The Effect of Pelvic Organ Prolapse on Sexual Function in a General Cohort of Women

IntroductionThis is a report about the effects of pelvic organ prolapse on sexual function in women.AimTo determine the effect of pelvic organ prolapse on sexual function in women.MethodsThe study group consisted of 1,267 sexually active women. Baseline characteristics, medical and obstetric history of the patients were recorded. All women underwent vaginal examination to determine the degree of prolapse by pelvic organ prolapse quantification (POPQ) system. Of 1,267 women, 342 (27.0%) had prolapse stage ≥2.Main Outcome Measure(s)The Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire short form (PISQ-12) scores of the women were recorded.Result(s)Women with genital prolapse had lower PISQ-12 scores than women without it. The difference resulted mainly from urinary incontinence during sexual activity, fear of incontinence and avoidance of intercourse due to prolapse. Multivariate analyses showed that genital prolapse was one of the confounding factors for sexual function.Conclusion(s)Pelvic floor dysfunction is a multi-faceted problem because it has both anatomical and functional aspects. Although pelvic organ prolapse had an effect on some aspects of sexuality, it has no effect on certain aspects of sexual function such as orgasm and sexual satisfaction. Tok EC, Yasa O, Ertunc D, Savas A, Durukan H, and Kanik A. The effect of pelvic organ prolapse on sexual function in a general cohort of women.     

A new instrument to measure sexual function in women with urinary incontinence or pelvic organ prolapse

OBJECTIVE: Our aim was to develop a condition-specific, reliable, validated, and self-administered instrument to evaluate sexual function in women with pelvic organ prolapse or urinary incontinence. STUDY DESIGN: The questionnaire was designed after review of the literature and of nonspecific validated instruments. The study was completed in 2 phases. In phase 1 a total of 83 women completed both our questionnaire and the Incontinence Impact Questionnaire-7, with 20 women undergoing test-retest reliability analyses. Item analysis was based on the internal consistency, the correlations with the Incontinence Impact Questionnaire-7, the patient's age and self-rating of satisfaction, and the results of reliability testing. For final validation the questionnaire was administered in phase 2 to 99 women. Factor and item analyses were repeated, results were correlated with the Sexual History Form-12, and comparison was made between patients with high depression scores and those with low depression scores on the Symptom Questionnaire. RESULTS: Factor analysis identified 3 domains, labeled Behavioral/Emotive, Physical, and Partner-Related. Sexual function scores were highly correlated with scores on the Sexual History Form-12 for the questionnaire (r = -0.74; P <.001) and for both the Behavioral/Emotive and the Partner-Related domains (r = -0.79 and -0.5, respectively; P <.001). The Physical domain was correlated with scores on the Incontinence Impact Questionnaire-7 (r = -0.63; P <.001). Women with high depression scores on the Symptom Questionnaire had significantly lower scores on the final questionnaire, in comparison with women without depression (P <.001). CONCLUSION: We developed a condition-specific, validated, and reliable instrument, containing 31 items divided into 3 domains, to evaluate sexual functioning in women with urinary incontinence or pelvic organ prolapse.     

Validation of a Chinese Version of the Short Form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire

IntroductionSexual dysfunction is prevalent in women with pelvic organ prolapse and/or urinary incontinence. An instrument is needed to assess sexual function in urogynecologic patients who speak Chinese.AimTo evaluate the reliability and validity of a Chinese translation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in urogynecologic patients in Taiwan.MethodsAfter a pilot study showing good test–retest reliability and internal consistency of the Chinese PISQ-12, 120 urogynecological patients and 63 normal women were recruited. All participants underwent the Pelvic Organ Prolapse Quantification (POP-Q) system and urodynamic assessment. They each completed the Chinese PISQ-12 and the short form of Incontinence Impact Questionnaire (IIQ-7).Main Outcome MeasuresPISQ-12, POP-Q system and IIQ-7 scores were compared between the urogynecologic patients and normal controls.ResultsThe test–retest reliability and internal consistency of the Chinese PISQ-12 total score (Pearson correlation coefficient r = 0.939, Cronbach's alpha = 0.892, respectively) and of each of its three domains were excellent. The mean total PISQ-12 score and mean scores in each domain indicated significantly worse sexual dysfunction in the urogynecologic group as compared with the control group were correlated with the severity of prolapse and distress caused by incontinence.ConclusionThis Chinese translation of the PISQ-12 is a reliable, consistent and valid instrument to evaluate sexual function in Taiwanese women with pelvic organ prolapse and/or urinary incontinence. Su T-H, and Lau H-H. Validation of a Chinese version of the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire.     

