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Sobti A, Shawer S, Ballard P, Khunda A. Bladder pain syndrome and sexual function: a systematic review and meta-analysis. Int Urogynecol J 2023; 34:2359-2371. [PMID: 37608090 DOI: 10.1007/s00192-023-05633-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/17/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Bladder pain syndrome (BPS)/interstitial cystitis can adversely affect physical, mental, and sexual health. The aim of the systematic review is to compare sexual function between patients with BPS and healthy controls and to examine whether or not treatment of BPS improves sexual function. METHODS A literature search was conducted on Embase, Medline, and other databases. Studies comparing sexual function in BPS patients with healthy controls and before/after treatment were included. Where appropriate, data were pooled in a meta-analysis, using a random effects model and the standardised mean difference (SMD) was used for comparison. RESULTS Out of 384 studies initially identified, 26 studies met the inclusion criteria for the systematic review and 11 for the meta-analysis. Six studies compared sexual function in BPS cases with healthy controls. All studies found that the Female Sexual Function Index (FSFI) was worse in BPS cases than in controls. Pooled data from 5 studies showed that the SMD was -1.02 (CI -1.64, -0.4) in total FSFI scores between the cases and controls, p=0.001. Further analysis showed better sexual function in all FSFI subdomains in healthy controls. Five studies compared sexual function in BPS patients before treatment with after treatment. Pooled data from 3 studies showed an overall improvement in total FSFI score after intravesical treatment: SMD=0.69 (CI 0.23, 1.14), p=0.003. Further analysis showed improvement in all subdomains. CONCLUSION Our review suggests that sexual function might be worse in BPS patients than in the general population, but it seems to improve with intravesical BPS treatment.
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Affiliation(s)
- A Sobti
- South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, TS4 3BW, UK.
| | - S Shawer
- South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, TS4 3BW, UK
| | - P Ballard
- South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, TS4 3BW, UK
| | - A Khunda
- South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, TS4 3BW, UK
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Mosca L, Riemma G, Braga A, Frigerio M, Ruffolo AF, Dominoni M, Munno GM, Uccella S, Serati M, Raffone A, Salvatore S, Torella M. Female Sexual Dysfunctions and Urogynecological Complaints: A Narrative Review. Medicina (B Aires) 2022; 58:medicina58080981. [PMID: 35893096 PMCID: PMC9331312 DOI: 10.3390/medicina58080981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Lavinia Mosca
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
| | - Gaetano Riemma
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland;
| | - Matteo Frigerio
- Department of Obstetrics and Gynecology, ASST Monza, Ospedale San Gerardo, 20900 Monza, Italy;
| | - Alessandro Ferdinando Ruffolo
- Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.F.R.); (S.S.)
| | - Mattia Dominoni
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Gaetano Maria Munno
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37100 Verona, Italy;
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy;
| | - Antonio Raffone
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Via Massarenti 13, 40138 Bologna, Italy;
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80100 Naples, Italy
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, Vita-Salute University and IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.F.R.); (S.S.)
| | - Marco Torella
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80128 Naples, Italy; (L.M.); (G.R.); (G.M.M.)
- Correspondence:
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Tosun ÖÇ, Dayıcan DK, Keser İ, Kurt S, Yıldırım M, Tosun G. Are clinically recommended pelvic floor muscle relaxation positions really efficient for muscle relaxation? Int Urogynecol J 2022; 33:2391-2400. [PMID: 35201370 DOI: 10.1007/s00192-022-05119-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Various positions for pelvic floor muscle (PFM) relaxation are recommended during PFM training in physiotherapy clinics. To our knowledge, there is no study addressing the most effective position for PFM and abdominal muscle relaxation. Therefore, the current study aimed to investigate the effect of different relaxation positions on PFM and abdominal muscle functions in women with urinary incontinence (UI). METHODS Sixty-seven women diagnosed with UI were enrolled in the study. The type, frequency, and amount of UI were assessed with the International Incontinence Questionnaire-Short Form and bladder diary. Superficial electromyography was used to assess PFM and abdominal muscle functions during three relaxation positions: modified butterfly pose (P1), modified child pose (P2), and modified deep squat with block (P3). Friedman variance analyses and Wilcoxon signed rank test with Bonferroni corrections were used to evaluate the difference between positions. RESULTS The most efficient position for PFM relaxation was P1 and followed by P3 and P2, respectively. The order was also the same for abdominal muscles (p < 0.001), P1 > P3 > P2. The rectus abdominis (RA) was the most affected muscle during PFM relaxation. The extent of relaxation of RA muscle increased as the extent of PFM relaxation increased (r = 0.298, p = 0.016). No difference was found between different types of UI during the same position in terms of PFM relaxation extents (p > 0.05). CONCLUSIONS Efficient PFM relaxation is maintained during positions recommended in physiotherapy clinics. The extent of PFM and abdominal muscle relaxation varies according to the positions.
