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Bhandari Randhawa S, Rizkallah A, Nelson DB, Duryea EL, Spong CY, Pruszynski JE, Rahn DD. Factors associated with persistent sexual dysfunction and pain 12 months postpartum. SEXUAL & REPRODUCTIVE HEALTHCARE 2024; 41:101001. [PMID: 38991483 DOI: 10.1016/j.srhc.2024.101001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 06/23/2024] [Accepted: 06/27/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE Identify factors associated with persistent sexual dysfunction and pain 12-months postpartum in an underserved population. METHODS Extending Maternal Care After Pregnancy (eMCAP) is a program addressing health needs/disparities of patients at risk for worse perinatal outcomes. Participants completed the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and Urinary Distress Index (UDI-6) 12-months postpartum. The PISQ-12 was dichotomized with scores < 32.5 indicating sexual dysfunction. Urinary incontinence (UI) was defined as at-least-somewhat bothersome (vs. none or not-at-all bothersome) urgency urinary incontinence (UUI) or stress urinary incontinence (SUI). Screening for anxiety and depression was completed using Generalized Anxiety Disorder-7 (GAD-7) and Edinburgh Postnatal Depression Scale (EPDS). Bivariate and multivariable logistic regression analyses were performed for sexual dysfunction vs. normal-function, and pain vs. no-pain, using demographic, peri/postpartum, and social-determinant-of-health variables as correlating factors. RESULTS 328 sexually active patients provided data. On bivariate analysis, sexual dysfunction (n = 31, 9.5%) vs. normal function (n = 297, 90.5%) groups showed no differences in age, BMI, parity, mode of delivery, episiotomy/laceration types, or breastfeeding. Sexual dysfunction was significantly associatedwith both UUI and SUI: 12 (39%) vs. 46 (15%) had UUI, p = 0.001, and 20 (65%) vs. 97 (33%) had SUI, P < 0.001; the dysfunction group also had higher GAD-7 and EPDS scores and greater overall stress levels. On multivariable analysis, SUI and stress remained significantly associated: OR (95% CI) 2.45 (1.02-6.03) and 1.81 (1.32-2.49), respectively. Comparing pain (n = 45, 13.7%) vs. no-pain (n = 283, 86.2%), dyspareunia patients endorsed greater stress levels. CONCLUSION The interplay between sexual health, incontinence, and mental health deserves further study, and all three should be routinely addressed in postpartum care.
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Affiliation(s)
- Sonia Bhandari Randhawa
- University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, Dallas, TX, United States.
| | - Andrea Rizkallah
- University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, Dallas, TX, United States
| | - David B Nelson
- University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, Dallas, TX, United States
| | - Elaine L Duryea
- University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, Dallas, TX, United States
| | - Catherine Y Spong
- University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, Dallas, TX, United States
| | - Jessica E Pruszynski
- University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, Dallas, TX, United States
| | - David D Rahn
- University of Texas Southwestern Medical Center, Department of Obstetrics and Gynecology, Dallas, TX, United States
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Hierink GM, Brinkman LAM, Hogenhout SA, Malmberg GGA, Trzpis M, van Eijndhoven HWF, Broens PMA. Age-specific reference scores for the PISQ-12 on female sexual functioning in the Netherlands: a retrospective population-based survey. J Sex Med 2024; 21:620-626. [PMID: 38715327 DOI: 10.1093/jsxmed/qdae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/29/2024] [Accepted: 03/24/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Female sexual dysfunction is common in the general population, with age emerging as a significant determinant of sexual activity and functioning. AIM To establish age-specific reference scores for the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in the general Dutch female population. METHODS A retrospective, cross-sectional, questionnaire-based study was conducted in the Netherlands. The study population comprised 2518 Dutch-speaking women aged ≥18 years, representing a cross section of the general Dutch population. The PISQ-12 was used to assess sexual functioning in heterosexual women. The Groningen Defecation and Fecal Continence questionnaire was utilized to demonstrate demographic factors. OUTCOMES We established age-specific reference scores for the PISQ-12 in the general Dutch population. RESULTS Of the 2518 women, 1592 (63.2%) were sexually active and 926 (36.8%) were not. Further analysis focused on the sexually active group: we found a decrease in mean total PISQ scores, ranging from 38.34 among 18- to 34-year-olds to 36.98 among ≥65-year-olds. Older women scored lower in the behavior domain, specifically pertaining to sexual desire (P < .001) and sexual excitement (P < .001). They also had lower scores in the partner-related domain regarding partner problems of erection (P < .001) and orgasm perception (P < .001). With increasing