Sexual Disorders in Women with Overactive Bladder and Urinary Stress Incontinence Compared to Controls: A Prospective Study

Introduction and Hypothesis Female urinary incontinence (UI) has a negative impact on sexual function and sexual quality of life (QoL) in women. But there is still no consensus on the type of UI or the prevalence of sexual dysfunction (SD). The aim of the study was to evaluate sexual disorders in women with overactive bladder (OAB) compared to patients with urinary stress incontinence (SUI) and healthy controls. Materials and Methods 106 women presenting to a urogynecological outpatient clinic (referral clinic) were investigated using standardized questionnaires and the Female Sexual Function Index (FSFI-d). All 65 incontinent women underwent a full urodynamic examination; the controls (31) were non-incontinent women in the same age range who came for routine check-ups or minor disorders not involving micturition or pelvic floor function. Women with mixed urinary incontinence, a history of previous medical or surgical treatment for UI, recurrent urinary tract infections, previous radiation therapy or pelvic organ prolapse of more than stage 2 on the Pelvic Organ Prolapse Quantification (POP-Q) system were excluded. Results 100 questionnaires could be evaluated (94.3%). Thirty-four women had urinary stress incontinence, 35 had OAB, 31 were controls. Mean age was 56 years, with no significant differences between groups. The scores of the questionnaire ranged from 2 to 35.1 points. The median score of OAB patients was significantly lower (17.6) than the median score of the controls (26.5; p = 0,004). The stress-incontinent women had a score of 21.95, which was lower than that of the controls but statistically non-significant (p = 0.051). In all subdomains, the OAB patients had lower scores than the stress-incontinent women and significantly lower values than the control group. Most striking was the impairment of “sexual interest in the last 4 weeks”. The figure for “none or almost no sexual activity” was 80% for the OAB group, 64.7% for the group of stress-incontinent women and 48% for the control group. Incontinence during intercourse was reported by one OAB patient and 4 stress-incontinent women but did not occur in the control group. Conclusions There is a high prevalence of SD in women with urinary incontinence. Patients with OAB reported a greater negative impact on sexual function and had significantly lower scores for the FSFI questionnaire than patients with stress incontinence or controls. Key words: overactive bladder, sexual disorder, coital incontinence, stress urinary incontinence, quality of life     

Sexual function following pelvic floor surgery

OBJECTIVE: To prospectively evaluate sexual function in women who underwent surgery for incontinence and/or prolapse using the Pelvic Organ Prolapse-Urinary Incontinence Sexual Questionnaire (PISQ), and to provide a preliminary evaluation of the PISQ's psychometric properties for a population of women in the United Kingdom. METHODS: Women who underwent surgery for pelvic organ prolapse and/or urinary incontinence completed the PISQ, the Sheffield Prolapse Symptoms Questionnaire, and the King's Health Questionnaire preoperatively and 4 months postoperatively. Rates of item completion were assessed to evaluate the performance of the PISQ, and Cronbach alpha values and item-total correlations were calculated for the full scale and each of the 3 domains (behavioral-emotive, physical, and partner-related). RESULTS: Thirty-five women responded to the questionnaire. Postoperatively an improvement was demonstrated for overall score (P=0.002), and for physical (P<0.001) and partner-related domains (P=0.004). CONCLUSION: Women reported a significant improvement in sexual function 4 months after surgery for incontinence and prolapse.     

Validation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in a Turkish population

Objective

To validate the Turkish translated version of short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12).

Study design

After the test–retest reliability and internal consistency were established in a pilot study, 270 patients were enrolled and general and subscale scores of the questionnaire were calculated. All participants underwent the International Continence Society (ICS) prolapse score (POP-Q) and urodynamic assessment. Main scores and scores of Prolapse Quality of Life questionnaire (PQoL) and Incontinence Impact Questionnaire (IIQ-7) were compared between patients with incontinence ± prolapse and asymptomatic women.

Results

62.24% of the participants showed urodynamic abnormality and/or leakage with or without prolapse. 28.91% had prolapse stage 3 or higher diagnosed by the POP-Q system. PISQ-12 showed a high internal consistency (Cronbach's alpha was 0.89). For test–retest reliability Spearman's rho was 0.72–0.79 for all domains. The mean scores of PISQ-12 were significantly better in asymptomatic women compared with the incontinence ± prolapse group. Sexual function was negatively affected by prolapse and/or incontinence as assessed with PQoL and IIQ-7 questionnaires.

