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Roth JD, Hensel DJ, Wiener JS, Younsi N, Stein R, Misseri R, Szymanski KM. Urinary and Fecal Incontinence During Sexual Activity Is Common and Bothersome Among Adults With Spina Bifida. Urology 2024; 186:54-60. [PMID: 38354913 DOI: 10.1016/j.urology.2023.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024]
Abstract
OBJECTIVE To evaluate the prevalence of and risk factors for urinary fecal incontinence (UI, FI) during sexual activity (UIS, FIS) among adults with spina bifida (SB). METHODS An international online survey of adults with SB was administered through SB clinics and SB organizations via social media. Adults with a history of masturbation or partnered sexual activity were included. The primary outcome was ever experiencing UIS/FIS. Nonparametric tests and logistic regression were used for analysis. RESULTS A total of 341 adults met inclusion criteria (median age: 36years, 59% female, 52% shunted, 48% community ambulators). Baseline UI in the last 4weeks was reported by 50% and FI by 41%. Nineteen (5%) had a urostomy. Eight (2%) had a colostomy. Overall, 93% had a history of partnered genital contact. Among adults without a diversion, UIS was more common than FIS (70% vs 45%, P < .001). Among adults without a urostomy, UIS was more common among women (76% vs 62%, P = .01) and those with baseline UI (84% vs 50%, P < .001). UIS was not associated with age, shunt, ambulatory, or catheterization status (P >=.32). On bivariate analysis, female sex and baseline UI were independent predictors of UIS (P <=.001). Among adults without a colostomy, FIS was associated with female sex (50% vs 39%, P = .046), baseline FI (59% vs 32%, P < .001), community ambulation (52% vs 40%, P = .04), but not age, shunt, or MACE status (P >=.27). On multivariate analysis, baseline FI was independently associated with FIS (P < .001). Among adults with UIS/FIS, 29% experienced UIS "almost always" to "always," compared to 5% for FIS (P < .001). Virtually all adults found UIS/FIS bothersome (>=96% for each), even when incontinence occurred "almost never." UIS/FIS mostly occurred before and/or during orgasm than afterward (P < .001). UIS was reported by 53% of adults with a urostomy (100% bothersome). FIS was reported by 38% of adults with a colostomy (100% bothersome). CONCLUSION Incontinence during sexual activity is a common problem for men and women with SB. Baseline incontinence is an independent, but not absolute, predictor of both. While FIS is less frequent than UIS, both are virtually always bothersome.
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Affiliation(s)
- Joshua D Roth
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN.
| | - Devon J Hensel
- Department of Pediatrics and Department of Sociology, Indiana University School of Medicine and Indiana University Purdue University Indianapolis, Indianapolis, IN
| | - John S Wiener
- Division of Pediatric Urology, Department of Urology, Duke University Medical Center, Durham, NC
| | - Nina Younsi
- Department of Pediatric, Adolescent and Reconstructive Urology University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
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Szymanski KM, Roth JD, Hensel DJ, Wiener JS, Younsi N, Stein R, Whittam B, Kaefer M, Rink RC, Cain MP, Misseri R. Sexual activity and function of adult men with spina bifida. J Pediatr Urol 2023:S1477-5131(23)00077-3. [PMID: 36935328 DOI: 10.1016/j.jpurol.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Data on sexual function of men with spina bifida (SB) is limited. We aimed to assess sexual activity and erectile dysfunction (ED) in a large international sample of men with SB. METHODS Men with SB (≥18yo) were recruited in an international online survey via clinics and social media. We collected data on demographics, ambulation (Hoffer classification), penile rigidity (Erection Hardness Score), sexual activity and ED (International Index of Erectile Function). Non-parametric tests were used. RESULTS A total of 162 men (median age 35, 62% shunted, 38% community ambulators) reported sexual desire similar to the general population (p = 0.82), but 55% were dissatisfied with their sex life (Summary Table). Overall, 36% reported full penile rigidity with erections, more commonly with better ambulation (p = 0.01), 69% had ever experienced orgasm and 84% ejaculated. In 44 men (27%) attempting sexual intercourse in the last 4 weeks, 59% had ED (11% severe, 7% moderate, 14% mild-moderate, 27% mild). In this group, 91% of men reporting less than full penile rigidity had ED, compared to 30% with full penile rigidity (p = 0.001). Overall, partnered non-genital contact in the last 3 months was reported by 56%, solo masturbation: 62%, partnered intercourse: 48% (31% vaginal). Of 54 men who used phosphodiesterase type 5 inhibitors (PDE5I), 80% reported improved erections, 56% improved intercourse. Overall, 40% reported non-genital erogenous zones as most pleasurable, especially with poorer ambulation (p = 0.002, chest/nipples: 73%). COMMENT Strengths of this study include anonymous, voluntary, online participation maximizing participation of a heterogenous, international population. Whenever available, we compared findings to published values for the general population. Since romantic and sexual activity is a complex intersection of interest, opportunity and ability, a more comprehensive assessment was beyond the study's scope. Future work will focus on the interplay with issues like incontinence. CONCLUSIONS ED was frequent among men with SB, especially in men with poorer ambulation. PDE5 inhibitors may be beneficial. Partnered sexual activity was reported by half of the men, although it may not involve penetrative intercourse.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA.
