The Portuguese validation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)

Brazilian Portuguese Translation and Validation of the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-IUGA revised

INTRODUCTION AND HYPOTHESIS

Condition-specific sexual questionnaires are important patient-reported outcome measures. The aim of this study was to translate and validate the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-International Urogynecology Association Revised (PISQ-IR) into Brazilian Portuguese and to clinically validate it in a Brazilian Portuguese-speaking population.

METHODS

Translation and validation of the PISQ-IR was performed according to the International Urogynecological Association-recommended process and guidelines. For external validity, PISQ-IR subscales were compared with the clinical measures, Pelvic Organ Prolapse Quantification system (POP-Q) stage, pelvic floor muscle tone, and Oxford Grading Scale (Pearson correlations). Descriptive statistics, internal consistency (Cronbach's alpha coefficient), and test-retest reliability (interclass correlation coefficient) were calculated for all PISQ-IR subscales.

RESULTS

A total of 120 sexually active and 106 not sexually active women were enrolled in the study between March 2015 and July 2019. Internal consistency was acceptable, with Cronbach's alpha values 0.60-0.80, except for the sexual arousal and orgasm, sexual arousal and partner-related issues, sexual arousal and condition-specific issues, global rating of sexual quality and condition impact subscales. PISQ-IR demonstrated good reliability (α > 0.6, CIC = 0.996). The agreement for each individual questionnaire item also individually presented substantial agreement between the assessments (κ 0.61-0.8). There was a correlation between PISQ-IR and POP, mixed, stress and fecal incontinence diagnosis and a positive correlation with pelvic floor muscle function according to the Oxford Scale in sexually active women. For sexually inactive women there was a correlation between PISQ-IR and mixed urinary symptoms.

CONCLUSIONS

The Brazilian Portuguese version of PISQ-IR is a reliable and valid tool that can be easily used for the identification and assessment of sexual function in Brazilian Portuguese-speaking women with pelvic floor disorders.

The Brazilian Portuguese version of the ICIQ-FLUTSsex: cross-cultural adaptation and measurement property analysis

INTRODUCTION AND HYPOTHESIS

The worldwide prevalence of sexual dysfunction in women is high; therefore, an adequate assessment of this condition is necessary, with instruments validated for the Brazilian population. The aim was to translate and adapt the International Consultation on Incontinence Questionnaire Female Sexual Matters Associated with Lower Urinary Tract Symptoms into Brazilian Portuguese (ICIQ-FLUTSsex-Br) and analyze its measurement properties.

METHODS

We recruited Brazilian women, literate, over 18 years old, who had had sexual intercourse in the last 4 weeks and had urinary loss. The translation and cross-cultural adaptation were performed following five stages: translation, synthesis, back translation, expert committee review, and pre-test. Measurement properties were analyzed using SPSS software, as follows: test-retest reliability using the intraclass correlation coefficient (ICC); construct validity using Pearson's correlation coefficient, by correlating the ICIQ-FLUTSsex-Br with the Female Sexual Function Index (FSFI) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12).

RESULTS

A total of 328 women participated in the study. The reproducibility was 0.88, the standard error of measurement was 0.29, and the minimal detectable change was 0.80 (95% CI). Moderate correlations were found between the total scores of the ICIQ-FLUTSsex and PISQ-12 questionnaires (0.54, p<0.01), confirming the hypotheses outlined. Weak correlations were also found for comparisons between the FSFI and ICIQ-FLUTSsex total scores (-0.56, p<0.01) and the PISQ-12 question about fear of incontinence hindering sexual intercourse (0.26, p<0.01).

CONCLUSION

The Portuguese-language version of the ICIQ-FLUTSsex-Br showed validity and reproducibility, making it a tool to be used in research and clinical practice by health professionals in Brazil.