Conclusion

The Turkish translated version of the PISQ-12 is a reliable, consistent and valid instrument to evaluate sexual functioning in women with urinary incontinence and/or pelvic organ prolapse. It is easy to understand that it may be easily administered and self-completed by the women.     

Sexual function in women with urinary incontinence and pelvic organ prolapse

OBJECTIVE: To compare sexual function in women with urinary incontinence and pelvic organ prolapse and to determine the effects of therapy on sexual function. METHODS: 343 community-dwelling women older than 45 years with urinary incontinence or advanced prolapse were recruited into a multi-armed clinical trial. Women with incontinence were stratified to receive estrogen therapy, behavioral therapy, or surgical therapy. Women with prolapse were enrolled in a randomized surgical trial. All women completed a standardized urogynecologic evaluation and a sexual function questionnaire at baseline and after therapy. RESULTS: Women with prolapse or detrusor instability were more likely to cite pelvic floor symptoms as a reason for sexual inactivity than were women with other conditions. One third of patients with prolapse reported that their pelvic floor condition affected their ability to have sexual relations "moderately" or "greatly" significantly more than did other groups. Patients with genuine stress incontinence who underwent surgical or behavioral therapy were less likely to report being worried about urine leakage during intercourse after therapy than at baseline. After surgery, women with prolapse were less likely to report that their symptoms affected their ability to have sexual relations compared with baseline. Overall sexual satisfaction was the same at baseline and remained unchanged in all therapeutic groups at 6 months. CONCLUSION: Prolapse is more likely than urinary incontinence to result in sexual inactivity and to be perceived as affecting sexual relations. However, overall sexual satisfaction appears to be independent of diagnosis of or therapy for urinary incontinence or prolapse.     

Effects of bariatric surgery on pelvic floor disorders in obese women: a meta-analysis

Purpose

Obesity is an established risk factor for pelvic floor disorders (PFD) but the effects of bariatric surgery on PFD are uncertain. This meta-analysis was conducted to evaluate the effects of bariatric surgery on PFD in obese women.

Methods

A systematic search of PubMed, Cochrane Library, CNKI and CBM databases up to October 2016 was performed, and studies reporting pre-operative and post-operative outcomes in obese women undergoing bariatric surgery were included. The Pelvic Floor Distress Inventory (PFDI-20), the Pelvic Floor Incontinence Questionnaire (PFIQ-7), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, Female Sexual Function Index and the International Consultation on Incontinence Questionnaire-Urinary Incontinence short form score were used for evaluating pelvic floor dysfunction after bariatric surgery.

Results

Eleven cohort studies were finally included. Pooled results revealed that bariatric surgery was associated with a significant improvement in PFD for obese women on the whole [PFDI-20: SMD = 0.89, 95% CI (0.44, 1.34), P < 0.001; PFIQ-7: SMD = 1.23, 95% CI (0.17, 2.29), P = 0.023]. In the subscale analysis, there was significant improvement in urinary incontinence and pelvic organ prolapse. However, no significant improvement was found in fecal incontinence and sexual function.

Conclusions

Bariatric surgery is associated with significant improvement in urinary incontinence, and has a benefit on pelvic organ prolapse for obese women. However, there is no significant improvement in fecal incontinence and sexual function. Further multi-center, large-scale and longer-term randomized controlled trials are needed to confirm these results.

     

Sexual function following trocar-guided mesh or vaginal native tissue repair in recurrent prolapse: a randomized controlled trial

IntroductionSurgical treatment of pelvic organ prolapse (POP) affects sexual function. Generally, this results in improved sexual function, but deterioration is reported also.AimThe purpose of this study was to evaluate and compare sexual function in patients with recurrent POP undergoing either a vaginal surgical repair with native tissue or a trocar‐guided mesh insertion.MethodsSexually active patients randomly assigned to either native tissue repair or trocar‐guided mesh insertion, which had completed the pelvic organ prolapse (POP)/urinary incontinence sexual questionnaire (PISQ‐12) both at baseline and at 12 months, were included. Total, subscale, and individual question analysis were performed. Logistic regression was used to identify factors that were independently associated with improvement/deterioration in total PISQ‐12 scores.Main Outcome MeasuresPrimary outcome was sexual function at 12 months following surgery, measured by the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ‐12). Secondary outcomes were the identification of factors independently associated with change in PISQ‐12 scores and changes in individual PISQ‐12 question scores.ResultsSixty patients were included; 32 in the mesh arm and 28 in the native tissue arm. At 12 months, PISQ‐12 scores were not different in both treatment arms (34.3, standard deviation [SD] 6.7 vs. 34.7, SD 5.7), but improvement was detected in the native tissue arm, whereas PISQ‐12 total score remained unchanged in the mesh arm. Deteriorations were observed in the behavioral/emotive subscale and partner‐related items in the mesh arm. In the native tissue arm, significant improvements in the physical and partner‐related subscales were observed. The presence of mesh exposure was independently associated with deterioration in total PISQ‐12 score.ConclusionAt 12 months, PISQ‐12 scores were not different in either treatment arm, but were affected differently by trocar‐guided mesh insertion or by native tissue repair. Mesh exposure was independently associated with deterioration in sexual function. Milani AL, Withagen MIJ, The HS, Nedelcu‐van der Wijk I, and Vierhout ME. Sexual function following trocar‐guided mesh or vaginal native tissue repair in recurrent prolapse: A randomized controlled trial. J Sex Med 2011;8:2944–2953.     

