Coital incontinence: what can we learn from urodynamic assessment?

Coital Incontinence: A Multicentre Study Evaluating Prevalence and Associations

INTRODUCTION AND HYPOTHESIS

Coital incontinence (CI) is common, with a significant impact on quality of life and sexual function. This multicentre study was aimed at measuring the association between overactive bladder (OAB), stress urinary incontinence (SUI) and different aspects of CI including orgasm and penetration incontinence.

METHODS

Following ethical approval, data from the electronic Personal Assessment Questionnaire-Pelvic Floor patient-reported outcome measure was collated for Urogynaecology outpatients from seven participating UK Hospitals between April 2018 and January 2022. Data were anonymised and analysed centrally using Excel.

RESULTS

A total of 12,877 responses were obtained, of which 4,843 were valid for inclusion. 79.3% of women presented with urinary incontinence of whom 41.6% also reported CI. 96.8% of women with CI reported mixed OAB and SUI, with 2.1% and 1.1% reporting pure OAB and SUI respectively. There was a small subset (2.4%) with no overt urinary incontinence who occasionally experienced CI. Spearman's rank-order correlation demonstrated a statistically significant association between CI symptom score with both SUI (R = 0.57, p < 0.001) and OAB (R = 0.40, p < 0.001); orgasm incontinence with SUI (R = 0.49, p < 0.001) and OAB (R = 0.36, P < 0.001); penetration incontinence with SUI (R = 0.48, p < 0.001) and OAB (R = 0.35, p < 0.001).

CONCLUSIONS

Coital incontinence is experienced by 42% of women with urinary incontinence. There is a statistically significant association between both SUI and OAB with orgasm incontinence and penetration incontinence, suggesting (a) common underlying mechanism(s). Limitations of this study include the large amount of missing data and the NHS outpatient setting that limit the conclusions that can be drawn from the data.

Does Sexual Intercourse Position Have a Role in Occurrence of Coital Urinary Incontinence?

INTRODUCTION AND HYPOTHESIS

This study was aimed at investigating the hypothesis that sexual intercourse positions may have an impact on the occurrence of coital urinary incontinence (CUI) in women.

METHODS

This case-control observational study enrolled 360 married, heterosexual, sexually active female participants with CUI. Each patient was evaluated using medical and sexual histories, questionnaires, physical examinations, and laboratory tests, including urodynamics. Participants were asked whether or not their intercourse positions had an impact on the occurrence of their CUI. Patients with intercourse position-dependent CUI were included in group 1, and those independent of it were allocated to group 2. The clinic and laboratory findings of the patient groups were compared.

RESULTS

The patients' mean age was 47.24 ± 0.57 years. Of these women, 28.9% (n = 104) were in group 1, and 71.1% (n = 256) were in group 2. Group 1 had a lower mean age, body mass index, Charlson comorbidity index, number of urinary incontinence episodes, severity of CUI and incontinence, and pad weight than group 2 (p < 0.05). The rates of detrusor overactivity and penetration type of CUI were higher in group 1 than in group 2 (p < 0.0009, p = 0.009 respectively). According to logistic regression analysis, the likelihood of sexual position-related CUI was 3.5 times higher in women with detrusor overactivity.

CONCLUSIONS

In certain patients, intercourse position is associated with the occurrence of CUI. This condition seems to be related to detrusor overactivity and is inversely associated with incontinence severity. However, further studies are necessary to explain this phenomenon.

The International Female Coital Incontinence Questionnaire: Translation, Validation, and Reliability Study of the Persian Version

INTRODUCTION AND HYPOTHESIS

This study was aimed at validating the Persian version of the International Female Coital Incontinence Questionnaire (IFCI-Q).

METHODS

In the current study, 150 sexually active women with complaints of any kind of sexual dysfunction from January 2022 to July 2023, who were referred to urogynecology outpatient clinics, completed the IFCI-Q. Age ≥ 18 years and sexually active women were the inclusion criteria for the study. Quantitative calculations were made to determine the content validity ratio and content validity index. A test-retest procedure was utilized to determine the scale reliability.