Validation of the Serbian version of the Pelvic Organ Prolapse/Urinary Incontinence/Sexual Questionnaire short form (PISQ-12)

INTRODUCTION AND HYPOTHESIS

Urinary incontinence (UI) and pelvic organ prolapse (POP) significantly decrease quality of life and sexual health. This study aimed to evaluate the reliability and validity of a Serbian adaptation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) used in assessing sexual function in women with UI and/or POP.

METHODS

This study included 416 women, 310 (74.5%) with UI and/or POP and 106 (25.5%) without UI and/or POP. The adaptation of the PISQ-12 to Serbian language was performed via back-translation. The content validity of the questionnaire was conducted by experts in the field. The reliability and validity of the PISQ-12 were analyzed. Evaluation of the data was performed using Content Validity Index (CVI), Cronbach's alpha, test-retest reliability, item total correlation and confirmatory factor analysis.

RESULTS

Content validity of the Serbian PISQ-12 was 1.00 (100%). Item total correlations were between 0.459 and 0.819 (P < 0.001). The PISQ-12 had an adequate and high internal consistency (Cronbach's alpha 0.806) as well as high test-retest reliability (Pearson correlation coefficient r = 0.807; P < 0.001). Factor analysis results revealed strong construct validity. The mean scores of PISQ-12 were significantly better in the control group compared with the women with UI and/or POP. Sexual function was negatively affected by UI and/or POP as assessed with SF-36 and I-QoL questionnaires.

CONCLUSIONS

This study showed that the Serbian version of the PISQ-12 is a reliable, consistent, valid and condition-specific instrument to assess sexual function in women with UI and/or POP.

Sexuality Assessment of the Brazilian Population: An Integrative Review of the Available Instruments

This paper provides an integrative review of psychometric instruments targeting sexual function and clinical measures of sexuality available to the Brazilian population. Our aim was to summarize the existing measures, indicating current development needs related to the quality of psychometric evidence, research design and untapped theoretical ground that could be relevant for clinical practice and research in sexuality. Electronic databases were searched. Additional records were found through a manual search. The general search terms and operators were (scale OR inventory OR questionnaire) AND (validation) AND (sexual beliefs OR sexuality OR sexual behavior OR sexual function OR sexual satisfaction) AND (Brazil or Brazilian). The results indicate a total of 18 developed or transculturally adapted and/or validated scales and questionnaires available in Brazilian Portuguese, covering sexual dysfunctions and clinical measures. Despite development, adaptation and validation efforts, there is a critical need for better psychometric and sampling strategies as well as norms for the clinical interpretation of test results. Ecological validity is also a challenge. At present, sexual assessments in Brazil offer some useful information, but reaching the applied clinical field remains a challenge.Supplemental data for this article is available online at https://doi.org/10.1080/0092623X.2022.2035869 .

Adaptação transcultural para o português brasileiro e propriedades de medida de questionários de função sexual para mulheres: revisão sistemática

RESUMO O objetivo deste estudo é elencar os questionários utilizados para avaliar a função sexual feminina, bem como analisar o processo de adaptação transcultural para o português brasileiro e as propriedades de medida testadas. Para tanto, foram realizadas buscas nas bases de dados PubMed, Embase, CINAHL e LILACS, usando palavras em inglês, português e espanhol. A partir dessas buscas, foram extraídos dados sobre a tradução, a adaptação transcultural e as propriedades de medida de cada questionário elegível de acordo com os critérios de inclusão. As propriedades de medida relatadas nas publicações foram analisadas por dois avaliadores usando o checklist do COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Um total de 46.987 estudos foi encontrado, dos quais 131 artigos foram analisados integralmente, e apenas 12 foram incluídos na amostra. Foram encontrados sete instrumentos de avaliação da função sexual feminina, e apenas três tiveram suas propriedades psicométricas avaliadas como boas, sendo o Female Sexual Function Index o instrumento mais validado para diferentes populações clínicas. Conclui-se que existe a necessidade de aprimoramento das versões validadas de instrumentos de detecção de disfunção sexual para a população feminina durante todo o seu ciclo de vida.

