Sexual Function and Quality of Life in Women with Urinary Incontinence Treated by a Complete Pelvic Floor Rehabilitation Program (Biofeedback, Functional Electrical Stimulation, Pelvic Floor Muscles Exercises, and Vaginal Cones)

Impact of pelvic floor muscle training on sexual function in women affected by stress urinary incontinence

Background

Pelvic floor muscle training can effectively improve pelvic floor muscle strength and activities; however, its impact on sexual function in women with stress urinary incontinence remains unclear.

Aim

The study sought to investigate the impact of pelvic floor muscle training on pelvic floor muscle and sexual function in women with stress urinary incontinence.

Methods

This was a retrospective observational study involving women who visited a urogynecologic clinic at a tertiary medical center. Patients with stress urinary incontinence without pelvic organ prolapse underwent pelvic floor muscle training programs that included biofeedback and intravaginal electrostimulation. Other evaluations included pelvic floor manometry, electromyography, and quality-of-life questionnaires, including the short forms of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, Urogenital Distress Inventory, and Incontinence Impact Questionnaire.

Outcomes

Clinical characteristics, vaginal squeezing and resting pressure, maximal pelvic floor contraction, duration of sustained contraction, quality-of-life scores, and sexual function were compared between baseline and after the pelvic floor muscle training programs.

Results

There were 61 women included in the study. The mean number of treatment sessions was 12.9 ± 6.3, and the mean treatment duration was 66.7 ± 32.1 days. The short forms of the Urogenital Distress Inventory (7.7 ± 3.8 vs 1.8 ± 2.1; P < .001) and Incontinence Impact Questionnaire (5.9 ± 4.3 vs 1.8 ± 2.0; P < .001) scores significantly improved after the pelvic floor muscle training program. In addition, all pelvic floor muscle activities significantly improved, including maximal vaginal squeezing pressure (58.7 ± 20.1 cmH2O vs 66.0 ± 24.7 cmH2O; P = .022), difference in vaginal resting and maximal squeezing pressure (25.3 ± 14.6 cmH2O vs 35.5 ± 16.0 cmH2O; P < .001), maximal pelvic muscle voluntary contraction (24.9 ± 13.8 μV vs 44.5 ± 18.9 μV; P < .001), and duration of contraction (6.2 ± 5.7 s vs 24.9 ± 14.6 s; P < .001). Nevertheless, the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire score demonstrated no significant improvement (28.8 ± 9.7 vs 29.2 ± 12.3; P = .752).

Clinical Implications

Pelvic floor muscle training programs may not improve sexual function in women with stress urinary incontinence.

Strengths and Limitations

The strength of this study is that we evaluated sexual function with validated questionnaires. The small sample size and lack of long-term data are the major limitations.

Conclusion

Pelvic floor muscle training can improve pelvic floor muscle activities and effectively treat stress urinary incontinence; however, it may not improve sexual function.

Urinary Symptoms and their Impact on Young Women's Sexual Function and Quality of Life

Sexuality and urinary function have received scarce research attention in younger women. In this cross-sectional survey study, prevalence, type, severity, and impact of urinary incontinence (UI), and its relationship with sexuality was investigated in 261 nulliparous women aged 18-27 (M = 19.08 years). Modules of the International Consultation on Incontinence Questionnaire and the Female Sexual Function Index assessed UI, sexual function, and quality of life. Thirty percent of the sample experienced UI, and 26% reported sexual function problems. A significant small negative correlation was found between UI and sexual lubrication (p = .017). Forty-three percent of participants in the total sample reported that they were bothered by urinary symptoms, and 13% avoided sexual activity due to urinary symptoms. Of those classified as incontinent, 90% were bothered by their symptoms. Urinary symptoms are impactful on the quality of life and sexual lives of young women, but despite their high prevalence, they remain a largely understudied and undertreated issue in this age group. Further research is crucial for improving awareness and access to treatment for this underserved population.

Effects of surface electrical stimulation during sitting on pelvic floor muscle function and sexual function in women with stress urinary incontinence

Objective

Dysfunction of the pelvic floor muscles (PFM) is associated with sexual dysfunction in women with stress urinary incontinence (SUI). The EasyK7 device was developed to stimulate the PFM by surface electrical stimulation during sitting (SESdS). We investigated the effects of SESdS on PFM function and sexual function in women with SUI.

Methods

Women with SUI were randomized into the SESdS and control groups. PFM function and sexual function were assessed using a perineometer and the pelvic organ prolapse–urinary incontinence sexual function questionnaire (PISQ), respectively. After 8 weeks, the groups were compared using either analysis of covariance with the baseline values as covariates or the paired Student's t-test.

