BERKELEY, CA (UroToday.com) - It has been already reported that female sexual function (FSF) is affected by lower urinary tract symptoms (LUTS) and dysfunctions. Nevertheless, data on the relative impairment of female sexuality in women with different types of LUTS are deficient, and the consistency of previous studies is often limited by several biases such as use of non-condition-specific instruments, and lack of a control group or urodynamic evaluation.
|"The presence and monitoring of sexual dysfunctions should be taken into account when choosing proper management of women with LUTS, especially when BPS and urinary incontinence are present."|
We designed an observational cross-sectional study with a control age-matched group in order to determine the impact of LUTS on FSF and to assess their relative detrimental effect. As a result, community-dwelling, sexually active women, aged 18 years or older and with different type of lower urinary tract disorders were included, such as urinary incontinence (stress, urgency and mixed), storage-phase LUTS indicating overactive bladder (OAB) syndrome, voiding-phase LUTS, and bladder pain syndrome (BPS). Women in the control group were sexually active but not complaining of any questionnaire-assessed LUTS.
The results confirmed that FSF is negatively and markedly affected among women with LUTS as compared with control women. All phases of sexual cycle were affected. Thus, orgasm intensity and frequency during intercourse, sexual desire, arousal, and satisfaction were clearly impaired among women with LUTS. Furthermore they reported a significantly higher frequency of urinary incontinence during intercourse, fear of urinary incontinence restricting sexual activity, unpleasant feelings, and pain during intercourse.
Although FSF was worse among older women, the detrimental impact on FSF of urinary incontinence, detrusor overactivity, and BPS was significant regardless of age.
BPS was associated with the worst FSF, mostly because of sexual pain, followed by urinary incontinence. It is known that pelvic pain due to inflammation of the bladder wall and neuropathic dysfunction, dyspareunia, and fear of pain during intercourse are particularly frequent among BPS patients and may cause resistance to penetration and consequent pelvic floor overactivity, vulvodynia, and vaginismus.
Although all clinical types of urinary incontinence appeared to affect FSF, UUI and MUI were associated with the worst FSF as compared with those with SUI or with dry OAB. These observations were corroborated by analyzing the urodynamic diagnoses. Dyspareunia secondary to urine dermatitis or urinary incontinence surgery, and uncontrollable leakage during intercourse, and related psychological consequences (fear of losing urine, embarrassment, diminished self-esteem) can explain the high risk of sexual dysfunction among incontinent patients.
Mechanisms associated with the impact of OAB on FSF can be the fear of leakage during stimulation and intercourse, the need to interrupt intercourse to void, urgency and frequency after coitus, and pelvic floor dysfunction.
Voiding-phase LUTS and urodynamic voiding dysfunctions did not appear to significantly impair FSF.
The biologic or psychological basis of the associations between LUTS and sexual dysfunction deserve further investigation. Although it is usually accepted that LUTS is a risk factor for sexual dysfunction, rather than the opposite, we are cautious in drawing conclusions about a causal relationship owing to the descriptive nature of cross-sectional studies.
The take home message is that the presence and monitoring of sexual dysfunctions should be taken into account when choosing proper management of women with LUTS, especially when BPS and urinary incontinence are present. A multidisciplinary approach is desirable for women expressing interest in improving their sexual function.
Emilio Sacco, MD, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Urology Department - "A. Gemelli" Hospital
Catholic University School of Medicine