Is Pelvic Floor Dysfunction an Independent Threat to Sexual Function? A Cross-Sectional Study in Women With Pelvic Floor Dysfunction

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• 作者：Ryan J. Li-Yun-Fong ; MD¹ ; Maryse Larouche ; MD² ; Momoe Hyakutake ; MD³ ; Nicole Koenig ; BS² ; Catherine Lovatt ; MD⁴ ; Roxana Geoffrion ; MD² ; Lori A. Brotto ; PhD² ; Terry Lee ; PhD⁵ ; Geoffrey W. Cundiff ; MD² ; ⁵ ; ^{geoff.cundiff@ubc.ca}
• 关键词：Pelvic Floor Dysfunction ; Incontinence ; Pelvic Organ Prolapse ; Female Sexual Dysfunction ; Menopause ; Sexual Desire
• 刊名：The Journal of Sexual Medicine
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：14
• 期：2
• 页码：226-237
• 全文大小：960 K
• 卷排序：14

文摘

Prior studies have reported an association of sexual dysfunction with pelvic floor dysfunction (PFD), but without defining causation.AimTo investigate predictors of sexual function in women with PFD, including pelvic organ prolapse, stress urinary incontinence, overactive bladder, obstructed defecation, and fecal incontinence.MethodsThis retrospective cross-sectional study included 755 women (mean age = 56 years, 68% postmenopausal) referred for PFD (2008–2013). Subjects underwent standardized history and examination, including demographics and assessment of pelvic floor function and sexual function using validated quality-of-life instruments. The physical examination included body mass index, Pelvic Organ Prolapse Quantification measurements, and pelvic muscle strength (Oxford scale). Proportional odds regression analysis tested patient characteristics, PFD, and other determinants of sexual dysfunction as predictors of sexual function.Main Outcome MeasuresThe Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7) to assess PFD and the Short Personal Experiences Questionnaire to assess sexual function.ResultsThe prevalence of PFD included pelvic organ prolapse (72%), stress urinary incontinence (66%), overactive bladder (78%), fecal incontinence (41%), and obstructed defecation (70%). Most subjects (74%) had a sexual partner and most (56%) reported recent sexual intercourse. Participants reported a low level of sexual desire and sexual enjoyment and moderate levels of sexual arousal and orgasm. When stratified by sexual enjoyment, 46% enjoyed sex and this group had lower PFDI and PFIQ scores, reflecting less quality-of-life burden. Pelvic organ prolapse, obstructed defecation, and fecal incontinence were associated with not enjoying sex. However, when adjusted for other determinants of sexual dysfunction (eg, aging, dyspareunia, atrophy, and partner issues), these associations disappeared.ConclusionWomen with PFD also have a large burden of sexual dysfunction, although this appears to be mediated by factors not unique to PFD.