Results

The final analysis included 16 subjects from each group. There were significant differences between the SESdS and control groups after the intervention, as well as within the SESdS group between the pre- and post-intervention measurements. The P-values for the differences in PFM measurements between the groups, and between the pre- and post- intervention measurements within the SESdS group, were 0.001 and 0.004 for power, 0.015 and 0.011 for strength, and 0.012 and 0.034 for endurance, respectively. In addition, in the PISQ, there were significant differences between the groups and between the pre- and post-intervention measurements within the SESdS group in the partner-related domain (between groups: P=0.003; within SESdS group: P=0.024) and total score (between groups: P<0.001; within SESdS group: P=0.001).

Conclusion

SESdS can improve PFM function and sexual function in women with SUI.

Trial Registration

Clinical Research Information Service Identifier: KCT0003357

Pelvic floor rehabilitation in the treatment of women with dyspareunia: a randomized controlled clinical trial

INTRODUCTION AND HYPOTHESIS

Dyspareunia, the symptom of painful sexual intercourse, is a common sexual dysfunction in reproductive-aged women. Because of its multifactorial etiology, a multidisciplinary approach may be required to treat it. Musculoskeletal factors play an important role; thus, rehabilitating the pelvic floor and modifying the tone of the pelvic floor muscles (PFMs) may be an effective way to treat this dysfunction. The aim of this randomized controlled clinical study was to evaluate the effects of pelvic floor rehabilitation techniques on dyspareunia.

METHODS

Of 84 women, assessed for eligibility, 64 women with dyspareunia were randomized into two groups: the experimental group (n = 32) received electrotherapy, manual therapy, and PFM exercises and the control group (n = 32) had no treatment while on the waiting list. Evaluations of PFM strength and endurance, sexual function, and pain were made directly before and after 3 months of treatment and at the 3-month follow-up.

RESULTS

Between-group changes showed significant improvement in the experimental group in comparison with control group. Mean difference in the PFM strength (according to the 0-5 Oxford scale) between groups was 2.01 and the mean difference of endurance was 6.26 s. Also, the mean difference in the Female Sexual Function Index score (the score ranges from 2 to 95) was 51.05, and the mean difference in the VAS score was 7.32. All of the changes were statistically significant (p < 0.05).

CONCLUSIONS

According to the results, pelvic floor rehabilitation is an important part of a multidisciplinary treatment approach to dyspareunia.

Pelvic Floor Muscle Parameters Affect Sexual Function After 8 Weeks of Transcutaneous Electrical Stimulation in Women with Stress Urinary Incontinence

INTRODUCTION

Stress urinary incontinence (SUI) is often associated with female sexual dysfunction. We investigated which pelvic floor muscle (PFM) parameters (strength, power, and endurance) are associated with improvement of sexual function after 8 weeks of transcutaneous electrical stimulation (TES) training.

AIM

This study was performed to determine the effects of TES in the seated position on PFM parameters and female sexual function and to identify correlation between improved PFM parameters and sexual function after 8 weeks of TES training in women with SUI.

METHODS

The present study was performed between August 2018 and November 2018 in women with SUI who were randomized into a TES group (n = 17) or a control group (n = 17). One subject in each of the TES and control groups ultimately withdrew during the intervention due to a lack of time. Both groups were measured at baseline and after 8 weeks of intervention.

MAIN OUTCOME MEASURE

As outcome measures, PFM parameters (strength, power, and endurance) and female sexual function were assessed using a perineometer and the Female Sexual Function Index (FSFI), respectively.

RESULTS

The final study population consisted of 32 women with SUI. There were significant differences in PFM strength, power, and endurance and FSFI domain scores (desire, arousal, orgasm, satisfaction, and total score) in both between-group analyses (TES vs control group) and within-group analyses (pre-TES vs post-TSE). Change in PFM endurance had the highest association with change in total FSFI total score (r = 0.437; P = .006), and change in PFM power had the highest association with change in FSFI satisfaction (r = 0.420; P = .008).

CONCLUSION

TES in a seated position showed a beneficial effect on sexual function in females with SUI. Consideration of PFM parameters associated with FSFI domain scores may be important when developing intervention guidelines to improve female sexual function. Hwang UJ, Lee MS, Jung SH, et al. Pelvic Floor Muscle Parameters Affect Sexual Function After 8 Weeks of Transcutaneous Electrical Stimulation in Women with Stress Urinary Incontinence. Sex Med 2019;7:505-513.