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Affiliation(s)
- Özge Çeliker Tosun
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Damla Korkmaz Dayıcan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Biruni University, Istanbul, Turkey.
| | - İrem Keser
- Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Sefa Kurt
- Department of Obstetrics and Gynecology, Dokuz Eylül University, Izmir, Turkey
| | - Meriç Yıldırım
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - Gökhan Tosun
- Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Izmir, Turkey
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Aalaie B, Tavana B, Rezasoltani Z, Aalaei S, Ghaderi J, Dadarkhah A. Biofeedback versus electrical stimulation for sexual dysfunction: a randomized clinical trial. Int Urogynecol J 2020; 32:1195-1203. [PMID: 32529563 DOI: 10.1007/s00192-020-04373-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/28/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Sexual dysfunction is a common problem in the general population. We compared the effects of biofeedback and electrical stimulation on the symptoms of sexual pain dysfunction in women with urinary stress incontinence. METHODS We carried out a parallel randomized clinical trial in an outpatient department for physical medicine and rehabilitation at a university hospital. Based on DSM-5 criteria for sexual dysfunction, 22 patients with sexual dysfunction and stress incontinence were included and randomly allocated to each study arm. The primary outcome measure was the total score on the Female Sexual Function Index. Each group underwent pertinent treatment for 100 min, two times a week for 6 weeks. RESULTS Both groups showed favorable outcomes in increasing Female Sexual Function Index mean scores and their domains. However, for improving sexual function, women in the biofeedback group benefited more than those receiving electrical stimulation. Biofeedback raised desire, arousal, lubrication, orgasm, and satisfaction scores more than electrical stimulation (all p ≤ 0.025). Both interventions decreased pain during or following vaginal penetration similarly (p = 0.985). CONCLUSIONS Both biofeedback and electrical stimulation increased the Female Sexual Function Index score. However, to improve sexual function, women undergoing biofeedback seem to benefit more than those receiving electrical stimulation. We recommend considering the prescription of biofeedback for the treatment of sexual dysfunction because of its efficacy, lack of adverse effects, and easy application.
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Affiliation(s)
- Behnaz Aalaie
- School of Medicine, Department of Physical Medicine and Rehabilitation, Aja University of Medical Sciences, Etemadzadeh St, Western Fatemi, Tehran, Islamic Republic of Iran, Postal code 1411718541
| | - Behroz Tavana
- Clinical Biomechanics and Ergonomics Research Center, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Zahra Rezasoltani
- Clinical Biomechanics and Ergonomics Research Center, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Solmaz Aalaei
- School of Medicine, Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamshid Ghaderi
- School of Medicine, Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Dadarkhah
- School of Medicine, Department of Physical Medicine and Rehabilitation, Aja University of Medical Sciences, Etemadzadeh St, Western Fatemi, Tehran, Islamic Republic of Iran, Postal code 1411718541.
- Clinical Biomechanics and Ergonomics Research Center, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran.
