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International Journal of Urology (2014)

doi: 10.1111/iju.12610

Original Article

Association of urinary incontinence and sexual function in women Cheng-Chen Su,1 Beth Yu-Chen Sun2 and Bang-Ping Jiann3,4 1

Department of Surgery, Division of Urology, Yuan’s General Hospital, 2Beth’s Clinic, 3Department of Medical Education and Research, Division of Basic Medical Research, Kaohsiung Veterans General Hospital, Kaohsiung, and 4School of Medicine, National Yang-Ming University, Taipei, Taiwan

Abbreviations & Acronyms FSD = female sexual difficulty FSFI = Female Sexual Function Index UI = urinary incontinence UTI = urinary tract infection Correspondence: Bang-Ping Jiann M.D., Department of Medical Education and Research, Division of Basic Medical Research, Kaohsiung Veterans General Hospital, no. 386, Ta-Chung First Road, Kaohsiung 81362, Taiwan. Email: [email protected] Received 6 May 2014; accepted 31 July 2014.

Objectives: To investigate the association between urinary incontinence and female sexual function in a non-clinical population. Methods: A self-administered questionnaire was distributed to 2159 female employees of two hospitals. Results: Of the 883 sexually active participants, pure stress urinary incontinence was reported in 18.3%, pure urge urinary incontinence in 6.8%, mixed urinary incontinence in 15.1% and no urinary incontinence in 59.8%. The prevalence of female sexual difficulty, defined by the Female Sexual Function Index total score ≤26.55, was 52.0%, 56.1%, 54.3% and 42.2%, respectively (P < 0.05). After adjustment of age, menstrual status, length of marriage, having children and relationship with the partner, all types of urinary incontinence showed a significant association with female sexual difficulty with an odds ratio of 1.6–1.8. Taking into consideration the individual domains, pure urge urinary incontinence was a risk factor for decreased sexual lubrication and more sexual pain, and mixed urinary incontinence was a risk factor for less sexual satisfaction, whereas pure stress urinary incontinence was not related to a difficulty in individual domains. Conclusions: Stress urinary incontinence and urge urinary incontinence are associated with general impairment of female sexual function to a mild degree. Only urge urinary incontinence is related to sexual difficulty in specific domains including sexual lubrication and sexual pain.

Key words: female sexual difficulty, female sexual function, individual domain, stress urinary incontinence, urge urinary incontinence.

Introduction Female sexual difficulty (with or without sexual distress) is highly prevalent, affecting 41–47% of women in general populations.1,2 The sexual problems of women include four major subtypes: desire, arousal, orgasm and pain.3 Female sexual functioning can be influenced by various and multiple factors, which include biological, psychosocial and contextual factors.4 There are correlations between different aspects of female sexual function.5 Even though there are some overlaps, different domains of female sexual function have different risk factors.1,6 UI is a common problem in women with a prevalence rate ranging from 10% to over 40% in community-based epidemiological surveys,7,8 but only one-quarter of the women with UI have sought treatment for it.7 Stress UI and urge UI are the main types of UI, and have different causal etiologies. Stress UI originates mostly from aging or childbirth injury because of an anatomical change, or because of neuromuscular compromise of the urethral sphincter itself.8 The cause of urge UI is poorly understood.8 Some factors including aging, menopause, repeated UTI and so on have been reported to have an association with urge UI.9 Sutherst reported that of the 208 female patients with UI, 43% maintained that the UI problem had adversely affected their sexual relations.10 Thereafter, UI has been often reported to have a negative impact on women’s sexuality. However, most of these studies were targeted at clinical cases,10–13 and some drawbacks were found in the study designs, such as no categorization in the types of UI14–16 or in the domains of female sexual function,10 or no adjustment of other factors related to female sexual function.11–13 Herein, we carried out an investigation of the associations between different types of UI and different domains of female sexual function.

Methods The present cross-sectional study was carried out in 2007–2008, and was approved by the institutional review board of Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. A © 2014 The Japanese Urological Association

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self-administered questionnaire was applied to 2159 female employees of two teaching hospitals in southern Taiwan. Given that this was an anonymous survey, signing written informed consent was not required, but a cover letter that described the purpose, procedures and so on of the project was given to participants. A total of 1580 participants returned the questionnaire, with a response rate of 73.2%. The questionnaire comprised 35 multiple choice and openended questions, which included the FSFI, and questions that inquired about urinary incontinence symptoms, demographic data and so on.17 The question regarding the stress UI symptom was: “Under which of the following conditions, will you have urinary incontinence (involuntary urine leakage)?: (i) when the abdomen pressure increases greatly; for example, weightlifting, coughing or sneezing; (ii) when abdominal pressure increases slightly; for example, walking or standing; (iii) any posture or condition; or (iv) I do not have a problem of urinary incontinence.” The participant was defined as having a stress UI symptom if the answer to the aforementioned question was (i), (ii) or (iii), and as having no stress UI symptom if (iv) was chosen. The other question regarding the urge UI symptom was: “How often do you experience urine leakage before you reach a toilet, when you have a desire to void?: (i) always or almost always; (ii) most of the time (more than half of the times); (iii) sometimes (around half of the times); (iv) a few times (less than half of the times); or (v) almost never or never.” If the participant responded as (i), (ii), (iii) or (iv), then she was defined as having an urge UI symptom, or else no urge UI symptom. Participants were classified into four groups according to their UI symptoms, and into the group with no UI if they had neither an urge nor a stress UI symptom; the group with pure stress UI, if they had only a stress, but no urge UI symptom; the group with pure urge UI if they had only an urge, but no stress UI symptom; and the group with mixed UI, if they had both stress and urge UI symptoms.

Outcome measures Female sexual function was assessed by a non-validated Chinese version of the FSFI. The FSFI assesses aspects of female sexual function in six areas: sexual desire, arousal, lubrication, orgasm, sexual satisfaction and sexual pain. Individual domain scores on the FSFI range from 0 to 6, with a higher score indicating better sexual function and less pain, and a score of zero indicating no sexual activity during the previous four weeks. The full score is obtained by adding the scores of the six domains.17 A total FSFI score of ≤26.55 and a score on the desire domain of

Association of urinary incontinence and sexual function in women.

To investigate the association between urinary incontinence and female sexual function in a non-clinical population...
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