Female Sexual Dysfunction and the Placebo Effect: A Meta-analysis

OBJECTIVE

To quantify the placebo effect of various pharmacologic modalities including neuromodulators, hormonal agents, and onabotulinum toxin A for female sexual dysfunction.

DATA SOURCES

Using Meta-analyses Of Observational Studies in Epidemiology guidelines, we conducted a systematic review of PubMed, EMBASE, ClinicalTrials.gov, and the Cochrane Review databases.

METHODS OF STUDY SELECTION

Eleven search terms, "female sexual dysfunction" "treatment" in combination with "hypoactive sexual desire," "arousal disorder," "sexual pain disorder," "genitourinary syndrome of menopause," "orgasmic disorder," "vulvovaginal atrophy," "vaginismus," "vaginal atrophy," "vulvodynia," and "vestibulitis," were used. Studies were included if their design was randomized, included a placebo arm, and used the Female Sexual Function Index as an outcome measure.

TABULATION, INTEGRATION, AND RESULTS

The placebo effect on the Female Sexual Function Index was compared with each respective study's treatment effect using inverse-variance weighting in a random-effects analysis model. Six hundred five relevant articles were retrieved. Twenty-four randomized controlled trials included a placebo arm. Of these, eight studies used the Female Sexual Function Index. Across these studies, 1,723 women with clinical pretreatment female sexual dysfunction received placebo. Two thousand two hundred thirty-six women were in the treatment arm of the respective studies and received various pharmacologic interventions including flibanserin, bupropion, onabotulinum toxin A, intravaginal prasterone, intranasal oxytocin, ospemifene, and bremelanotide. Women receiving placebo improved 3.62 (95% CI 3.29-3.94) on the Female Sexual Function Index. The treatment arm had a corresponding increase of 5.35 (95% CI 4.13-6.57).

CONCLUSION

This meta-analysis of Level I evidence demonstrates that 67.7% of the treatment effect for female sexual dysfunction is accounted for by placebo. Our findings suggest that the current treatments for female sexual dysfunction are, overall, minimally superior to placebo, which emphasizes the ongoing need for more efficacious treatment for female sexual dysfunction.

A comparison of sacral neuromodulation vs. transvaginal electrical stimulation for the treatment of refractory overactive bladder: the impact on quality of life, body image, sexual function, and emotional well-being

Overactive bladder syndrome (OAB) is defined by the presence of urinary urgency, with or without urge incontinence, usually accompanied by an increase in urinary frequency and nocturia in the absence of urinary tract infections (UTI) or other diseases. The overall prevalence of OAB symptoms in the female population is reported to be 16.6% and increases with advancing age and menopause. The aetiology of OAB is not fully understood and is likely to affect a heterogeneous population of patients due to changes to their central and peripheral nervous systems. Although OAB is frequently associated with female sexual dysfunction (FSD), its real impact on sexual function in women has been evaluated only in a few studies. The first line of treatment for OAB includes behavioural modification and physical therapy, either as monotherapies or in combination. Many patients who have not had success in managing their symptoms with more conservative therapies may decide to resort to third-line treatments for refractory OAB. These treatments include neuromodulation therapies, particularly transvaginal electrical stimulation (TES) and sacral neuromodulation (SN). The aim of this short commentary is to provide an overview of the effectiveness of these treatments and of their impact on quality of life, body image, sexual function, and emotional well-being.

A Review of Commercial and Medical-Grade Physiological Monitoring Devices for Biofeedback-Assisted Quality of Life Improvement Studies

With the rise in wearable technology and "health culture", we are seeing an increasing interest and affordances in studying how to not only prolong life expectancy but also in how to improve individuals' quality of life. On the one hand, this attempts to give meaning to the increasing life expectancy, as living above a certain threshold of pain and lack of autonomy or mobility is both degrading and unfair. On the other hand, it lowers the cost of continuous care, as individuals with high quality of life indexes tend to have lower hospital readmissions or secondary complications, not to mention higher physical and mental health. In this paper, we evaluate the current state of the art in physiological therapy (biofeedback) along with the existing medical grade and consumer grade hardware for physiological research. We provide a quick primer on the most commonly monitored physiologic metrics, as well as a brief discussion on the current state of the art in biofeedback-assisted medical applications. We then go on to present a comparative analysis between medical and consumer grade biofeedback devices and discuss the hardware specifications and potential practical applications of each consumer grade device in terms of functionality and adaptability for controlled (laboratory) and uncontrolled (field) studies. We end this article with some empirical observations based on our study so that readers might use take them into consideration when arranging a laboratory or real-world experience, thus avoiding costly time delays and material expenditures.