age, negative emotional reaction scores were higher (P < .001). In the physical domain, we observed significantly different scores for pain during sexual intercourse (P < .001) and restrictions in sexual activity due to fear of urinary leakage (P < .001), with the lowest scores in the youngest group. CLINICAL IMPLICATIONS These age-specific references scores of the PISQ-12 provide an overview of sexual functioning of a general population, which enables caregivers to assess and interpret patients' individual scores more accurately. STRENGTHS AND LIMITATIONS We included only sexually active women in our subanalyses, potentially introducing selection bias for older women with better physical conditions. The study's strength lies in its extensive sample size, representing a cross section of the general Dutch population. Furthermore, the self-administered questionnaire approach helped minimize embarrassment and obtain realistic responses. CONCLUSION Our study demonstrated age-specific PISQ-12 reference scores and highlighted associations between aging and diminishing scores of sexual desire, sexual excitement, erection problems, and orgasm perception, while women aged 18 to 34 years reported the lowest scores for pain during intercourse and limited sexual activity due to fear of urinary leakage.
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Affiliation(s)
- G Marije Hierink
- Anorectal Physiology Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, the Netherlands
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, 9700 RB, the Netherlands
| | - Lauret A M Brinkman
- Anorectal Physiology Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, the Netherlands
| | - Sietske A Hogenhout
- Anorectal Physiology Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, the Netherlands
| | - G G Alec Malmberg
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, 9700 RB, the Netherlands
| | - Monika Trzpis
- Anorectal Physiology Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, the Netherlands
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, the Netherlands
| | | | - Paul M A Broens
- Anorectal Physiology Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, the Netherlands
- Division of Pediatric Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, the Netherlands
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Dieter AA, Halder GE, Pennycuff JF, Singh R, El-Nashar SA, Lipetskaia L, Orejuela FJ, Jeppson PC, Sleemi A, Raman SV, Balk EM, Rogers RG, Antosh DD. Patient-Reported Outcome Measures for Use in Women With Pelvic Organ Prolapse: A Systematic Review. Obstet Gynecol 2023; 141:1098-1114. [PMID: 37073897 PMCID: PMC10524573 DOI: 10.1097/aog.0000000000005212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/23/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To describe the psychometric properties of existing patient-reported outcome measures for women with prolapse using the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) framework. Additional objectives were to describe the patient-reported outcome scoring method or interpretation, methods of administration, and to compile a list of the non-English languages in which the patient-reported outcomes are reportedly validated. DATA SOURCES PubMed and EMBASE was searched through September 2021. Study characteristics, patient-reported outcome details, and psychometric testing data were extracted. Methodologic quality was assessed with COSMIN guidelines. METHODS OF STUDY SELECTION Studies reporting the validation of a patient-reported outcome in women with prolapse (or women with pelvic floor disorders that included a prolapse assessment) and reporting psychometric testing data on English-language patient-reported outcome for at least one measurement property per COSMIN and the U.S. Department of Health and Human Services definitions were included, as well as studies reporting the translation of an existing patient-reported outcome into another language, a new method of patient-reported outcome administration, or a scoring interpretation. Studies reporting only pretreatment and posttreatment scores, only content or face validity, or only findings for nonprolapse domains of the patient-reported outcome were excluded. TABULATION, INTEGRATION, AND RESULTS Fifty-four studies covering 32 patient-reported outcomes were included; 106 studies assessing translation into a non-English language were excluded from the formal review. The number of validation studies per patient-reported outcome (one version of one questionnaire) ranged from 1 to 11. Reliability was the most reported measurement property, and most measurement properties received an average rating of sufficient. The condition-specific patient-reported outcomes had on average more studies and reported data across more measurement properties compared with adapted and generic patient-reported outcomes. CONCLUSION Although measurement property data vary on patient-reported outcomes for women with prolapse, most data were of good quality. Overall, condition-specific patient-reported outcomes had more studies and reported data across more measurement properties. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021278796.