| | - Joshua D Roth
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - Devon J Hensel
- Department of Pediatrics and Department of Sociology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - John S Wiener
- Section of Pediatric Urology, Duke University Medical Center, Durham, NC, USA
| | - Nina Younsi
- Department of Pediatric, Adolescent and Reconstructive Urology University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Benjamin Whittam
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - Martin Kaefer
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - Richard C Rink
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - Mark P Cain
- Department of Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
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Hensel DJ, Misseri R, Wiener JS, Roth JD, Whittam BM, Cain MP, Szymanski KM. Solo and Partnered Sexual Behavior Among an International Sample of Adults With Spina Bifida. J Sex Med 2022; 19:1766-1777. [PMID: 36216747 DOI: 10.1016/j.jsxm.2022.08.201] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/19/2022] [Accepted: 08/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Spina bifida (SB) may differentially impact adults' participation in solo and partnered sexual behaviors, but little research investigates this topic. AIM Describe solo and partnered sexual behaviors among an international sample of adult men and women with SB. MAIN OUTCOME MEASURES Ever participated (no/yes) and recent participation (>1 year ago/within last year) in solo masturbation, cuddled with a partner, held hands with a partner, kissed a partner, touched a partner's genital, had genitals touched by a partner, gave a partner oral sex, received oral sex from a partner, vaginal sex, anal sex, and sex toy use. METHODS Data were drawn from a larger cross-sectional, internet-based survey assessing the sexual behaviors of an international sample of men and women with SB. We used logistic regression to examine the impact of background (gender, age, independent living, and relationship status) and health (shunt status, ambulation, and genital sensation) factors on each outcome. RESULTS The sample consisted of 345 respondents aged 18-73 years from 26 nations. Very few (<3%) had no lifetime experience with any solo or partnered behaviors; 25.0% reported participating in all behaviors at some point in their lives. The median number of past year sexual behaviors (of 16 total) was 7. Lifetime and recent participation were associated with demographic and health factors. CLINICAL IMPLICATIONS Despite impairment, adults with spina bifida do participate in solo and partnered sexual behaviors. Medical personnel who work with this population should include discussions about sexuality as part of routine care. STRENGTHS & LIMITATIONS Although this research measured solo and partnered sexual behavior in large international sample of adults with spina bifida, it is limited by its cross-sectional retrospective design and non-clinical convenience sample. CONCLUSION Despite disability, many adults with SB participate in solo and partnered sexual behavior. Medical and psychosocial supports are needed to help adults in this population enjoy sexuality in a healthy and safe manner. Hensel DJ, Misseri R, Wiener JS, et al. Solo and Partnered Sexual Behavior Among an International Sample of Adults With Spina Bifida. J Sex Med 2022;19:1766-1777.
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Affiliation(s)
- Devon J Hensel
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Sociology, Indiana University Purdue University-Indianapolis, Indianapolis, IN, USA.
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - John S Wiener
- Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Joshua D Roth
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Benjamin M Whittam
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
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EDITORIAL COMMENT. Urology 2021; 156:319. [PMID: 34758573 DOI: 10.1016/j.urology.2021.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/02/2021] [Indexed: 11/21/2022]
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Sexual Function of Men and Women With Spina Bifida: A Scoping Literature Review. Sex Med Rev 2021; 9:244-266. [PMID: 33608247 DOI: 10.1016/j.sxmr.2020.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/30/2020] [Accepted: 09/06/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION As most adults with spina bifida are either sexually active or interested in becoming sexually active, providers should understand how spina bifida impacts sexual function and options for treatment. OBJECTIVES The objective of this study is to summarize the current literature describing how features of spina bifida impact sexual function in men and women, effective available treatment options for sexual dysfunction, and to identify research gaps. METHODS Searches were conducted in PubMed, CINAHL Complete, PsychInfo, Cochrane Central, Scopus, and Web of Science Core Collection databases using keywords related to spina bifida and sexual function. 34 primary research studies were included. RESULTS Most men (56-96%) can achieve an erection, although it may be insufficient for penetration. Although 50-88% ejaculate, it is often dripping, retrograde, or insensate. Twenty percent to 67% achieve orgasm. Generally, men with lower lesions and intact sacral reflexes have better outcomes, although some men with all levels of lesion report good function. Sildenafil is efficacious at treating erectile dysfunction for most men. The "TO-MAXimize sensation, sexuality, and quality of life" procedure may improve sexual function in selected men with low-level lesions. Female sexual function and treatment is less well understood. Women may experience decreased arousal, difficulties with orgasm, and pain. No treatment has been studied in women. Bowel and bladder incontinence during intercourse appears to be bothersome to men and women. Although both men and women have diminished sexual satisfaction, their sexual desire appears to be least impacted. Present studies are limited by studies' small, heterogeneous populations, the misuse of validated questionnaires in the sexually inactive population, and the lack of a validated questionnaire specific to people with spina bifida. CONCLUSIONS Spina bifida impacts the sexual function of both men and women. Future studies should seek a better understanding of female sexual function and treatment, use validated questionnaires appropriately, and ultimately create a validated sexual function questionnaire specific to this population. Streur CS, Corona L, Smith JE, et al. Sexual Function of Men and Women With Spina Bifida: A Scoping Literature Review. Sex Med Rev 2021;9:244-266.