Prevalence and Risk Factors of Relationship Dissatisfaction in Women During the First Year After Childbirth: Implications for Family and Relationship Counseling

The aim of this study was to investigate the rate of relationship dissatisfaction among Australian women during the first year after childbirth and to uncover factors affecting their relationships. Postnatal women who had given birth during the previous 12 months were invited to participate in a cross-sectional online study. A comprehensive, multisection questionnaire, as well as the Relationship Assessment Scale (RAS), Female Sexual Function Index (FSFI), and Patient Health Questionnaire - 8 (PHQ-8), were used to collect data. Responses were analyzed using SPSS for Windows. Results showed that 37.2% of the participants experienced relationship dissatisfaction. Results of the multiple logistic regression revealed that the following were significant risk factors for relationship dissatisfaction during the first postpartum year: annual income of less than AU$50,000, sexual dysfunction, and a clinical diagnosis of depression and having symptoms of depression according to the PHQ-8 scores (p < 0.05). Compared to women in a heterosexual relationship, women who were in a same-sex relationship were less likely to have relationship dissatisfaction. In addition, in the period six to 12 months postpartum, women were less likely to have relationship dissatisfaction compared to the period 5 months or less postpartum (p < 0.05).

[Effects of Electric Stimulation and Biofeedback for Pelvic Floor Muscle Exercise in Women with Vaginal Rejuvenation Women]

PURPOSE

The purpose of this study was to investigate the effects of pelvic floor muscle exercise using electric stimulation and biofeedback on maximum pressure of vaginal contraction, vaginal contraction duration and sexual function in women who have had vaginal rejuvenation.

METHODS

The research design was a non-equivalent control group non-synchronized design study. Participants in this study were women who had vaginal rejuvenation at C obstetrics and gynecology hospital. The 15 participants in the experimental group were given pelvic floor muscle exercise using electric stimulation and biofeedback and the 15 participants in the control group received self pelvic floor muscle exercise.

RESULTS

For maximum pressure of vaginal contraction, the experimental group showed a statistically significant increase compared to than the control group (t=5.96, p<.001). For vaginal contraction duration, the experimental group also showed a statistically significant increase compared to the control group (t=3.23, p=.003). For women's sexual function, the experimental group showed a significant increase when compared to the control group in total sexual function scores (t=3.41, p=.002).

CONCLUSION

The results indicate that pelvic floor muscle exercise with electric stimulation and biofeedback after vaginal rejuvenation is effective in strengthening vaginal contraction pressure, vaginal contraction and that it also positively functions to increase women's sexual function.

Prevalence and risk factors of sexual dysfunction in postpartum Australian women

INTRODUCTION

Female sexual dysfunction is highly prevalent and reportedly has adverse impacts on quality of life. Although it is prevalent after childbirth, women rarely seek advice or treatment from health care professionals.

AIM

The aim of this study was to assess the sexual functioning of Australian women during the first year after childbirth.

METHODS

Postpartum women who had given birth during the previous 12 months were invited to participate in this cross-sectional study. A multidimensional online questionnaire was designed for this study. This questionnaire included a background section, the Female Sexual Function Index, the Patient Health Questionnaire (PHQ-8), and the Relationship Assessment Scale. Responses from 325 women were analyzed.

RESULTS

Almost two-thirds of women (64.3%) reported that they had experienced sexual dysfunction during the first year after childbirth, and almost three-quarters reported they experienced sexual dissatisfaction (70.5 %). The most prevalent types of sexual dysfunction reported by the affected women were sexual desire disorder (81.2%), orgasmic problems (53.5%), and sexual arousal disorder (52.3%). The following were significant risk factors for sexual dysfunction: fortnightly or less frequent sexual activity, not being the initiator of sexual activity with a partner, late resumption of postnatal sexual activity (at 9 or more weeks), the first 5 months after childbirth, primiparity, depression, and relationship dissatisfaction.

CONCLUSION

Sexual satisfaction is important for maintaining quality of life for postpartum women. Health care providers and postpartum women need to be encouraged to include sexual problems in their discussions.

Questionnaires in the assessment of sexual function in women with urinary incontinence and pelvic organ prolapse

CONTEXT

Integrating sexual health in clinical practice is important. In women with pelvic floor disorders, the evaluation of the anatomical defects, lower urinary tract function and the anorectal function often receives more attention than the sexual function.

METHODS

Review of Medline using defined search terms to identify articles related to sexual health assessment in urogynecology and manual analyses was performed. Only articles published in English or Spanish were included.