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Xiang Y, Tang Y, Li J, Li D. How Is the Sexual Function of Premenopausal Chinese Women Without Hyperlipidemia? Sex Med 2019; 8:65-75. [PMID: 31837966 PMCID: PMC7042168 DOI: 10.1016/j.esxm.2019.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/05/2019] [Accepted: 10/26/2019] [Indexed: 01/23/2023] Open
Abstract
Introduction Most premenopausal women in China have normal lipid profiles while the sexual function among them was scarcely demonstrated. Aim To find out the characteristics of the sexual function in premenopausal Chinese women without hyperlipidemia using the Female Sexual Function Index (FSFI) and the Golombok Rust Inventory of Sexual Satisfaction (GRISS). Methods This cross-sectional study was performed to find out the characteristics of sexual function in premenopausal Chinese women without hyperlipidemia. Between January 2019 and March 2019, we recruited 216 women, 25–49 years of age. Data from questionnaires and health checkups were collected and analyzed. Main Outcome Measure We report the prevalence of and factors related to female sexual dysfunction (FSD) in premenopausal Chinese women without hyperlipidemia in accordance with the FSFI and the GRISS. Results The prevalence of FSD in our study was 46.2%. The mean age was 38.07 ± 6.94 years. More highly educated women suffered from FSD than those in the control group (61.1% vs 35.2%, P < .05). Binge eating was significantly different between the groups (P = .023). Multiple logistic regression analyses demonstrated that total cholesterol level was positively associated with low desire (OR, 2.13; 95% CI, 1.10–4.13; P = .025) and so was the low-density lipoprotein level (OR, 2.18; 95% CI, 1.03–4.62; P = .0.041). The high-density lipoprotein level was inversely associated with infrequency (OR, 0.18; 95% CI, 0.06–0.59; P = .004). More women with FSD had orgasm disorder than those in the control group, for 83.3% vs 35.2% in the FSFI (P < .001), 88.9% vs 54.3% in the GRISS (P < .001), respectively. Dissatisfaction remained the most common issue for the control group in both the FSFI and the GRISS (90.50% and 58.10%, respectively). Conclusions FSD is frequent in premenopausal Chinese women without hyperlipidemia. Dissatisfaction as the common problem influenced over half of them and orgasm disorder is a severe sexual issue for women with FSD. Xiang Y, Tang Y, Li J, et al. How Is the Sexual Function of Premenopausal Chinese Women Without Hyperlipidemia. J Sex Med 2019;8:65–75.
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Affiliation(s)
- Yali Xiang
- Health Management Center, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, P.R. China
| | - Yuxin Tang
- Department of Urology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, P.R. China
| | - Jiaqun Li
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China.
| | - Dongjie Li
- Department of Geriatric Urology, Xiangya International Medical Center, Xiangya Hospital, Central South University, Changsha, P.R. China; National Clinical Research Center for Geriatric Disorders, Changsha, P.R. China.
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Bilgic D, Gokyıldız Surucu S, Kizilkaya Beji N, Yalcin O. Sexual function and urinary incontinence complaints and other urinary tract symptoms of perimenopausal Turkish women. PSYCHOL HEALTH MED 2019; 24:1111-1122. [DOI: 10.1080/13548506.2019.1595679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Dilek Bilgic
- Gyneocologic and Obstetric Nursing Department, Dokuz Eylul University Faculty of Nursing, İzmir, Turkey
| | | | | | - Onay Yalcin
- Department of Obstetrics and Gynecology, Division of Urogynecology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
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Arslan B, Onuk O, Eroglu A, Gezmis TC, Aydin M. Female sexual function following a novel transobturator sling procedure without paraurethral dissection (modified-TOT). Int Braz J Urol 2017; 43:142-149. [PMID: 28124537 PMCID: PMC5293395 DOI: 10.1590/s1677-5538.ibju.2016.0270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/28/2016] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To determine whether there is a difference in sexual function after modified and classical TOT procedures. MATERIALS AND METHODS Of the 80 sexually active women with SUI, 36 underwent na original outside-in TOT as described by Delorme, and 44 underwent modified TOT procedure, between 2011 and 2015. The severity of incontinence and sexual function were evaluated using International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and Female Sexual Function Index (FSFI) questionnaires preoperatively and 3 months after surgery. RESULTS The postoperative ICIQ-SF score was significantly lower than the preoperative ICIQ-SF score in both groups (p=0.004 for modified TOT and p=0.002 for classical TOT). There was no significant difference in the ICIQ-SF score reduction between the two groups (14.1±2.1 vs. 14.4±1.9; p=0.892). Complication rates according to the Clavien-Dindo classification were also similar in both groups. In both groups, difference between preoperative and postoperative FSFI scores revealed a statistically significant improvement in all domains. Comparison of postoperative 3-month FSFI scores of modified and classical TOT groups showed statistically significant differences in arousal, lubrication and orgasm domains. Desire, satisfaction, pain and total FSFI scores did not differ significantly between two groups. CONCLUSION The modified TOT technique is a simple, reliable and minimal invasive procedure. The cure rate of incontinence and complication rates are the same as those of the classical TOT technique. However, due to the positive effects of minimal tissue damage on sexual arousal and orgasmic function, modified TOT has an advantage over the classical TOT.