RESULTS

The mean (SD) age of participants was 35.66 (7.03) years. Among a total of 150 women, 21 (14.0%) had coital incontinence (CI), and this disorder happened during penetration in 11 cases (7.3%), orgasm in 9 (6.1%), or both conditions in one woman (0.7%). The intraclass correlation coefficient (95% confidence interval) was 0.79 (0.74, 0.84), and the Cronbach's α coefficient was 0.89. A positive association between the Female Sexual Function Index and the IFCI-Q was also demonstrated by the criteria validity (r = 0. 87 and p = 0.001).

CONCLUSION

Regarding validity and reliability, the Persian version of the IFCI-Q can properly evaluate CI in women with sexual dysfunction or complaining of CI.

Urinary symptoms and female sexual dysfunction in women with type 1 diabetes: the role of depression

BACKGROUND

Some reports suggest that women with type 1 diabetes (T1D) have a greater burden of female sexual dysfunction (FSD) than women without T1D, but the etiology of this elevated risk is poorly understood.

AIM

To examine the associations between FSD and urinary incontinence/lower urinary tract symptoms (UI/LUTS) in women with T1D and to evaluate how depression may mediate these relationships.

METHODS

LUTS and UI symptoms were assessed in women with T1D who participated in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study. Multivariable logistic regression models estimated associations between FSD and UI/LUTS (overall and specific domains) and the impact of depression on these associations.

OUTCOMES

FSD was measured with the Female Sexual Function Index-Reduced.

RESULTS

In total, 499 self-reported sexually active women completed validated assessments of sexual and urinary function (mean ± SD age, 47.7 ± 7.6 years; T1D duration, 23.4 ± 5.15 years). FSD was reported in 232 (46%) responders. The frequency of UI and LUTS was 125 (25.1%) and 96 (19.2%), respectively. Neither UI nor its subcategories (urge, stress) were associated with FSD. Although LUTS (odds ratio [OR], 1.75; 95% CI, 1.09-2.77) and its symptoms of urgency (OR, 1.99; 95% CI, 1.09-3.61) and incomplete emptying (OR, 2.44; 95% CI, 1.23-4.85) were associated with FSD, these associations were attenuated following adjustment for depression and antidepressant medication use. Depression indicators were independently associated with FSD overall and across domains.

CLINICAL IMPLICATIONS

The complex interplay of voiding dysfunction, mental health, and sexual function warrants further investigation to understand the potential implications for patient assessment, goal setting, treatment, and care planning.

STRENGTHS AND LIMITATIONS

Data are from a prospective study of individuals with T1D. These results are unable to explore cause-and-effect relationships among LUTS, UI, depression, and FSD. The sample may not be representative of the general population of women with T1D. Because participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study are mostly White, generalizing the findings to other races and to type 2 diabetes may not be appropriate. While exclusion of sexually inactive women likely biases our findings toward the null, this design element permitted study of LUTS and UI in relation to aspects of FSD, the primary objective of this study.

CONCLUSIONS

The significant associations between LUTS/UI and FSD among middle-aged women with T1D were greatly attenuated when depression was considered a mediating factor.

The association of coital incontinence with clinical factors and single voiding cycle ambulatory urodynamic monitoring findings in women

Introduction

Coital incontinence (CI) is a frequent problem in women with urinary incontinence (UI) with significant impact on female sexuality and quality of life. The underlying mechanism is controversial; it has been known that CI is associated with both stress urinary incontinence (SUI) and detrusor overactivity (DO). However, recently it has been reported that CI is mainly related with SUI and urethral incompetence, but not with DO. Ambulatory urodynamic monitoring (AUM) has been shown to be a sensitive tool for the detection of DO. The aim of this study was to investigate the clinical risk factors for CI and the association of CI with urodynamic diagnoses at single voiding cycle AUM.

Methods

Records of sexually active women with urinary incontinence attending the urogynaecology unit of a university hospital, who completed the PISQ-12 were reviewed retrospectively (n = 1,005). Patients were grouped using the 6th question; patients answering “never” to this question were considered as continent during coitus (n = 591) and patients reporting any urinary leakage at coitus were considered to have CI (n = 414). Demographics, clinical examination findings, incontinence severity measured by the Sandvik Incontinence Severity Index, scores of Turkish validated questionnaires (PFDI-20, IIQ-7, OAB-V8, and PISQ-12) and single voiding cycle AUM findings were compared, and univariate and multivariate logistic regression analyses were performed.