RESULTS

Only 50% of women attending urogynecological clinics are sexually active. Of those, 60% present with some sort of sexual sexual dysfunction (FSD). Questionnaires and sexuality scales would facilitate discussion of sexual matters between the Health Care professionals and the women, and may increase the likelihood of FSD being diagnosed. The Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ) and the PISQ-IR (IUGA-Revised) are the only female sexual function specific questionnaires currently validated and developed specifically to assess sexual function in women with urinary incontinence and/or pelvic organ prolapse. Furthermore, the PISQ-IR also allows evaluation of the outcomes of women who are not sexually active when requiring urogynecologic care. PISQ-IR is also designed for international validation. In order to use the PISQ-IR in Spain, a proper interpretation and validation of the questionnaire is needed.

CONCLUSIONS

The evaluation of sexual function through specific questionnaires facilitates the identification of the sexual dysfunctions associated to the pelvic floor disorders. The inclusion of sexuality questionnaires as an outcome measure allows to analyze the impact in the sexual life of women treated for an urogynecological problem.

Experience of pelvic floor muscle exercises among women in Taiwan: a qualitative study of improvement in urinary incontinence and sexuality

AIMS AND OBJECTIVES

To gain an in-depth understanding of women's experiences of performing pelvic floor muscle exercises for urinary incontinence and the impact on their sexuality.

BACKGROUND

Urinary incontinence is not a life-threatening disorder; however, it has been shown to have detrimental effects on quality of life in terms of psychological, social and sexual dysfunction. Pelvic floor muscle exercises is the first recommended strategy for managing mild to moderate urinary incontinence as it is noninvasive and cost effective. Pelvic floor muscle exercises reduce incontinence and strengthen the pelvic floor muscles, which positively affects sexual function in women. Currently, the data are scarce for qualitative literature regarding the subjective experiences of Taiwanese women undergoing pelvic floor muscle exercises and the impact on their urinary incontinence and sexuality.

DESIGN

Qualitative exploratory study.

METHODS

Semi-structured in depth interviews were undertaken with twelve women who had completed a pelvic floor muscle exercises program in Taiwan. Data were analysed using thematic analysis.

RESULTS

Themes were related to Taiwanese women's initial feelings that urinary incontinence was inevitable and the effects on their sexuality. Three core themes were identified: perceptions of inevitability, developing awareness and gaining control and sexual taboo. Through developing awareness and control of their pelvic floor muscles women expressed improvement in urinary incontinence. Sexual enjoyment, body image, self confidence and sexuality were also enhanced.

CONCLUSION

Pelvic floor muscle exercises had a positive effect on urinary incontinence and sexuality. The findings demonstrated that sex is a taboo topic for many Taiwanese women. With the sensitive management of pelvic floor muscle exercises programs this issue can be addressed.

RELEVANCE TO CLINICAL PRACTICE

This study raises awareness of healthcare professionals by identifying how Taiwanese women perceive pelvic floor muscles. The positive impact of pelvic floor muscle exercises upon both urinary incontinence and sexuality within the Taiwanese context are addressed. Nurses may also, with greater confidence initiate discussion of women's sexual concerns as part of managing urinary incontinence.

Predictors of improvement in sexual function of women with urinary incontinence after treatment with pelvic floor exercises: a secondary analysis

INTRODUCTION

Women with urinary incontinence (UI) frequently present with complaints of sexual problems.

AIM

To evaluate the predictors of sexual function improvement after participating in three physical therapy sessions and performing home-based pelvic floor muscle exercises (PFME) for the treatment of female UI.

METHODS

This is a secondary analysis of a randomized trial with a 3-month follow-up in which the sexual function of 54 women with UI was evaluated. These women joined three supervised physiotherapy sessions that included PFME and health education during 1 month, with a 15-day interval between each session, and kept practicing home-based PFME for a further 2 months.

MAIN OUTCOME MEASURE

Sexual function was assessed using the Female Sexual Quotient, the pelvic floor muscle strength was measured using the modified Oxford scale, and UI was assessed using the International Consultation on Incontinence Questionnaire.

RESULTS

The mean of sexual quotient score improved after treatment (P = 0.001). With respect to specific domains of sexual function, improvement was observed only in the questions about sexual desire, arousal/excitement, and orgasm. Before treatment, 18 women (33.3%) were classified as having sexual dysfunction, and after treatment, eight remained with sexual dysfunction and two other joined this category (total of 18.5%). Those women who had sexual dysfunction at baseline experienced a higher level of improvement of the sexual quotient compared with those without sexual dysfunction (P = 0.001, 95% CI = 9.1-31.9). A multivariate linear regression with backward elimination revealed the following predictors of improvement of the sexual quotient: higher parity, higher adherence to PFME, improvement in the strength of PFM, and a decrease in the frequency of urine leakage (R(2)  = 0.497).