Assessment of the Psychometric Properties of the Short‐Form Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12) following Surgical Placement of Prolift+M: A Transvaginal Partially Absorbable Mesh System for the Treatment of Pelvic Organ Prolapse

IntroductionImpairment of sexual function is a significant problem among women suffering from pelvic organ prolapse (POP). Because anatomical measures of POP do not always correspond with patients' subjective reports of their condition, patient‐reported outcome measures may provide additional valuable information regarding the experiences of women who have undergone surgery. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12) is a validated, widely used condition‐specific questionnaire focused on sexual function among patients with POP or urinary incontinence.AimThis study aims to report sexual function outcomes as measured by PISQ‐12 and to evaluate the psychometric characteristics of the questionnaire following surgical mesh implant for the treatment of POP.Main Outcome MeasuresThe PISQ‐12 was used to measure sexual function, while a set of other measures, namely, Pelvic Organ Prolapse Quantification, Patient Global Impression of Change, Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and Surgical Satisfaction Questionnaire, was used for validation.MethodsData for the study were collected from a prospective multicenter, single‐arm study of surgical POP repair via the transvaginal placement of a partially absorbable mesh system. For baseline, month 3, and month 12 following POP surgery, several psychometric properties of the PISQ‐12 were evaluated, including internal consistency (Cronbach's alpha), concurrent validity, discriminant validity, and responsiveness.ResultsAs measured by the PISQ‐12 questionnaire, statistically significant improvements were observed in the composite summary score as well as all three subscale scores at 1 year. The PISQ‐12 generally demonstrated good psychometric properties including internal consistency reliability, validity, and responsiveness. The PISQ‐12 items had good distributional properties at baseline, with substantial ceiling effects at follow‐up visits reflecting improvements experienced by the patients.ConclusionThe PISQ‐12 is a valid measure of sexual function in studies involving patients with POP. Roy S, Mohandas A, Coyne K, Gelhorn H, Gauld J, Sikirica V, and Milani AL. Assessment of the psychometric properties of the short‐form prolapse/urinary incontinence sexual questionnaire (PISQ‐12) following surgical placement of prolift+M: A transvaginal partially absorbable mesh system for the treatment of pelvic organ prolapse. J Sex Med 12;9:1190–1199.     

Predictors of Improvement in Sexual Function of Women with Urinary Incontinence After Treatment with Pelvic Floor Exercises: A Secondary Analysis

IntroductionWomen with urinary incontinence (UI) frequently present with complaints of sexual problems.AimTo 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.MethodsThis 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 MeasureSexual 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.ResultsThe 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 (R² = 0.497).ConclusionPFME was more beneficial with regard to sexual function in those women who presented with sexual dysfunction at baseline. Sacomori C and Cardoso FL. Predictors of improvement in sexual function of women with urinary incontinence after treatment with pelvic floor exercises: A secondary analysis. J Sex Med 2015;12:746–755.     

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

IntroductionPrior 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.     