Results

Among all sexually active women with UI, 41.2% had CI; UI was more severe, symptom bother was higher, related quality of life (p &lt; 0.001) and sexual function were worse (≤0.018) in these women. Younger age (OR 0.967, p &lt; 0.001), history of vaginal delivery (OR 2.127, p = 0.019), smoking (OR 1.490, p = 0.041), postural UI (OR 2.012, p = 0.001), positive cough stress test (OR 2.193, p &lt; 0.001), and positive SEST (OR 1.756, p = 0.01) were found as independent clinical factors associated with CI. Urodynamic SUI (OR 2.168, p = 0.001) and MUI (OR 1.874, p = 0.002) were found as significant and independent urodynamic diagnoses associated with CI, whereas no association was found with DO or UUI.

Conclusion

Both clinical and AUM findings supported that CI is a more severe form of UI that it is mainly related with SUI and urethral incompetence, but not with UUI or DO.

Female Sexual Dysfunctions and Urogynecological Complaints: A Narrative Review

Female sexual dysfunctions represent a real widespread problem, usually faced from a psychological point of view; however, millions of women worldwide are impacted by pelvic floor dysfunction, personal shame and social taboos, however, continue to inhibit free conversation on the subject. Women's quality of life is considerably improved by screening, diagnosing, and controlling urogenital and sexual issues. This review aims to provide a critical perspective of urogenital conditions and common disturbances in female sexual function associated with these issues. It also includes a discussion of postpartum pelvic dysfunction.

Quality of Life, Psychological Wellbeing, and Sexuality in Women with Urinary Incontinence—Where Are We Now: A Narrative Review

Urinary incontinence (UI) is a very common condition, negatively affecting social, occupational, domestic, and psychophysical wellbeing. In particular, a peculiar and detrimental effect of UI has been described concerning sexual function. However, the impact of UI on quality of life is not fully understood yet, and further investigation into this issue is warranted. With this narrative review, we aimed to report the current evidence from recent literature regarding the quality of life and psychological wellbeing in patients with urinary incontinence, with a special focus on sexual function and its evolution after UI treatment. There is strong evidence that urinary incontinence—in its different forms, including stress urinary incontinence, urge urinary incontinence, mixed urinary incontinence, and coital urinary incontinence—negatively affects female sexual function. Treatments aimed to cure urinary incontinence—including pelvic floor muscles training, medications, and surgery—seem to improve quality of life by recovering, at least in part, sexual function. In conclusion, there is a substantial association between involuntary urinary loss and sex life quality. However, few studies are available and more evidence is needed before consistent conclusions can be made.

The International Female Coital Incontinence Questionnaire (IFCI-Q): Development, Validation and Reliability Study

INTRODUCTION

Coital urinary incontinence is an underestimated urinary symptom characterized by urine leakage during intercourse with a serious impact on female sexual function, which often may lead to the abandon of sexual activity. To date, there are no specific validated questionnaires for coital incontinence (CI).

AIM

Aim of the study was to develop and validate a questionnaire "International Female Coital Incontinence- Questionnaire" (IFCI-Q) to evaluate the presence, severity and type of CI and its impact on quality of sexual intercourse.

METHODS

The IFCI-Q validation process included the following stages: (i) Questionnaire development and expert focus group (urologists and gynecologists experts in the field of functional urology); (ii) Administration of IFCI-Q to sexually active women complained for CI, by cognitive interview; (iii) Expert focus group to assess for content validity; (iv) Psychometric assessment of internal consistency by Cronbach's alpha calculation; (v) Test-retest reliability.

MAIN OUTCOME MEASURE

Aim of the questionnaire was to evaluate the presence, severity and type of CI, its impact on quality of sexual intercourse and psychological status and to identify concomitant urinary symptoms. Psychometric properties outcomes: internal consistency and reliability are considered acceptable for Cronbach's α coefficient >0.7 and Cohen's k-test >0.6, respectively. Test-retest reliability was detected by administering the questionnaire twice to the all included women with a time interval of 2 weeks. The content validity was evaluated by a panel of clinical experts.