Female sexual function and quality of life after pelvic floor surgery: a prospective observational study

INTRODUCTION AND HYPOTHESIS

Knowledge about the impact of pelvic floor surgery on sexual function is limited and inconsistent. A prospective study assessed the impact of surgery for prolapse (POP) or stress urinary incontinence (SUI) on sexual function and determined the biopsychosocial predictors for changes in sexual function after surgery.

MATERIALS AND METHODS

Sexually active women scheduled for correction of POP and/or SUI were recruited over a 6-month period. Consenting participants were asked to complete the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) to evaluate sexual function. The King's Health Questionnaire and Prolapse Quality-of-Life Questionnaire were used to assess UI and POP symptoms and their impact on quality of life (QoL), respectively. Women were reviewed over a period of 1 year post-surgery.

RESULTS

Ninety-one patients were followed up over 1 year. After stratification into only or both SUI and POP surgery, global sexual function improved significantly in each group (p < 0.001). The improvement in the overall QoL score after pelvic surgery showed a significant correlation with the improvement in global sexual function (SUI group: r = - 0.38, p < 0.01; POP group: r = - 0.44, p < 0.05). For women undergoing SUI surgery, only educational level and prior hysterectomy had a significant association with improved sexual function. For women undergoing POP surgery with or without SUI surgical repair, no sociodemographic characteristics were preditive of improvement of sexual function.

CONCLUSIONS

Significantly improved sexual function was observed 1 year after pelvic floor surgery, and the improvement was predicted by other social and physical factors in addition to normal functional anatomy.

Vaginal Sacrospinous Ligament Fixation Using Tissue Anchoring System Versus a Traditional Technique for Women With Apical Vaginal Prolapse: A Randomized Controlled Trial

OBJECTIVE

The aim of the study was to compare the efficacy and safety of the tissue anchoring system (TAS) kit versus the traditional technique for sacrospinous ligament fixation (SSLF) to treat apical vaginal wall prolapse.

METHODS

A prospective randomized controlled multicenter study of noninferiority involving women with apical prolapse (C-point≥+1). Primary outcome is surgical success as C-point≤-4 at the 1-year follow-up. Secondary outcomes are success according to the composite criteria as C-point≤-4, Ba-point ≤0, and Bp-point ≤0; POP-Q measures of the vaginal compartments; intraoperative findings, complications; reoperation rate; hospital stay; and quality of life and sexual functioning (PISQ-12). It was estimated that 50 individuals per group would yield an 80% power for a noninferiority margin of 15%.

RESULTS

Ninety-nine women were randomized: TAS (n = 55) and traditional SSLF (n = 44). The groups' preoperative data were similar. Drop-out rate was 11% for 12-month follow-up. Success rates were 90% for TAS and 80% for traditional SSLF (P = 0.0006; absolute difference, 9.8%; 90% confidence interval, -5.2 to 24.8) with the sensivity analyses per-protocol considering only the subjects that completed the 12-month follow-up and 80% versus 73%, respectively (P = 0.0048; absolute difference, 7.3%; 90% confidence interval, -9.6 to 24.2) by sensivity analyses considering the total number of participants randomized and treated with drop-out cases as failure. We detected shorter intraoperative time to dissect and reach the SSL, shorter length of hospitalization, lower rates of urinary tract infection, and lower pain scores in the first 30 days postoperative in the TAS compared with the traditional SSLF groups (P < 0.05). There was an improvement in women's quality of life that did not differ between groups.

CONCLUSIONS

The modified technique of SSLF using the TAS kit is noninferior to the traditional technique for the treatment of apical compartment in 12-month follow-up.