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Affiliation(s)
- Burak Arslan
- Department of Urology, Istanbul Taksim Training and Research Hospital, Turkey
| | - Ozkan Onuk
- Department of Urology, Istanbul Taksim Training and Research Hospital, Turkey
| | - Ali Eroglu
- Department of Urology, Istanbul Taksim Training and Research Hospital, Turkey
| | - Tugrul Cem Gezmis
- Department of Urology, Istanbul Taksim Training and Research Hospital, Turkey
| | - Memduh Aydin
- Department of Urology, Istanbul Taksim Training and Research Hospital, Turkey
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Moccellin AS, Rett MT, Driusso P. Existe alteração na função dos músculos do assoalho pélvico e abdominais de primigestas no segundo e terceiro trimestre gestacional? FISIOTERAPIA E PESQUISA 2016. [DOI: 10.1590/1809-2950/14156523022016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo deste estudo é comparar a função dos músculos do assoalho pélvico no segundo e terceiro trimestre gestacional de primigestas. Foi desenvolvido em duas unidades de Saúde da Família do município de Aracaju (SE). As gestantes foram submetidas a três avaliações da função dos músculos do assoalho pélvico por meio da eletromiografia de superfície: até 16 semanas gestacionais, entre a 24ª-28ª e 34ª-36ª semanas gestacionais. Foram registrados valores de repouso, contrações voluntárias máximas e contrações sustentadas. Os dados foram tabulados no Microsoft Excel e analisados estatisticamente no programa Statistica. Adotou-se um nível de significância de 5% (p≤0,05). Participaram do estudo 19 primigestas, com média de idade de 21,74±3,65 anos. Houve aumento da massa corporal no 3º trimestre gestacional em relação ao período pré-gestacional e diminuição da média do sinal dos músculos do assoalho pélvico durante o repouso ao longo das três avaliações. A musculatura abdominal diminuiu a média do sinal no repouso e durante a contração sustentada nas avaliações 2 e 3 comparadas à avaliação 1. Pode-se concluir que outros fatores, além dos relacionados ao aumento da massa corporal materna, podem estar associados à sobrecarga nos MAP durante a gestação logo no primeiro trimestre. Essa sobrecarga pode fazer que as gestantes apresentem um tônus muscular próximo ao limite superior de referência, alterando o padrão de atividade eletromiográfica principalmente no repouso, a fim de manter a função de sustentação dos órgãos pélvicos e de continência.