RESULTS

Thirty women (mean ± SD age: 43.4 ± 17.1 years) complained of CI completed the IFCI-Q. A total of 43.4% of patients had OAB symptoms, 23.3% had mixed urinary incontinence (UI) and 6.6% complained of stress UI. Patients with CI during penetration had a higher prevalence of predominant SUI (7/10), and all women suffering from CI during orgasm had OAB symptoms (11/11). A total of 80% women feel depressed and 56.6% patients reported that CI restricts their sexual activity. Internal consistency and replicability of data were in the adequate range (Cronbach α = 0.737). The test-retest procedure revealed that the k-values of each item are very good.

CONCLUSION

IFCI-Q is a reliable questionnaire on CI and demonstrated a high level of internal consistency and reliability. Gubbiotti M, Giannantoni A, Rubilotta E, et al. The International Female Coital Incontinence Questionnaire (IFCI-Q): Development, Validation and Reliability Study. J Sex Med 2022;19:158-163.

Is coital incontinence a manifestation of urodynamic stress incontinence or detrusor overactivity?

INTRODUCTION AND HYPOTHESIS

Coital incontinence (CI) is an underreported symptom among sexually active women. It has been assumed that incontinence at penetration (CIAP) is due to urodynamic stress incontinence (USI), while coital incontinence at orgasm (CIAO) is thought to be due to detrusor overactivity (DO).

METHODS

To evaluate demographic and urodynamic findings associated with coital incontinence (CI) and to confirm the hypotheses 'CIAP is associated with USI' and 'CIAO is associated with DO we performed a retrospective study of 661 sexually active women attending a tertiary clinic between January 2017 and December 2019 for pelvic floor dysfunction. All patients filled in a standardized questionnaire and had a clinical examination and multichannel urodynamic testing. Women were asked if they experienced urine leakage during intercourse and the timing of such leakage.

RESULTS

Of 661 sexually active women, one third (n = 220) reported coital incontinence. While 121 (18%) women experienced CIAP, 172 (26%) had CIAO and 76 (11.5%) suffered both. For women with pure USI, the prevalence of CIAP (61.7%) and CIAO (69.5%) was significantly higher than for women with pure DO, where only 12.3% had CIAP and 8.6% had CIAO. Factors significantly associated with CI were body mass index, mid-urethral closure pressure (MUCP) and abdominal leak point pressure (ALPP). When only women with pure USI or DO were included, USI remained associated with CI while DO was not.

CONCLUSIONS

CI is clearly associated with SUI and USI and is likely to share etio-pathogenetic mechanisms. CI seems to be a manifestation of USI, even when it occurs during orgasm.

Development and validity of a questionnaire for coital urinary incontinence: clinical and urodynamic analysis

INTRODUCTION AND HYPOTHESIS

To develop and validate a questionnaire (coital incontinence questionnaire-CIQ) for CI and perform clinical and urodynamic analysis of patients with CI.

METHODS

A total of 414 female patients with urinary incontinence undergoing urodynamics were included in this study. All patients were evaluated with a detailed history, questionnaires, physical examination, relevant laboratory tests and urodynamics. Content, construct and convergent validity of the questionnaire were evaluated. Patients were divided into groups: with CI (group 1) and without CI (group 2).

RESULTS

Overall test-retest reliability coefficients of CIQ were high (r = 0.968, p = 0.01), and the internal consistency was excellent (Cronbach's alpha, 0.964). The test-retest scores did not show a statistically significant difference (p = 0.158). Approximately 34% of these women had CI. Body mass index (BMI), parity, daily incontinence episodes, daily pad counts and 1-h pad test results were higher in group 1 than group 2 (p < 0.05). Multivariate analysis revealed that a daily incontinence episode, BMI, maximum cystometric capacity and PdetQmax were statistically significant factors associated with CI. Urinary incontinence types were different between groups (p < 0.0001). Incontinence with both penetration and orgasm was the most common form of CI (54.4%), and CI severity differed significantly among the forms of CI (p = 0.007). CI negatively interferes with patients' sexual life, their relationship with their partner and quality of life in most patients.

CONCLUSIONS

The CIQ is a reliable, valid and useful tool for assessment of all aspects of CI in women. CI seems to be related to the severity of urinary incontinence. Further studies are needed to clarify this subject.

[Coital incontinence]

INTRODUCTION

Urinary incontinence may seriously impact quality of life, self-image and subsequently the sexual life. Beside this fact, urinary leakage can specifically occur during sexual intercourse, formally named coital incontinence, and thus lead to specific alteration of the sexual life.