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Cichowski S, Grzybowska ME, Halder GE, Jansen S, Gold D, Espuña M, Jha S, Al-Badr A, Abdelrahman A, Rogers RG. International Urogynecology Consultation: Patient Reported Outcome Measures (PROs) use in the evaluation of patients with pelvic organ prolapse. Int Urogynecol J 2022; 33:2603-2631. [PMID: 35980442 DOI: 10.1007/s00192-022-05315-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Patient-reported outcome measure instruments include patient-reported outcomes (PROs) and patient-reported goals (PRGs), which allow practitioners to measure symptoms and determine outcomes of treatment that matter to patients. METHODS This is a structured review completed by the International Urogynecology Consultation (IUC), sponsored by the International Urogynecological Association (IUGA). The aim of this working group was to evaluate and synthesize the existing evidence for PROs and PRGs in the initial clinical work-up/evaluation and research arena for patients with pelvic organ prolapse (POP). RESULTS The initial search generated 3589 non-duplicated studies. After abstract review by 4 authors, 211 full texts were assessed for eligibility by 2 writing group members, and 199 studies were reviewed in detail. Any disagreements on abstract or full-text articles were resolved by a third reviewer or during video meetings as a group. The list of POP PROs and information on PRGs was developed from these articles. Tables were generated to describe the validation of each PRO and to provide currently available, validated translations. CONCLUSIONS All patients presenting for POP should be evaluated for vaginal, bladder, bowel and sexual symptoms including their goals for symptom treatment. This screening can be facilitated by a validated PRO; however, most PROs provide more information than needed to provide clinical care and were designed for research purposes.
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Affiliation(s)
| | - Magdalena Emilia Grzybowska
- Department of Gynecology, Gynecological Oncology and Gynecological Endocrinology Medical University of Gdansk, Gdansk, Poland
| | | | | | - Daniela Gold
- Department of Gynecology, Medical University Graz, Graz, Austria
| | | | - Swati Jha
- Sheffield Teaching Hospitals NHS trust, Sheffield, UK
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Sir E, Güngör M, Üçer O, Aksoy A. Evaluation of sexual function in women with labia minora hypertrophy: A preliminary study. Rev Int Androl 2018; 16:45-49. [PMID: 30300124 DOI: 10.1016/j.androl.2017.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 05/15/2017] [Accepted: 06/04/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To compare the sexual functions in women with labia minora hypertrophy and age-matched healthy controls. MATERIAL AND METHOD 43 patients with labia minora hypertrophy and 30 age-matched healthy controls were enrolled in the present study. The sexual functions of the women were evaluated by using the index of female sexual function (IFSF). RESULTS Mean ages of the patients and controls were 30.06±7.11 and 31.34±4.12 (p=0.41), respectively. Mean total IFSF scores of the patients and controls were 24.18±3.24 and 27.53±4.43 (p<0.05), respectively. The subscale scores of IFSF-lubrication, orgasm, satisfaction and pain in the patient group were significantly lower than in the control group (respectively, p<0.001, p<0.05, p<0.001 and p<0.05). There was no statistically significant difference between IFSF-arousal scores of the patient and control groups (p=0.30). The mean IFSF-desire scores of the patient group was higher than the controls (p<0.001). Labia minora hypertrophy was significantly associated with female sexual dysfunction (odds ratio [OR]=14.97, 95% confidence interval [Cl]=[3.66-61.21], p<0.001). CONCLUSION This study suggests that patients with labia minora hypertrophy have poorer lubrication, satisfaction, pain, and orgasm scores on the IFSF scale compared to age-matched healthy controls.