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Assessing sexual problems in women at midlife using the short version of the female sexual function index. Maturitas 2015; 82:299-303. [PMID: 26323235 DOI: 10.1016/j.maturitas.2015.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/02/2015] [Accepted: 07/06/2015] [Indexed: 01/23/2023]
Abstract
Assessment of sexual function is a complex process, especially in women, which requires in any individual case: time, appropriate training and experience. The prevalence of female sexual dysfunction is quite variable depending on the studied population, assessment methods, comorbid conditions and treatments, and age. A large number of screening methods have been developed over the last decades which range from tedious, exhaustive and boring tools to very simple standardized questionnaires. The 19-item female sexual function index (FSFI-19) is among the most used and useful- instrument designed to assess female sexual function in all types of circumstances, sexual orientation and perform the comparison of transcultural factors. A short 6-item- version of the FSFI-19 has been developed to provide a quick general approach to the six original domains (one item per domain). Nevertheless, further studies are needed to demonstrate its validity in different clinical situations as it has been extensively demonstrated with the original tool.
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Leaver RB. Female urology - too long the poor relation? INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2015. [DOI: 10.1111/ijun.12082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kanter G, Rogers RG, Pauls RN, Kammerer-Doak D, Thakar R. A strong pelvic floor is associated with higher rates of sexual activity in women with pelvic floor disorders. Int Urogynecol J 2015; 26:991-6. [PMID: 25994625 DOI: 10.1007/s00192-014-2583-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 11/10/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We evaluated the associations between pelvic floor muscle strength and tone with sexual activity and sexual function in women with pelvic floor disorders. METHODS This was a secondary analysis of a multicenter study of women with pelvic floor disorders from the USA and UK performed to validate the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Participants were surveyed about whether they were sexually active and completed the PISQ-IR and the Female Sexual Function Index (FSFI) questionnaires to assess sexual function. Physical examinations included assessment of pelvic floor strength by the Oxford Grading Scale, and assessment of pelvic floor tone as per ICS guidelines. RESULTS The cohort of 585 women was middle-aged (mean age 54.9 ± 12.1) with 395 (67.5 %) reporting sexual activity. Women with a strong pelvic floor (n = 275) were more likely to report sexual activity than women with weak strength (n = 280; 75.3 vs 61.8 %, p < 0.001), but normal or hypoactive pelvic floor tone was not associated with sexual activity (68.8 vs 60.2 %, normal vs hypoactive, p = 0.08). After multivariable analysis, a strong pelvic floor remained predictive of sexual activity (OR 1.89, CI 1.18-3.03, p < 0.01). Among sexually active women (n = 370), a strong pelvic floor was associated with higher scores on the PISQ-IR domain of condition impact (parameter estimate 0.20± 0.09, p = 0.04), and the FSFI orgasm domain (PE 0.51 ± 0.17, p = 0.004). CONCLUSION A strong pelvic floor is associated with higher rates of sexual activity as well as higher sexual function scores on the condition impact domain of the PISQ-IR and the orgasm domain of the FSFI.
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Affiliation(s)
- Gregg Kanter
- Department of Obstetrics and Gynecology, MSC 10-5580, University of New Mexico, Albuquerque, NM, 87131-0001, USA,
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Lee MH, Wu HC, Lin JY, Tan TH, Chan PC, Chen YF. Development and evaluation of an E-health system to care for patients with bladder pain syndrome/interstitial cystitis. Int J Urol 2015; 21 Suppl 1:62-8. [PMID: 24807502 DOI: 10.1111/iju.12336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 10/04/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic disease that highly degrades the quality of life for patients. In the present study, Internet intervention was used to care for bladder pain syndrome/interstitial cystitis patients to alleviate their pain and bothering symptoms. METHODS Healthcare education was carried out through the Internet by asking the patients, who were randomly divided into study (40 patients) and control (40 patients) groups, to check possible sensitive foods, habits, and behaviors weekly to remind and consolidate important rules for promoting quality of life. The symptom flares consultation through short message service with the Internet used to elevate healthcare efficiency was undertaken. Questionnaires, including Short Form 36 health survey, O'Leary-Sant symptom and problem indices, as well as visual analog scales pain and urgency scales, were used to evaluate quality of life and disease severity improvements before and after information and communication technology intervention. The outcome was evaluated at week 8. RESULTS The quality of life of both the control and study groups was significantly improved. The quality of life and visual analog scales for the patients in the study group with information and communication technology intervention showed a much greater improvement compared with the patients in the control group (P < 0.05). CONCLUSIONS The E-health system was shown to be effective in improving quality of life of bladder pain syndrome/interstitial cystitis patients through intervention of Internet healthcare education and short message service for the consolidation of healthy behavior and lifestyle in the 8-week follow up.