CONCLUSION

PFME was more beneficial with regard to sexual function in those women who presented with sexual dysfunction at baseline.

Sexual and bladder comorbidity in women

Sexual dysfunction in women is defined as disorders of sexual desire, arousal, orgasm, and/or sexual pain, which result in significant personal distress and may have a negative effect on a woman's health and an impact on her quality of life. A comprehensive understanding of the anatomic, neurobiologic, and psychologic mechanisms behind women's sexual function and dysfunction is of paramount importance. This chapter reviews the most frequent comorbid conditions related to urinary tract symptoms (thus including symptoms related to overactive bladder syndrome and urinary incontinence) and sexual dysfunction in women. Likewise, it considers the different disorders from the point of view of daily clinical practice.

Effect of vaginal electrical stimulation on female sexual functions: a randomized study

INTRODUCTION

Female sexual dysfunction (FSD) is a common problem that may be encountered in the interruption of normal sexual functioning in the sexual response cycle. Women with a pelvic floor disorder who scored low on the Female Sexual Function Index (FSFI) showed an improvement in their sexual life following treatment by vaginal electrical stimulation (VES).

AIM

The aim of this trial was to evaluate the effectiveness of VES in women with FSD without a predominant pelvic floor disorder or urinary incontinence.

METHODS

Forty-two women with FSD were randomly allocated to VES and placebo groups. Pelvic floor muscle (PFM) assessment and the FSFI questionnaire were performed at baseline and after the completion of sessions. VES treatment was administered using a vaginal probe. The probe was inserted, and a medium-frequency (50 Hz) alternating current was administered for a duty cycle of 5 seconds on followed by a 5-second rest.

MAIN OUTCOMES MEASURES

Primary outcome measure was the improvement in FSFI score. PFM assessments were performed according to the PERFECT scheme.

RESULTS

Total FSFI scores improved significantly in both the VES group and the control group. Results show that in the VES group, there was an improvement in total score and FSFI domains that improved including arousal, desire, orgasm, and satisfaction. Similarly, control group domains that improved were desire, arousal, and orgasm. But there was no significant increase in satisfaction scores in the placebo group. No significant changes in pain or lubrication domains were seen in either group. Power, endurance, fast contractions, and repetitions were significantly improved in the VES group.

CONCLUSIONS

The lack of significant differences between the placebo and VES groups, except the satisfaction domain, puts into question the effectiveness of electrical stimulation as a monotherapy in treating primary FSD without pelvic floor disorder.

Effect of vaginal spheres and pelvic floor muscle training in women with urinary incontinence: a randomized, controlled trial

AIMS

To compare the efficacy and safety of Kegel exercises performed with or without, vaginal spheres as treatment for women with urinary incontinence.

METHODS

Multicentre parallel-group, open, randomized controlled trial. Women were allocated to either a pelvic floor muscle-training program consisting of Kegel exercises performed twice daily, 5 days/week at home, over 6 months with vaginal spheres, or to the same program without spheres. The primary endpoint was women's report of urinary incontinence at 6 months using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF). Secondary outcome measures were the 1 hr pad-test, King's Health Questionnaire (KHQ) and a five-point Likert scale for subjective evaluation. Adherence was measured with the Morisky-Green test.

RESULTS

Thirty-seven women were randomized to the spheres group and 33 to the control group. The primary endpoint was evaluated in 65 women (35 in the spheres group vs. 30 controls). ICIQ-UI-SF results improved significantly at 1-month follow-up in the spheres group (P < 0.01) and at 6 months in the controls. The 1 hr pad-test improved in the spheres group but not in the control group. No significant differences were found in the KHQ results or in the subjective evaluation of efficacy and safety. Adherence was higher in the spheres group but differences were not significant. Mild transient side effects were reported in four patients in the spheres group and one in the control group.

CONCLUSIONS

Both treatments improved urinary incontinence but women who performed the exercises with vaginal spheres showed an earlier improvement. Vaginal spheres were well tolerated and safe.

Behavioral Intervention Program versus Vaginal Cones on Stress Urinary Incontinence and Related Quality of Life: A Randomized Clinical Trial

OBJECTIVE

To compare the efficacy of behavioral intervention program and vaginal cones on stress urinary incontinence.

METHODS

In this randomized clinical trial, 60 women aged 25-65 years with stress urinary incontinence were randomly divided into two groups, those who participated in a behavioral intervention program (n=30) and those who used vaginal cones (n=30). The women in the behavioral intervention group were instructed on pelvic floor exercise and bladder control strategies. In the other group, pelvic floor exercises were performed using the vaginal cones. All participants were treated for 12 weeks and followed-up every 2 weeks. The subjective changes in severity of stress urinary incontinence were measured using a detection stress urinary incontinence severity questionnaire, leakage index, and a 3-day urinary diary. The objective changes were measured by pad test. For better evaluation of the effects, two questionnaires were used: Incontinence Quality of Life and King's Health Questionnaire.