Perioperative pelvic floor muscle training did not improve outcomes in women undergoing pelvic organ prolapse surgery: a randomised trial

QUESTION

In women undergoing surgery for pelvic organ prolapse (POP), what is the average effect of the addition of perioperative pelvic floor muscle training on pelvic organ prolapse symptoms, pelvic floor muscle strength, quality of life, sexual function and perceived improvement after surgery?

DESIGN

Randomised controlled trial with concealed allocation, blinded assessors, and intention-to-treat analysis.

PARTICIPANTS

Ninety-six women with an indication for POP surgery.

INTERVENTION

The experimental group received a 9-week pelvic floor muscle training protocol with four sessions before the surgery and seven sessions after the surgery. The control group received surgery only.

OUTCOME MEASURES

Symptoms were assessed using the Pelvic Floor Distress Inventory (PFDI-20), which is scored from 0 'unaffected' to 300 'worst affected'. Secondary outcomes were assessed using vaginal manometry, validated questionnaires and Patient Global Impression of Improvement, which is scored from 1 'very much better' to 7 'very much worse'. All participants were evaluated 15 days before surgery, and at Days 40 and 90 after surgery.

RESULTS

There was no substantial difference in POP symptoms between the experimental and control groups at Day 40 (31 (SD 24) versus 38 (SD 42), adjusted mean difference -6, 95% CI -25 to 13) or Day 90 (27 (SD 27) versus 33 (SD 33), adjusted mean difference -4, 95% CI -23 to 14). The experimental group perceived marginally greater global improvement than the control group; mean difference -0.4 (95% CI -0.8 to -0.1) at Day 90. However, the estimated effect of additional perioperative pelvic floor muscle training was estimated to be not beneficial enough to be considered worthwhile for any other secondary outcomes.

CONCLUSION

In women undergoing POP surgery, additional perioperative pelvic floor muscle training had negligibly small effects on POP symptoms, pelvic floor muscle strength, quality of life or sexual function.

TRIAL REGISTRATION

ReBEC, RBR-29kgz5.

Impact of urinary incontinence types on women's quality of life

OBJECTIVE

To identify the most frequent type of urinary incontinence in women assisted in two outpatient clinics of urogynecology, and to compare general and specific quality of life among the different types of incontinence measured through validated questionnaires.

METHOD

Cross-sectional study conducted at the urogynecology outpatient clinic. The following questionnaires were used for quality of life assessment: Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), International Consultation Incontinence Questionnaire Short-Form (ICIQ-SF), King's Health Questionnaire (KHQ), and Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ-12).

RESULTS

The study included 556 women. Mixed Urinary Incontinence was the most frequent type (n=348/62.6%), followed by Stress Urinary Incontinence (n=173/31.1%) and Urge Urinary Incontinence (n=35/6.3%). Women with mixed urinary incontinence had greater impact on the general (SF-36) and specific quality of life (KHQ and ICIQ-SF) compared to the others (p<0.05). In the evaluation of sexual function (PISQ-12), there was no difference between groups (p=0.28).

CONCLUSION

All types of urinary incontinence interfere both in the general and specific quality of life, but women with mixed urinary incontinence are the most affected.

Validation of the short forms of the Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in Finnish

Background

Although several validated generic health-related quality of life instruments exist, disease-specific instruments are important as they are often more sensitive to changes in symptom severity. It is essential to validate the instruments in a new population and language before their use. The objective of the study was to translate into Finnish the short forms of three condition-specific questionnaires (PFDI-20, PFIQ-7 and PISQ-12) and to evaluate their psychometric properties in Finnish women with symptomatic pelvic organ prolapse.

Methods

A multistep translation method was used followed by an evaluation of validity and reliability in prolapse patients. Convergent and discriminant validity, internal consistency and reliability via test-retest were calculated.