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Truong H, Salib A, Rowe CK. The Use of Social Media in Pediatric Urology-Forging New Paths or Crossing Boundaries? Curr Urol Rep 2019; 20:72. [PMID: 31620926 DOI: 10.1007/s11934-019-0928-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] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW There has been a remarkable change in how people connect, access, and share professional and medical information over social media. This perspective article describes opportunities, potential pitfalls, and guidelines for social media use by pediatric urology providers. RECENT FINDINGS Pediatric urologists have effectively used social media to connect and share expertise, augment scientific conference participation, promote themselves and their research, disseminate guidelines and best practices, participate in virtual journal clubs, and engage with patients and their families. Information shared over social media is not protected by copyright law, not confidential, not regulated, permanent, and subjected to public domain and scrutiny. Despite these potential pitfalls, social media is a useful tool if best practices are observed and online communication adheres to professional guidelines and organizational policy. Social media use in healthcare is here to stay and pediatric urologists have online visibility whether or not they choose to actively participate. Despite new legal, ethical, and professional considerations that social media introduces, a well-executed social media presence provides pediatric urologists a wealth of new opportunities for networking, research, and disseminating high-quality medical information online.
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Affiliation(s)
- Hong Truong
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 1025 Walnut St, Suite 1112, Philadelphia, PA, 19107, USA. .,Division of Pediatric Urology, Connecticut Children's Medical Center, Hartford, CT, USA.
| | - Andrew Salib
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 1025 Walnut St, Suite 1112, Philadelphia, PA, 19107, USA.,Division of Pediatric Urology, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Courtney K Rowe
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, 1025 Walnut St, Suite 1112, Philadelphia, PA, 19107, USA.,Division of Pediatric Urology, Connecticut Children's Medical Center, Hartford, CT, USA
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Dogan HS, Stein R, ‘T Hoen LA, Bogaert G, Nijman RJM, Tekgul S, Quaedackers J, Silay MS, Radmayr C. Are EAU/ESPU pediatric urology guideline recommendations on neurogenic bladder well received by the patients? Results of a survey on awareness in spina bifida patients and caregivers. Neurourol Urodyn 2019; 38:1625-1631. [DOI: 10.1002/nau.24024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/17/2019] [Accepted: 04/22/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Hasan S. Dogan
- Department of Urology, Division of Pediatric UrologyHacettepe University Faculty of MedicineAnkara Turkey
| | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive UrologyHeidelberg UniversityMannheim Germany
- University of Medical Center MannheimMannheim Germany
| | | | - Guy Bogaert
- Department of UrologyUniversity Hospitals of the KU LeuvenLeuven Belgium
| | - Rien J. M. Nijman
- Department of UrologyUniversity Medical Center GroningenGroningen The Netherlands
| | - Serdar Tekgul
- Department of Urology, Division of Pediatric UrologyHacettepe University Faculty of MedicineAnkara Turkey
| | - Josine Quaedackers
- Department of UrologyUniversity Medical Center GroningenGroningen The Netherlands
| | - Mesrur S. Silay
- Division of Pediatric Urology, Istanbul Memorial HospitalIstanbul Gelisim UniversityIstanbul Turkey
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Wiener JS, Frimberger DC, Wood H. Spina Bifida Health-care Guidelines for Men's Health. Urology 2018; 116:218-226. [PMID: 29545051 DOI: 10.1016/j.urology.2018.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/06/2017] [Accepted: 01/04/2018] [Indexed: 11/30/2022]
Abstract
Spina bifida has traditionally been regarded as a pediatric health issue with little regard to adult consequences of the disorder. The congenital neurologic and urologic anomalies, as well as sequelae of bladder management, can have a profound impact on adult male sexual function. Abnormalities in testicular descent, development, and function; fertility; penile sensation; erectile function; ejaculatory function; and orgasmic function are common. Prostate cancer has been diagnosed in men with spina bifida, but little data are available to guide screening, diagnosis, and treatment efforts. The Spina Bifida Association has supported development of guidelines for health care providers to address male health issues in individuals with spina bifida throughout their lives.
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Affiliation(s)
- John S Wiener
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC.
| | - Dominic C Frimberger
- Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK
| | - Hadley Wood
- Department of Urology, Cleveland Clinic, Cleveland, OH
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