RESULTS

Among the 51 women who completed the study, 25 subjects were in the vaginal cones group and 26 participated in the behavioral intervention program. The changes in leakage rate on pad test and leakage index in the behavioral intervention program group were significantly higher than in the vaginal cones group (p=0.001 and p=0.008, respectively), but the severity of stress urinary incontinence was not significantly different between the two groups (p=0.2). The changes in strength of the pelvic floor, Incontinence Quality of Life, and King's Health Questionnaire scores showed no significant differences between the two groups after 12 weeks of intervention.

CONCLUSION

Vaginal cones and behavioral intervention programs are both effective methods of treatment for mild to moderate stress urinary incontinence, but the behavioral intervention program is superior to vaginal cones in terms of cost-effectiveness and side effects.

Characteristics of patients seeking outpatient rehabilitation for pelvic-floor dysfunction

BACKGROUND

Pelvic-floor dysfunction (PFD) affects a substantial proportion of individuals, especially women.

OBJECTIVE

The purposes of this study were: (1) to describe the characteristics of individuals with disorders associated with PFD who were seeking outpatient physical therapy services and (2) to identify the prevalence of specific pelvic-floor disorders in the group.

DESIGN

This was a prospective, longitudinal, cohort study of 2,452 patients (mean age=50 years, SD=16, range=18-91) being treated in 109 outpatient physical therapy clinics in 26 states (United States) for their PFD.

METHODS

This study examined patient demographic variables and summarized patient self-reported responses to questions related to urinary and bowel functioning at admission prior to receiving the therapy for their PFD disorders.

RESULTS

Patients primarily were female (92%), were under 65 years of age (39%: 18 to <45 years; 39%: 45 to <65 years; 21%: 65 years or older), and had chronic symptoms (74%). Overall, 67% of the patients reported that they had urinary problems, 27% reported bowel problems, and 39% had pelvic pain. Among those who had urinary or bowel disorders, 32% and 54% reported leakage and constipation, respectively, as their only problem. Among patients who had pelvic pain, most (56%) reported that the pain was in the abdominal area. Combinations of urinary, bowel, or pelvic-floor pain disorders occurred in 31% of the patients.

LIMITATIONS

Because this study was a secondary analysis of data collected prospectively, the researchers were not in control of the data collection procedure. Missing data were common.

CONCLUSIONS

Data suggested most patients with PFD receiving outpatient physical therapy services were female, younger than 65 years, and had disorders lasting for more than 90 days. Combinations of urinary, bowel, or pelvic-floor pain disorders were not uncommon.

Urogenital complaints and female sexual dysfunction. Part 2

INTRODUCTION

Female sexual dysfunction (FSD) is common in women with urogenital disorders that occur as a result of pelvic floor muscle and fascial laxity.

AIM

Provide a comprehensive review of FSD as it relates to common urogenital disorders including pelvic organ prolapse (POP) and stress urinary incontinence (SUI) and to discuss the impact of the surgical repair of these disorders on sexual function.

METHODS

Systematic search of the medical literature using a number of related terms including FSD, POP, SUI, surgical repair, graft augmentation, complications, and dyspareunia.

MAIN OUTCOME MEASURES

Review of the medical literature to identify the relation between FSD and common urogenital disorders in women and to describe appropriate treatment strategies to improve quality of life (QOL) and sexual function.

RESULTS

FSD is common in women with POP and SUI. Treatment options for POP and SUI include behavioral, pharmacological, and surgical methods which can also affect sexual function.

CONCLUSIONS

Sexual dysfunction is a common, underestimated complaint in women with POP and SUI. Treatment should be tailored toward improving sexual function and QOL. Surgical correction is generally beneficial but occasionally can result in negative alterations in sexual function. Patient selection and methods used for surgical repair are important factors in determining anatomical and functional success.