Results

Sixty-three patients waiting for prolapse surgery filled the three questionnaires within two weeks. Response rate for each item was high in PFDI-20 and PISQ-12 (99.8 and 98.9% respectively). For PFIQ-7 response rate was only 60%. In PFIQ-7, six respondents (9.5%) reached the minimum value of zero showing floor effect. None of the instruments had ceiling effect. Based on the item-total correlations both PFIQ-7 and PFDI-20 had acceptable convergent validity, while the convergent validity of PISQ-12 was lower, r = 0.138–0.711. However, in this instrument only three questions (questions 6, 10 and 11) had r < 0.3 while others had r ≥ 0.380. In the test-retest analysis all the three instruments showed good reliability (ICC 0.75–0.92). Similarly, the internal consistency of the instruments, measured by Cronbach’s α, was good (range 0.69–0.96) indicating high homogeneity.

Conclusions

Finnish validated translation of the PFDI-20 and PISQ-12 have acceptable psychometric properties and can be used for both research purposes and clinical evaluation of pelvic organ prolapse symptoms. The Finnish version of PFIQ-7 displayed low response rate and some evidence of a floor effect, and thus its use is not recommended in its current form.

Electronic supplementary material

The online version of this article (doi:10.1186/s12955-017-0648-2) contains supplementary material, which is available to authorized users.

Evaluation of sexual dysfunction in female patients presenting with faecal incontinence or defecation disorder

PURPOSE

Female patients with pelvic floor diseases may suffer from several sexual disorders and sexual life impairments. The aim of this manuscript was to evaluate sexual dysfunction in female patients presenting with faecal incontinence (FI) and defecation disorder (DD).

METHODS

A retrospective review was performed of a prospectively collected database of sexually active women referred to the pelvic floor clinic, who completed the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-12 (PISQ-12) at first visit. Statistical analysis was performed to evaluate and compare sexual dysfunction between patients with FI and DD and with published data on the general population. Regression analysis was used to identify predictors of sexual dysfunction and surgery.

RESULTS

Three hundred thirteen patients were included, 192 (61%) with FI and 121 (39%) with DD. The patients with DD received more non-gynaecological surgical procedures (p = 0.023). More patients with DD received surgery for their current pelvic floor disease (p < 0.001). Major sexual impairment (PISQ-12 < 30) was found in 100 patients (31.9%). The mean PISQ-12 (33.2 ± 7.2) score was by 5 points lower than those reported in the general population from PISQ-validating studies. Prior anorectal surgery (odds ratio (OR) = 15.4), partner ejaculation problems (PISQ item 11, OR = 2.5), reduced sexual arousal (item 2, OR = 2.1), and orgasm perception (item 13, OR = 2.1) were the strongest predictors of worse sexual function in patients with FI. Patients with DD were almost 15 times more likely to receive subsequent surgery (OR = 14.6, p < 0.001), whereas fear of urine leakage almost doubled the risk.

CONCLUSIONS

Sexual dysfunction is prevalent among patients suffering from FI and DD, and questionnaires are useful in recognizing these patients. Subsequent surgery is more common for patients with DD compared to those with FI.

Female urinary incontinence and sexuality

Urinary incontinence is a common problem among women and it is estimated that between 15 and 55% of them complain of lower urinary symptoms. The most prevalent form of urinary incontinence is associated with stress, followed by mixed urinary incontinence and urge urinary incontinence. It is a symptom with several effects on quality of life of women mainly in their social, familiar and sexual domains. Female reproductive and urinary systems share anatomical structures, which promotes that urinary problems interfere with sexual function in females. This article is a review of both the concepts of female urinary incontinence and its impact on global and sexual quality of life. Nowadays, it is assumed that urinary incontinence, especially urge urinary incontinence, promotes anxiety and several self-esteem damages in women. The odour and the fear of incontinence during sexual intercourse affect female sexual function and this is related with the unpredictability and the chronicity of incontinence, namely urge urinary incontinence. Female urinary incontinence management involves conservative (pelvic floor muscle training), surgical and pharmacological treatment. Both conservative and surgical treatments have been studied about its benefit in urinary incontinence and also the impact among female sexual function. Unfortunately, there are sparse articles that evaluate the benefits of female sexual function with drug management of incontinence.

