New Studies Highlight Need for Focus on Women’s Pelvic Health and Care for Voiding Disorders

San Francisco, CA (UroToday.com) – Female pelvic health can impact a woman’s overall wellness, and conditions such as voiding dysfunction and sexual pain can have significant impacts on quality of life. Three new studies being presented during the American Urological Association (AUA) 2019 Annual Meeting in Chicago bring light to a need for a comprehensive approach to pelvic floor care, attention to symptoms and patients’ adherence to treatment. These abstracts will be presented to the media during a special session for media on Saturday, May 4 at 11 a.m. Dr. Brian Stork, Assistant Clinical Professor of Urology at the University of Michigan, will moderate the session. 

Abstracts presented include: 

Publication # PD20-05 Risk Factors For Dyspareunia Among Female Athletes 
Sexual pain may be more prevalent in female cyclists than previously known, according to this secondary analysis of a cross-sectional study on the impacts of cycling on urinary and sexual wellness. In reviewing data for 2,115 female athletes, researchers identified 1,175 healthy cyclists who reported levels of sexual pain and analyzed associated risk factors using the Female Sexual Function Index. 

Key findings include: 
  • Having genital nodules or genital numbness was associated with a higher risk of sexual pain. 
  • Women athletes who reported satisfaction with emotional closeness to a sexual partner had a decreased risk of sexual pain. 

Publication # PD31-03 Proportion of Women With Overactive Bladder Who Progress From Second- To Third-Line Treatment In A Real-World Setting 

Overactive bladder (OAB) is a common condition affecting nearly half of women. While many women actively seek first-line treatment for OAB, it is not well-known how many continue treatment or progress to second- or third-line therapies. Using data from the Truven MarketScan claims database, researchers identified 17,429 women with OAB who were prescribed second-line treatments and assessed how patients progressed with their care. 

Key findings include: 
  • Nearly one-third (5,331) did not refill their prescriptions or receive third-line treatments within two years.
  • More than one third (6,295 or 36 percent) refilled their prescription at least once, but had discontinued their prescription by two years.
  • Only 24 percent (4,265) were refilling their prescriptions at two years, with 25 percent (383) of this group progressing from second- to third-line treatment. 
Publication # PD25-08 Effects of Bowel Habits on Social Behavior 
Bowel dysfunction outside a known medical diagnosis is more prevalent than appreciated, and can have a significant impact on patients’ psychosocial behavior. In this study of 4,789 women with voiding dysfunction – bowel and urinary – not related to another medical condition, researchers at Vanderbilt University worked to identify potential symptoms that may impact behavior. 

Key findings include: 
  • Of the 4,789 participants in the study, 2,661 (55.6 percent) reported at least one episode of bowel leakage over the previous three months, and 29 reported staying home more often than they would like due to their symptoms. 
  • Staying at home due to bowel symptoms was not significantly associated with urinary frequency or bowel frequency. Patients with unpredictable bowel leakage were more likely to stay home as a result of their symptoms. 
  • Patients who reported more than one episode of bowel leakage were more likely to have depressive symptoms. 
“Female pelvic health is an important area of study as these conditions affect millions of women,” Dr. Stork said. “It is important that we understand not only how these prevalent conditions affect day-to-day life, but also how we can ensure that women get treatment.” 
Abstracts:
PD20-05 
Risk factors for dyspareunia among female athletes 
Kirkpatrick B. Fergus, Andrew J. Cohen, Benjamin N. Breyer 

Introduction: Dyspareunia incurs a considerable toll on quality of life for those affected, and is a complex disorder with poorly understood risk factors. The purpose of this study is to determine demographic, relationship and health risk factors for dyspareunia in a population of healthy female athletes. 

Methods:
This is a secondary analysis of a cross-sectional study on the impacts of cycling on urinary and sexual wellness of female athletes. Participants were recruited online and through sporting clubs. Those with complete survey data were included. We assessed the role of demographic, relationship, and health risk factors in sexual pain using the Female Sexual Function Index (FSFI). A final multivariate logistic regression model was constructed using risk factors identified in univariate analysis with p < 0.05. 

Results:
A total of 2,115 women were included, with 1,175 (56%) reporting any level of sexual pain or greater, 364 (17%) reporting frequent pain, and 378 (18%) reporting severe pain. This was a healthy sample, with less than 5% reporting diabetes or hypertension, and a median BMI of 23.3 (IQR 21.4-25.7). Figure 1 shows the distribution of sexual pain according to age. Risk factors associated with reporting any sexual pain are shown in Table 1. Increasing age, BMI, and reporting current alcohol use were protective; by contrast, having genital nodules OR 1.49 (95% CI 1.22-1.82) or experiencing genital numbness OR 1.29 (1.06-1.57) were associated with sexual pain. Reporting being &[Prime]moderately satisfied&[Prime] or &[Prime]very satisfied&[Prime] with emotional closeness to a sexual partner was associated with decreased odds of sexual pain. 