Avaliação da qualidade de vida e da perda urinária de mulheres com bexiga hiperativa tratadas com eletroestimulação transvaginal ou do nervo tibial

Trata-se de um ensaio clínico prospectivo comparativo que objetivou comparar os efeitos do tratamento com eletroestimulação transvaginal (ET) e do nervo tibial (ENT) sobre a qualidade de vida (QV) e queixas de perda urinária em mulheres com bexiga hiperativa. Participaram 42 pacientes com bexiga hiperativa ou incontinência urinária (IU) mista e foram divididas para tratamento com ET ou ENT. A QV foi avaliada pelo questionário de QV genérico, o Medical Outcomes Study Short Form 36 (SF-36) e um questionário específico para IU, o Incontinence Quality of Life Instrument (I-QOL). Os relatos de perdas urinárias e incômodos ocasionados foram avaliados, respectivamente, por meio do diário miccional de 24 horas e Escala Visual Analógica (EVA). O tratamento foi realizado uma vez por semana, totalizando doze semanas. O grupo da ENT teve melhora significativa em três domínios do I-QOL, na EVA, que avaliou o grau de incômodo causado pela IU e em quatro aspectos do diário miccional. No grupo de ET houve melhora significativa de dois domínios do SF-36, três domínios do I-QOL, na EVA e em quatro aspectos do diário. Houve melhora da QV em ambos os grupos, assim como uma diminuição das queixas de perda urinária, entretanto, o grupo que recebeu ET obteve melhora nos escores em dois domínios do questionário de QV genérico após o tratamento, que teve limitação por aspectos físicos e limitação por aspectos emocionais. O que não ocorreu com o grupo de ENT.

Sexual function before and after non-surgical treatment for stress urinary incontinence

OBJECTIVES: (1) to describe sexual function in women seeking treatment of stress urinary incontinence (SUI); (2) to compare the impact on sexual function of three SUI treatments; and (3) to investigate whether non-surgical treatment of SUI is associated with improved sexual function. METHODS: Women with SUI were randomized to continence pessary, behavioral therapy (pelvic floor muscle training and continence strategies), or combination therapy. Sexual function was assessed at baseline and 3-months using short forms of the Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire (PISQ-12) and the Personal Experiences Questionnaire (SPEQ). Successful treatment of SUI was assessed with a patient global impression of improvement. ANOVA was used to compare scores between groups. RESULTS: At baseline, sexual function was worse among women with mixed incontinence compared to those with pure SUI. After therapy, successful treatment of SUI was associated with greater improvement in PISQ-12 score (2.26 ± 3.24 versus 0.48 ± 3.76, p=0.0007), greater improvement in incontinence with sexual activity (0.45 ± 0.84 versus 0.01 ± 0.71, p=0.0002), and greater reduction in restriction in sexual activity related to fear of incontinence (0.32 ± 0.76 versus -0.06 ± 0.78, p=0.0008). Among those successfully treated for SUI, improvement in continence during sexual activity was greater in both the combined therapy group (p=0.019) and the behavioral group (p=0.02) compared to the pessary group. CONCLUSIONS: Successful non-surgical treatment of SUI is associated with improvements in incontinence-specific measures of sexual function. Behavioral therapy may be preferred to pessary for treatment of SUI among women whose incontinence interferes with sexual function.

How do continence nurses address sexual function and a history of sexual abuse in daily practice? Results of a pilot study

INTRODUCTION

There is a strong association between urological complaints, sexual dysfunction, and history of sexual abuse (SA), and it is unknown whether urological continence nurses integrate this knowledge in their daily practice.

AIM

To evaluate how, in their daily practice, Dutch urological continence nurses address sexual dysfunction and possible SA.

METHODS

An anonymous 19-item questionnaire was distributed among all Dutch urinary continence nurses visiting their yearly congress.

MAIN OUTCOME MEASURES

The survey results.

RESULTS

The response rate was 48.9% (93/190). Of the respondents, 11.8% did not ask their female patients about sexual function; 37.6% asked only rarely; 44.1% asked often; and 6.5% always asked. Sexual functioning in males was not evaluated by the majority of the nurses (13.2% never, and 46.2% rarely). A minority of continence nurses asked males about sexual functioning (36.3% often and 4.3% always). Important reasons for not asking were insufficient knowledge of how to adequately ask males (38.9%) and females (47.8%) about sexual problems, and because nurses assumed the urologist had addressed this issue (48.1% asking males, 39.1% asking females). Younger nurses found it particularly difficult to raise sexual issues with both male and female patients (P=0.001 and P=0.003, respectively). Screening for sexual dysfunction was stated to be important by almost all nurses (65.2% "quite important," and 31.5% "very important"). Within their patient population, both male and female, 28% of the nurses never asked about SA and 49.5% asked only rarely.

CONCLUSION

Dutch urological incontinence nurses acknowledge the importance of sexual problems in their patient population, but asking about this issue was not part of routine care. The main reasons for not asking, according to the nurses' responses, were that they had insufficient knowledge and that they assumed the urologist had already asked about sexual problems.