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Affiliation(s)
- Ming-Huei Lee
- Department of Management Information System, Central Taiwan University of Science and Technology, Taichung, Taiwan; Department of Urology, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan
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Castagna G, Montorsi F, Salonia A. Sexual and bladder comorbidity in women. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:165-76. [PMID: 26003244 DOI: 10.1016/b978-0-444-63247-0.00010-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Giulia Castagna
- Universitá Vita-Salute San Raffaele, Milan, Italy; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Universitá Vita-Salute San Raffaele, Milan, Italy; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy.
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Berzuk K. The Pelvic Floor Muscle: the Link Between Bladder, Bowel, and…Sex? A Review of Current Pelvic Therapy Approaches for Diagnosis and Treatment of Sexual Disorders. CURRENT SEXUAL HEALTH REPORTS 2014. [DOI: 10.1007/s11930-014-0025-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lee D, Zimmern PE. Female Sexual Dysfunction Management After Pubovaginal/Midurethral Sling Surgery. CURRENT SEXUAL HEALTH REPORTS 2014. [DOI: 10.1007/s11930-014-0024-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Vieillefosse S, Thubert T, Deffieux X. [Miduretral sling and sexuality: a systematic review]. Prog Urol 2014; 24:682-90. [PMID: 25214449 DOI: 10.1016/j.purol.2014.06.013] [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: 06/04/2014] [Revised: 06/26/2014] [Accepted: 06/30/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess influence of miduretral sling (MUS) on patient's sexuality. METHODS A comprehensive literature review using Pubmed, Medline, Embase and Cochrane: "stress urinary incontinence", "sexual function", "anti-incontinence surgery", "minimaly invasive slings", "mid-urethral slings", "tension-free vaginal tape", "transobturator vaginal tape". Sixty-nine articles really dealt with the impact of MUS on sexuality. RESULTS The data were expressed as the median and interquartile range (IQR; 25th-75th percentile). After MUS surgery, 30% (21-37) patients had sexuality improvement, 8.5% (4.7-14) had sexuality impairment and 60% (53-73) didn't report change on their sexuality. CONCLUSION MUS surgery didn't seem to impair significantly patient's sexuality.
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Affiliation(s)
- S Vieillefosse
- Gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - T Thubert
- Gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
| | - X Deffieux
- Gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
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Siedhoff MT, Carey ET, Findley AD, Hobbs KA, Moulder JK, Steege JF. Post-hysterectomy Dyspareunia. J Minim Invasive Gynecol 2014; 21:567-75. [DOI: 10.1016/j.jmig.2014.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/13/2014] [Accepted: 02/14/2014] [Indexed: 12/13/2022]
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Outcomes of a comprehensive nonsurgical approach to pelvic floor rehabilitation for urinary symptoms, defecatory dysfunction, and pelvic pain. Female Pelvic Med Reconstr Surg 2013; 19:260-5. [PMID: 23982573 DOI: 10.1097/spv.0b013e31829cbb9b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The authors' intent was to determine the clinical efficacy of comprehensive pelvic floor rehabilitation among women with symptoms of pelvic floor dysfunction (PFD). METHODS We performed a retrospective analysis of women referred to an academic female pelvic medicine and reconstructive surgery practice for PFD. Data were gathered from the records of 778 women referred for pelvic floor therapy for urinary, bowel, pelvic pain, and sexual symptoms over the course of 4 years. RESULTS Patients who completed at least 5 therapy sessions reported a mean symptom improvement of 80% in each of the 3 main categories analyzed, namely, urinary incontinence, defecatory dysfunction, and pelvic pain. CONCLUSIONS Comprehensive, nonoperative management of PFD including pelvic floor muscle training, biofeedback, electrogalvanic stimulation, constipation management, behavioral modification, incontinence devices, and pharmacotherapy including vaginal estrogen is effective in the treatment of women with PFD.