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Affiliation(s)
- Emin Sir
- Izmir Bozyaka Training and Research Hospital, Plastic and Reconstructive Surgery Clinic, Izmir, Turkey
| | - Melike Güngör
- Izmir Bozyaka Training and Research Hospital, Plastic and Reconstructive Surgery Clinic, Izmir, Turkey
| | - Oktay Üçer
- Celal Bayar University, Faculty of Medicine, Department of Urology, Manisa, Turkey.
| | - Alper Aksoy
- Konur Medical Center, Plastic and Reconstructive Surgery Clinic, Bursa, Turkey
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Segal S, John G, Sammel M, Andy UU, Chu C, Arya LA, Brown J, Schmitz K. Urinary incontinence and other pelvic floor disorders after radiation therapy in endometrial cancer survivors. Maturitas 2017; 105:83-88. [PMID: 28396018 DOI: 10.1016/j.maturitas.2017.03.313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate radiation therapy as a risk factor for urinary or fecal incontinence, pelvic organ prolapse, and sexual dysfunction in endometrial cancer survivors. STUDY DESIGN We performed a retrospective cohort study of endometrial cancer survivors. Data were collected using a mailed survey and the medical record. Validated questionnaires were used to generate rates of urinary incontinence and other pelvic floor disorders. The incidence rates of pelvic floor disorders were compared across groups with different exposures to radiation. RESULTS Of the 149 endometrial cancer survivors, 41% received radiation therapy. Fifty-one percent of women reported urine leakage. The rates of urinary incontinence in women exposed and not exposed to vaginal brachytherapy (VBT) or whole-pelvis radiation were 48% and 58%, respectively (p=0.47). The incidence of fecal incontinence did not differ between groups, but the score for overall sexual function was significantly higher in women who did not undergo radiation therapy. On multivariable analysis, significant risk factors for urinary incontinence were age (AOR 1.06 95% CI 1.02, 1.10) and BMI (AOR 1.07 95% CI 1.02, 1.11), but treatment with radiation was not significantly associated with urinary incontinence, or fecal incontinence (p>0.05). Age, BMI, and radiation exposure were independent predictors of decreased sexual function score (p<0.01). CONCLUSION Local or regional radiation is not associated with urinary or fecal incontinence, but may contribute to sexual dysfunction in endometrial cancer survivors.
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Affiliation(s)
- Saya Segal
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, and Division of Urology, Department of Surgery, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, United States.
| | - Gabriella John
- Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| | - Mary Sammel
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Uduak Umoh Andy
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania; Philadelphia, PA, United States
| | - Christina Chu
- Division of Gynecologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Lily A Arya
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania; Philadelphia, PA, United States
| | - Justin Brown
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Kathryn Schmitz
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Hung M, Su T, Lin Y, Huang W, Lin T, Hsu C, Chuang F, Tsai C, Shen P, Chen G. Changes in Sexual Function of Women with Refractory Interstitial Cystitis/Bladder Pain Syndrome after Intravesical Therapy with a Hyaluronic Acid Solution. J Sex Med 2014; 11:2256-63. [DOI: 10.1111/jsm.12507] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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The association between fecal incontinence and sexual activity and function in women attending a tertiary referral center. Int Urogynecol J 2013; 24:1489-94. [PMID: 23389640 DOI: 10.1007/s00192-013-2044-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To determine whether fecal incontinence (FI) is associated with sexual activity and to compare sexual function in women with and without FI. METHODS We conducted a retrospective chart review of all new patients seen in an academic urogynecology clinic. Women who reported fecal incontinence, as defined by loss of fecal material on the Wexner scale, were compared with those without fecal incontinence. We compared sexual activity and Pelvic Organ Prolapse Incontinence Sexual Questionnaire-12 (PISQ-12) scores between groups. RESULTS In our population of women with pelvic floor disorder, 588 women reported FI compared with 527 who did not. On multivariate analysis, FI was not associated with sexual activity status, but was associated with worsened PISQ-12 scores (p < 0.001). PISQ-12 item analysis found that women with FI reported more dyspareunia, fear, and avoidance of sexual activity with greater partner problems (all p <0.05) than women without FI. CONCLUSIONS Women with FI were as likely to engage in sexual relations as women without FI; however, sexually active women with FI had poorer sexual function than those without FI.
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The effect of uterine fibroid embolization on lower urinary tract symptoms. Int Urogynecol J 2012; 24:1341-5. [DOI: 10.1007/s00192-012-2013-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 11/22/2012] [Indexed: 10/27/2022]
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