AIM

To analyse the prevalence, pathophysiological mechanisms and possible therapeutic options for coital urinary incontinence.

METHODS

Related terms to urinary incontinence and sexual dysfunction were search on PubMed database.

RESULTS

Whereas at least a quarter of incontinent women have a coital incontinence, this symptom was rarely spontaneously reported. Some women had only coital incontinence (7.6 to 20% of cases). In men, urinary incontinence during sexual intercourse was mainly observed after prostatectomy in 20 to 64% of cases. Coital incontinence requires precise assessment. Indeed, it can occur whatever the phase of coitus: local stimulation (20-30%), excitement (13-18%), penetration (62.9-68%), movements back and forth, orgasm (27-37.1%). Cervico-urethral hypermobility, sphincter incompetence, urethral instability, detrusor overactivity could be the principal physiopathological mechanisms. In men, the main cause was a stress incontinence secondary to sphincter deficiency. Specific therapeutic strategies have proved their effectiveness. The rehabilitative approach (RR=0.25, CI [0.06-1.01]), medicinal (anticholinergic were effective in 59% of cases) or surgical therapeutic (slings with an efficiency of 87%) was proposed to patients.

CONCLUSION

Coital incontinence is a common and troublesome symptom. Its precise assessment may suggest a specific mechanism and thus a specific treatment.

Differential diagnostics of female "sexual" fluids: a narrative review

INTRODUCTION AND HYPOTHESIS

Women expel various kinds of fluids during sexual activities. These are manifestations of sexual arousal and orgasm or coital incontinence. This study is aimed at suggesting a diagnostic scheme to differentiate among these phenomena.

METHODS

Web of Science and Ovid (MEDLINE) databases were systematically searched from 1950 to 2017 for articles on various fluid expulsion phenomena in women during sexual activities, which contain relevant information on sources and composition of the expelled fluids.

RESULTS

An ultra-filtrate of blood plasma of variable quantity, which is composed of transvaginal transudate at sexual stimulation, enables vaginal lubrication. Female ejaculation (FE) is the secretion of a few milliliters of thick, milky fluid by the female prostate (Skene's glands) during orgasm, which contains prostate-specific antigen. Squirting (SQ) is defined as the orgasmic transurethral expulsion of tenths of milliliters of a form of urine containing various concentrations of urea, creatinine, and uric acid. FE and SQ are two phenomena with different mechanisms. Coital incontinence (CI) could be classified into penetration and orgasm forms, which could be associated with stress urinary incontinence or detrusor hyperactivity.

CONCLUSION

Squirting, FE, and CI are different phenomena with various mechanisms and could be differentiated according to source, quantity, expulsion mechanism, and subjective feelings during sexual activities.

Evaluation of coital incontinence by electronic questionnaire: prevalence, associations and outcomes in women attending a urogynaecology clinic

INTRODUCTION AND HYPOTHESIS

Coital incontinence is the involuntary leakage of urine during sexual intercourse and is divided into that occurring with penetration and that occurring with orgasm. Mechanisms of coital incontinence are poorly understood. The aim of this retrospective study was to measure the prevalence of coital incontinence and evaluate the association among various types of coital incontinence with stress urinary incontinence (SUI), overactive bladder (OAB) and impact on quality-of-life in women attending a urogynaecology clinic.

METHODS

A total of 2,312 women completed the electronic Personal Assessment Questionnaire-Pelvic Floor (ePAQ-PF) in advance of their urogynaecology consultation. Logistic regression and Spearman's rank-order correlation evaluated associations between types of coital incontinence and OAB and SUI. The Mann-Whitney test evaluated the relationship between coital incontinence and self-reported quality of sex life and self-avoidance and partner avoidance of sex. Subgroup analysis analysed outcomes in 84 women with coital incontinence undergoing treatment with tension-free vaginal tape (TVT).

RESULTS

Prevalence of coital incontinence in the cohort was 30%. Symptoms of OAB (p < 0.005) and SUI (p < 0.005) were significantly and independently associated with both types of coital incontinence (orgasm and penetration). In women with coital incontinence compared with those without, there was significant self-avoidance of sex (p < 0.0005), partner avoidance of sex (p < 0.0005) and impaired quality of sex life due to sexual problems (p < 0.005). The impact of this was significant in each group. Subgroup analysis of 84 women undergoing TVT showed significant improvement in all coital incontinence symptoms 3 months post-operatively.