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The Role of Sacral Nerve Stimulation in Female Pelvic Floor Disorders. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2013. [DOI: 10.1007/s13669-013-0052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Intra-vaginal diazepam for high-tone pelvic floor dysfunction: a randomized placebo-controlled trial. Int Urogynecol J 2013; 24:1915-23. [DOI: 10.1007/s00192-013-2108-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 03/26/2013] [Indexed: 10/26/2022]
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Clegg M, Towner A, Wylie K. Should questionnaires of female sexual dysfunction be used in routine clinical practice? Maturitas 2012; 72:160-4. [PMID: 22521685 DOI: 10.1016/j.maturitas.2012.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
Abstract
AIMS The aim of this paper is to explore the potential value of questionnaires in routine clinical practice to assess female sexual dysfunction (FSD), and to identify if this could increase the competence of a physician in the initial management of women with these problems. The rationale to encourage Health Care Professionals (HCPs) to engage women in dialogue about their sexual health is that it may enhance a woman's quality of life (which may lead to improved general health) and might lead to timely interventions and possible preventative measures for certain diseases. METHOD A short literature review of the most relevant publications was undertaken evaluating current practice. RESULTS FSD can have a negative impact on women's well-being and can also be an early symptom of underlying disease. Many HCPs do not broach the subject, consequently women do not get the opportunity either to voice their sexual concerns or access appropriate services. Review of currently available FSD questionnaires suggests that many but not all are generally inappropriate for use in routine clinical practice. Kriston et al.'s STEFFI-2 may be an appropriate starting point. Evidence suggests that this would facilitate discussion of sexual matters between the HCP and the women, and increase the likelihood of FSD being diagnosed. CONCLUSIONS Following this review of the literature, the authors strongly recommend that HCPs include FSD questionnaires as part of their routine engagement with women. However, the questionnaire would need to be used as part of the overall assessment and cannot replace a detailed case history and examination, which should lead to effective treatment and management of FSD. The authors recommend further research in the following areas: • Effective training for HCPs. • FSD as an early presentation of sub-clinical disease. • The cost-benefit of early treatment of FSD. • A standardised, validated FSD screening tool. • Benefits of using FSD screener in routine clinical practice.
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Jang MY, Long CY, Chuang SM, Huang CH, Lin HY, Wu WJ, Juan YS. Sexual dysfunction in women with ketamine cystitis: a case-control study. BJU Int 2011; 110:427-31. [DOI: 10.1111/j.1464-410x.2011.10780.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Goldstein S. Staying stagnant means falling behind. J Sex Med 2011; 8:2393-4. [PMID: 21884424 DOI: 10.1111/j.1743-6109.2011.02429.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jha S, Ammenbal M, Metwally M. Impact of incontinence surgery on sexual function: a systematic review and meta-analysis. J Sex Med 2011; 9:34-43. [PMID: 21699671 DOI: 10.1111/j.1743-6109.2011.02366.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Urinary incontinence has an adverse impact on sexual function. The reports on sexual function following the treatment of urinary incontinence are confusing. AIM To investigate the impact of surgery for stress incontinence on coital incontinence and overall sexual function. METHODS Cochrane Incontinence Group Specialized Register of Controlled Trials, The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched for trials of incontinence surgery assessing sexual function and coital incontinence before and after surgery. Observational studies and randomized controlled trials investigating the impact of surgical correction of stress urinary incontinence on sexual function were included. Surgical interventions included tension-free vaginal tape (TVT), Tension Free Vaginal Tape-Obturator (TVT-O), transobturator tape (TOT), Burch, and autologous fascial sling (AFS). Studies that included patients undergoing concurrent prolapse surgery were excluded from the analysis. Data extraction and analysis was performed independently by two authors. Coital incontinence was analyzed separately and odds ratios (ORs) with 95% confidence intervals (CI ) calculated. The data were analyzed in Review Manager 5 software. MAIN OUTCOME MEASURE Changes in sexual function and coital incontinence following surgery for urinary incontinence. RESULTS Twenty-one articles were identified, which assessed sexual function and/or coital incontinence following continence surgery in the absence of prolapse. Results suggest evidence for a significant reduction in coital incontinence post surgery (OR 0.11; 95% CI 0.07, 0.17). CONCLUSIONS Coital incontinence is significantly reduced following continence surgery. There were several methodological problems with the quality of the primary research particularly related to heterogeneity of studies, use of different outcome measures, and the absence of well-designed randomized controlled trials.
