse staging (P = .71). FSFI scores were independently associated with BIPOP scores (β = –0.052; P = .02). The mean scores for the BAQ Attractiveness subscale was 17.01 ± 4.07 in women with POP and 16.97 ± 4.60 in those without POP (P = .93). Older age was the sole characteristic associated with being sexually inactive in women with POP; regarding sexual function, a better body image and higher attractiveness scores were independently associated with a higher FSFI score. As for the Portuguese validation of the BIPOP instrument, the adapted version maintained good internal consistency (α = 0.908), good reliability (intraclass correlation coefficient, 0.94), and adequate construct validity.
Women with POP may not relate sexual function or attractiveness to POP extension. An impaired body image is associated with worse perception of attractiveness and increased risk for sexual dysfunction.
As strengths, we used a specific genital body image scale, and this is first study of its kind among Brazilian women. As for weaknesses, we encountered low educational levels in the women with POP.
Among women with POP, the anatomic features of the prolapse do not seem to interfere with genital body image or with sexual function. In addition, the presence of POP was not associated with being sexually active or inactive.
Moroni RM, da Silva Lara LA, Ferreira CHJ, et al. Assessment of Body Image, Sexual Function, and Attractiveness in Women With Genital Prolapse: A Cross-Sectional Study With Validation of the Body Image in the Pelvic Organ Prolapse (BIPOP) Questionnaire. J Sex Med 2019;16:126–136.