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Sexual function in women with pelvic floor and lower urinary tract disorders

Authors
Yuko Komesu, MD
Rebecca G Rogers, MD
Section Editor
Linda Brubaker, MD, FACS, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG

INTRODUCTION

In women, sexual dysfunction and pelvic floor disorders (PFDs) are common problems, both of which diminish quality of life. This topic will review the impact of PFD (pelvic organ prolapse, stress urinary incontinence, anal incontinence) and their treatment on sexual function. Other aspects of female sexual function and pelvic floor disorders can be found separately.

SIGNIFICANCE

The high prevalence of sexual dysfunction in women with pelvic floor disorders is significant because sexuality is an important component of overall quality of life [1]. Avoidance of intercourse has been reported to occur in 11-45 percent of women with urinary incontinence [2-6]. Women with symptomatic pelvic organ prolapse are less likely to engage in sexual relations and more likely to note sexual dysfunction compared with their asymptomatic counterparts [2,7-10]. In a retrospective review of women undergoing urogynecologic surgery, nearly one-third indicated that they avoided sexual activity because of pelvic floor symptoms [11]. Treatment of PFD can reduce sexual dysfunction. Studies using validated questionnaires report improved sexual function in up to 70 percent of women treated for PFD [2,12,13].  

Women with prolapse also report poorer body image [14]. In one study, women with prolapse ≥Stage 2 reported feeling isolated and less attractive, and often changed sexual intimacy practices or avoided sexual intimacy altogether [15].

The extent of sexual dysfunction in women with PFD is difficult to ascertain because of varied definitions of dysfunction and because affected patients may not present for treatment or report the problem [16-25].

RESEARCH TOOLS FOR ASSESSMENT OF SEXUAL FUNCTION

In research studies, the validated questionnaires specifically developed to assess sexual function in women with urinary incontinence and/or pelvic organ prolapse are the Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ) and its 12-question short form, the PISQ-12 [13,26-29]. Limitations of the PISQ include that it has only been validated in female heterosexual activity, it has not been validated in women with anal incontinence, and it was designed to be administered to women who have engaged in sexual relations in the last six months. Subsequently, an international group of investigators revised the PISQ; the newer version, PISQ-IR, includes both women who report that they are sexually active as well as women who report no sexual activity. Importantly, women with fecal incontinence were included in the validation [30-32].

                       

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