CONCLUSION

Using an electronic questionnaire before consultation has identified coital incontinence to be a prevalent symptom, having a significant impact on the patient's sex life. Coital incontinence at orgasm and penetration are both significantly associated with SUI and OAB.

Urinary leakage during sexual intercourse among women with incontinence: Incidence and risk factors

BACKGROUND

Coital incontinence is an under-reported disorder among women with urinary incontinence. Women seldom voluntarily report this condition, and as such, related data remains limited and is at times conflicting.

AIMS AND OBJECTIVES

To investigate the incidence and quality of life in women with coital incontinence and to determine associated predictors.

METHODS

This observational study involved 505 sexually active women attending the urogynecologic clinic for symptomatic urinary incontinence at a tertiary medical center. All of the patients were consulted about the experience of coital incontinence and completed evaluations including urodynamics, and valid questionnaires including the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, the Urogenital Distress Inventory and the Incontinence Impact Questionnaire.

RESULTS

Of these women, 281 (56%) had coital incontinence, while 224 (44%) did not. Among women with coital incontinence, 181 (64%) had urodynamic-proven stress incontinence, 29 (10%) had mixed incontinence, and 15 (5%) had detrusor overactivity. Only 25 (9%) sought consultation for this disorder before direct questioning. Fifty percent (84/281) of the women rarely or sometimes had incontinence during coitus, while 33% (92/281) often had incontinence, and 17% (48/281) always had incontinence. The frequency of coital incontinence was not different regarding the types of incontinence (p = 0.153). Women with mixed incontinence had the worst sexual quality of life and incontinence-related symptom distress. Based on univariate analysis, higher body mass index (OR 2.47, p = 0.027), and lower maximal urethral closure pressure (≤ 30 cmH2O) (OR 4.56, p = 0.007) were possible predictors for coital incontinence. Multivariate analysis showed lower MUCP was independently significant predictors (OR3.93, p = 0.042).

CONCLUSIONS

The prevalence of coital intercourse in urinary incontinence women was high. Coital incontinence in these women was associated with abnormal urodynamic diagnosis and urethral dysfunction.

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.

Coital incontinence: a factor for deteriorated health-related quality of life and sexual function in women with urodynamic stress urinary incontinence

INTRODUCTION AND HYPOTHESIS

To assess the impact of coital incontinence (CI) on health-related quality of life (HRQoL) and quality of sexual function (QSF) in women with urodynamic stress urinary incontinence (SUI).

METHODS

Women were recruited for this cross-sectional study from among 289 patients with lower urinary tract symptoms, underwent clinical and urodynamic evaluation. Of these 289 women, 127 sexually active women with SUI completed the King's Health Questionnaire (KHQ) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ), of whom 97 were enrolled for the study. The study group comprised 53 women with CI occurring 'sometimes', 'usually' or 'always', and the control group comprised 44 women without CI. Total and individual domain scores were evaluated.

RESULTS

CI was reported by 65.35 % of the women. The frequency of CI was correlated with lower educational level and higher body mass index (r = 0.22 and r = 0.23, respectively; p = 0.01). The KHQ results showed significantly lower HRQoL in women with CI in all domains (p < 0.05) apart from Sleep/energy' (p = 0.054). PISQ revealed no significant differences in QSF in the Behavioral/emotive and Partner-related domains (34.3 ± 10.0 vs. 33.0 ± 12.2 and 18.0 ± 2.9 vs. 18.2 ± 3.6, respectively). Women with CI reported a significantly lower QSF in the Physical domain (29.1 ± 6.6 vs. 35.0 ± 4.6, p = 0.001), and the total PISQ score was lower but the difference was not significant (81.4 ± 14.3 vs. 86.2 ± 16.5). Total PISQ score was correlated with age (r = -0.28, p = 0.001). Women with CI were significantly more likely to admit that fear of incontinence or fear of embarrassment restricted their sexual activity (p < 0.001).

CONCLUSIONS

A large percentage (65.35 %) of women with SUI reported CI, which had a negative impact on HRQoL and QSF in the Physical domain, but no significant impact on overall QSF.