Conclusions: We report a surprisingly high, previously unknown prevalence of sexual pain in healthy, female athletes. Physicians should elicit careful sexual histories to ensure such problems are diagnosed. Importantly, emotional closeness and intimacy remains an essential component of sexual wellness among this cohort. Future research should explore the role of the dyadic relationship in both men and women&[prime]s sexual function and in interventions that seek to improve sexual functioning. 

Funding: none 

PD31-03 

Proportion Of Women With Overactive Bladder Who Progress From Second- To Third-Line Treatment In A Real-World Setting 
Erika Wolff, Thomas Cook, Anna Kirby, John Gore 

Introduction: Overactive bladder (OAB) affects nearly half of women. Per AUA/SUFU treatment guidelines, patients should be offered first-line behavioral therapies, second-line medical treatment, and then third-line procedure-based treatment (botox injections or neuromodulation) if needed. Numerous studies have shown that most patients diagnosed with OAB are not prescribed medications and those who are discontinue medications within one year due to side effects, lack of efficacy, and/or cost. However, it remains unknown how frequently female patients in the U.S. progress from second- to third-line treatment in a real-world setting. The purpose of this study was to determine the proportion of women who undergo third-line treatment within two years of initiating medications. 

Methods: A retrospective cohort study of adult women diagnosed with non-neurogenic OAB and prescribed a second-line medical treatment was conducted using the Truven MarketScan, a nationally representative administrative claims database. All women aged 63 or less who had their first OAB medication prescription claim between January 1, 2013, and December 31, 2014, were included. Women were excluded if they did not have continuous enrollment for at least one year prior to and two years following their first prescription claim. The primary outcome was the proportion of women at two years following the first prescription claim who 1) never refilled their prescription, 2) discontinued their prescription, 3) had filled a prescription within the previous 90 days, and 4) received a third-line treatment. 

Results:
Of the 17,429 women diagnosed with OAB and prescribed second-line medical treatment, nearly one-third (n=5,331, 30%) did not refill their prescription or receive third-line treatment within two years. A total of 6,295 (36%) women refilled their prescription at least once but discontinued their prescription by two years, and 4,265 (24%) had OAB medication claims at two years. Only 1,538 (9%) progressed from second- to third-line treatment, 383 (25%) of whom also had OAB medication claims at two years. 

Conclusions:
Two years after initiation of medications for OAB, two-thirds of women were neither on second-line medical treatment nor had undergone a third-line treatment. Less than 10% of women progressed from second- to third-line treatment. While it is not possible to assess symptom severity, response to treatment, or whether third-line treatments were offered in this claims database, when combined with findings from previous studies, these results highlight a potential gap in the treatment of women with OAB. 

Funding: None 

MP56-19 

Effects of Bowel Habits on Social Behavior 
Sophia Goodridge , Casey Kowalik, Siobhan Hartigan, Melissa Kaufman, Roger Dmochowski , Stuart Reynolds 

Introduction: The psychosocial impact of bowel symptoms in the pediatric population has been well described in the literature. In contrast, sparse information is available regarding the impact of bowel dysfunction on adultsocial behavior. Herein we aim to identify potential bowel symptoms which may impact adult psychosocial behavior. 

Methods:
This was an IRB approved, cohort study surveying women >/=18 years of age regarding their bowel habits and medical history. The ICIQ_FLUTS and ICIQ_B was used to assess bowel and bladder function. We excluded participants with prior colectomy, cystectomy or diagnosis of neurologic conditions, interstitial cystitis, inflammatory bowel syndrome or inflammatory bowel disease. Bowel dysfunction was defined as having a bowel movement >2 times per day and/or experiencing involuntary bowel leakage. The Pearson Chi squared test was used to measure the association. 

Results: There were 4789 participants who met inclusion criteria. Of these participants, 2661 (55.6%) reported at least one episode of bowel leakage over the past three months. Twenty-nine respondents reported staying at home more often than they would like “most of the time to always” due to their bowel symptoms. Staying at home due to bowel symptoms was not significantly associated with urinary frequency (p= .211) or bowel frequency (p=0.072). Unpredictable bowel leakage experienced “sometime to always” and inability to control loss of stool, loose or solid, were associated with patients staying at home due to bowel symptoms (p<0.0001). Depression was positively associated in patients who reported >1 episode of bowel leakage (p<0.001). Anxiety was not found to be statistically significantly associated with bowel leakage (p=.348). 

Conclusions:
Bowel dysfunction outside of a known medical diagnosis is prevalent at rates that are higher than appreciated. Patients experiencing uncontrollable bowel leakage limit their social engagements and report higher rates of depression than those who do not experience bowel leakage. This information is critical for clinicians responsible for the care of patients with voiding dysfunction to provide comprehensive pelvic floor care. 

Funding: This work was supported by the Office of Medical Student Research at Vanderbilt University School of Medicine and through the Vanderbilt Institute for Clinical and Translational Research by Clinical Translational Science Award number UL1 TR002243 from the National Center for Advancing Translational Sciences and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number 1K23DK103910-01A1. 

Complete AUA 2019 Conference Coverage 
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