The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12): validation of the Dutch version

Objectives and hypothesis

To establish the reliability and validity of the Dutch version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in women with pelvic floor dysfunction.

Methods

The PISQ-12 was translated into Dutch following a standardized translation process. A group of 124 women involved in a heterosexual relationship who had had symptoms of urinary incontinence, fecal incontinence and/or pelvic organ prolapse for at least 3 months were eligible for inclusion. A reference group was used for assessment of discriminative ability. Data were analyzed for internal consistency, reproducibility, construct validity, responsiveness, and interpretability. An alteration was made to item 12 and was corrected for during the analysis.

Results

The patient group comprised 70 of the 124 eligible women, and the reference group comprised 208 women from a panel representative of the Dutch female population. The Dutch PISQ-12 showed an adequate internal consistency with a Cronbach’s alpha of 0.57 – 0.69, increasing with correction for item 12 to 0.69 – 0.75, for the reference and patient group, respectively. Scores in the patient group were lower (32.6 ± 6.9) than in the reference group (36.3 ± 4.8; p = 0.0001), indicating a lower sexual function in the patient group and good discriminative ability. Reproducibility was excellent with an intraclass correlation coefficient for agreement of 0.93 (0.88 – 0.96). A positive correlation was found with the Short Form-12 Health Survey (SF-12) measure representing good criterion validity. Due to the small number of patients who had received treatment at the 6-month follow-up, no significant responsiveness could be established.

Conclusions

This study showed that the Dutch version of the PISQ-12 has good validity and reliability. The PISQ-12 will enable Dutch physicians to evaluate sexual dysfunction in women with pelvic floor disorders.

Validation of Hebrew versions of the Pelvic Floor Distress Inventory, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, and the Urgency, Severity and Impact Questionnaire

OBJECTIVE

Validated objective tools in the native languages of investigated populations are important for evaluating effects of medical disorders and treatments. The aim of our study was to validate a Hebrew version of the validated questionnaires commonly used in the field of urogynecology.

METHODS

This is a 2-step, prospective, multicenter study. Using a back-translation method, Hebrew-language versions of the following questionnaires were developed: Pelvic Floor Distress Inventory, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, and the Urgency, Severity and Impact Questionnaire. The questionnaires were administered in both Hebrew and English to 56 bilingual patients with pelvic organ prolapse and/or urinary incontinence. To test reliability, the participants were asked to refill the questionnaires in Hebrew 2 weeks later. Scores from the Hebrew and English versions were compared, using the Wilcoxon signed rank test. Correlations between versions were assessed by the Spearman test. P < 0.05 or less was considered significant.

RESULTS

Scores from the Hebrew and English versions were found to be highly correlated, ρ = 0.61-0.96; P < 0.001. No differences in total scores were detected between the 2 versions of the 3 questionnaires and their subcategories (P > 0.05). Cronbach alpha values were good (0.65-096) for all questionnaires. Scores were highly correlated when the patients refilled the questionnaires in Hebrew (ρ = 0.81-0.98; P < 0.001).

CONCLUSIONS

This study provides validated Hebrew versions of 3 well-accepted pelvic floor questionnaires. These questionnaires will enable standardization when assessing women with pelvic floor dysfunction.

Quality of Life Questionnaires for the Assessment of Pelvic Organ Prolapse: Use in Clinical Practice

Over the past decade, the use of quality of life (QOL) questionnaires in the evaluation of pelvic organ prolapse (POP) has become a standard part of most clinical studies. Investigators have attempted to correlate QOL scores with objective findings and treatment efficacy and as outcome measures in comparing different treatment modalities. Many of the QOL questionnaires are available in short forms, making them easier to adapt to clinical settings. This article includes an overview of several validated QOL questionnaires and their application in studies whose results provide useful guidelines for health care professionals who diagnose and manage women with POP.