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Affiliation(s)
- Swati Jha
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, UK.
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Wehbe SA, Kellogg S, Whitmore K. Urogenital complaints and female sexual dysfunction. Part 2. J Sex Med 2011; 7:2304-17; quiz 2318-9. [PMID: 20653832 DOI: 10.1111/j.1743-6109.2010.01951.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
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.
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Affiliation(s)
- Salim A Wehbe
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Drexel University College of Medicine, Philadelphia, PA, USA.
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Gardella B, Porru D, Nappi RE, Daccò MD, Chiesa A, Spinillo A. Interstitial Cystitis is Associated with Vulvodynia and Sexual Dysfunction—A Case-Control Study. J Sex Med 2011; 8:1726-34. [DOI: 10.1111/j.1743-6109.2011.02251.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mohr S, Kuhn P, Mueller MD, Kuhn A. Painful Love—“Hispareunia” after Sling Erosion of the Female Partner. J Sex Med 2011; 8:1740-6. [DOI: 10.1111/j.1743-6109.2011.02261.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Current world literature. Curr Opin Support Palliat Care 2011; 5:174-83. [PMID: 21521986 DOI: 10.1097/spc.0b013e3283473351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Signorello D, Seitz CC, Berner L, Trenti E, Martini T, Galantini A, Lusuardi L, Lodde M, Pycha A. Impact of Sacral Neuromodulation on Female Sexual Function and His Correlation with Clinical Outcome and Quality of Life Indexes: A Monocentric Experience. J Sex Med 2011; 8:1147-55. [DOI: 10.1111/j.1743-6109.2010.02189.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sacral neuromodulations for female lower urinary tract, pelvic floor, and bowel disorders. Curr Opin Obstet Gynecol 2011; 22:414-9. [PMID: 20724927 DOI: 10.1097/gco.0b013e32833e49d7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In recent years, sacral neuromodulation (SNM) has been investigated for the treatment of various types of lower urinary tract and bowel dysfunctions. This review discusses recently published data related to the therapeutic applications of SNM in female lower urinary tract, pelvic floor, and bowel disorders. RECENT FINDINGS SNM has been employed initially in the treatment of refractory idiopathic overactive bladder, urge urinary incontinence, and chronic nonobstructive urinary retention. Since then, several studies, including randomized and controlled trials, have confirmed the therapeutic effects of SNM in these disorders. The applications of SNM are now extended to the treatment of other female pelvic problems, such as fecal incontinence, chronic constipation, interstitial cystitis/painful bladder syndrome, sexual dysfunction, and neurogenic disorders, with similar promising results. SUMMARY SNM is approved by the Food and Drug Administration for the treatment of idiopathic overactive bladder, urge urinary incontinence, and chronic nonobstructive urinary retention. SNM is not yet an approved method for the treatment of other pelvic disorders, but data supporting its benefit are emerging. The major advantage of SNM lies in its potential to treat the bladder, urethral sphincter, anal sphincters, and pelvic floor muscles simultaneously, which might result in better therapeutic effects.
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Bekker MD, Van Driel MF, Pelger RCM, Lycklama à Nijeholt GAB, Elzevier HW. How do continence nurses address sexual function and a history of sexual abuse in daily practice? Results of a pilot study. J Sex Med 2010; 8:367-75. [PMID: 20946147 DOI: 10.1111/j.1743-6109.2010.02044.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
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.
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Affiliation(s)
- Milou D Bekker
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands.
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