The relationship of vaginal prolapse severity to symptoms and quality of life

OBJECTIVE: To assess the relationship and location of vaginal prolapse severity to symptoms and quality of life. DESIGN: A prospective observational study. SETTING: Urogynaecology Unit, Imperial College, St Mary's Hospital, London. POPULATION: Women with and without symptoms of vaginal prolapse. METHODS: All women completed a validated Prolapse Quality of Life (P-QOL) questionnaire. This included a urinary, bowel and sexual symptom questionnaire. All women were examined using the Pelvic Organ Prolapse Quantification system (POP-Q). POP-Q scores in those with and without prolapse symptoms were compared. Urinary and bowel symptoms and sexual function were compared and related to prolapse severity and location. MAIN OUTCOME MEASURES: POP-Q scores, P-QOL scores, urinary and bowel symptoms and sexual function. RESULTS: Three hundred and fifty-five women were recruited-233 symptomatic and 122 asymptomatic of prolapse. The median P-QOL domain scores ranged between 42-100 in symptomatic women and 0-25 in those who were asymptomatic. The stage of prolapse was significantly higher in those symptomatic of prolapse (P < 0.001) except for perineal body (PB) measurement. Urinary symptoms were not correlated with uterovaginal prolapse severity whereas bowel symptoms were strongly associated with posterior vaginal wall prolapse. Cervical descent was found to have a relationship with sexual dysfunction symptoms. CONCLUSIONS: Women who present with symptoms specific to pelvic organ prolapse demonstrate greater degrees of pelvic relaxation than women who present without symptoms. Prolapse severity and quality of life scores are significantly different in those women symptomatic of prolapse. There was a stronger relationship between posterior prolapse and bowel symptoms than anterior prolapse and urinary symptoms. Sexual dysfunction was related to cervical descent.     

Sexual function and pelvic floor disorders

Sexual wellbeing is an important aspect of women's health. Female sexual dysfunction is multifactorial and involves physical, social and psychological dimensions. Dysfunction may result from lack of sexual desire, sexual pain or arousal, and orgasmic problems. Sexual dysfunction is common and increases with age and pelvic floor disorders such as urinary incontinence and pelvic organ prolapse. Surgical treatment of pelvic floor disorders has been poorly studied but has the potential to improve sexual satisfaction or to cause sexual difficulties. New instruments such as condition-specific sexual questionnaires have recently been developed and will help us to better evaluate the results of incontinence and prolapse surgery on sexual function.     

Sexual Activity After Bariatric Surgery: A Prospective Monocentric Study Using the PISQ-IR Questionnaire

IntroductionObesity can lead to pelvic floor disorders, interfering with women’s sexual life; Prolapse/Incontinence Sexual Questionnaire-International Urogynecology Association–Revised (PISQ-IR) is a new instrument to measure sexual life in women with pelvic floor disorders.AimsTo assess the utility of using PISQ-IR in morbidly obese women undergoing bariatric surgery and to show the improvement of bariatric surgery on sexuality.MethodsThis prospective monocentric study included all women who underwent bariatric surgery from June 2016–May 2017. Sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) was performed by 1 surgeon, and data were collected by 1 researcher. Demographics, medical history, number of deliveries, and type of bariatric surgery (SG or RYGB) were collected at baseline. At the 1-year follow-up consultation, postoperative complications, percentage of total body weight loss (TWL) and percentage excess weight loss were assessed. Questionnaires were given at baseline and at 1-year follow-up.Main Outcome MeasuresPostoperative complications and total weight loss were measured at the 1-year follow-up. Sexual activity, using the PISQ-IR, and pelvic organ prolapse, urinary incontinence, and anal incontinence, using the urinary symptom profile and PFDI (Pelvic Floor Distress Inventory) 20, were compared before surgery and at 1-year follow-up.Results72 patients were included at baseline, 54 (75%) were considered for final analysis (30 RYGB and 24 SG), and 51 patients were considered for PISQ-IR. The mean preoperative body mass index was 41 ± 5.4 kg/m², and mean age was 43 ± 11.8 years. Both procedures induced an important weight loss (mean TWL of 33%) and had a similar percentage of TWL for each procedure: 31 (15–46) for SG vs 34 (9–51) for RYGB. 9 patients (17 [6%]) became sexually active 1 year after surgery. For the sexually inactive population after 1 year, there was no differences in the PISQ-IR in the follow-up. When body mass index loss was >13 kg/m², a higher percentage of the sexually active population improved their different scores, and there were significant results for both global quality of life and desire (P = .026 and .046). The other questionnaires showed a significant decrease in urinary incontinence symptoms (P < .001) associated with weight loss, whereas there was no difference in terms of pelvic organ prolapse or anal incontinence.ConclusionPISQ-IR is a useful instrument to measure sexual function regarding pelvic floor disorders. Bariatric surgery improves sexual activity in obese women 1 year after surgery.Treacy PJ, Mazoyer C, Falagario U, et al. Sexual Activity After Bariatric Surgery: A Prospective Monocentric Study Using the PISQ-IR Questionnaire. J Sex Med 2019;16:1930–1937.     

Continuing Medical Education: Urogenital Complaints and Female Sexual Dysfunction (Part 2) (CME)

IntroductionFemale sexual dysfunction (FSD) is common in women with urogenital disorders that occur as a result of pelvic floor muscle and fascial laxity.AimProvide 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.MethodsSystematic search of the medical literature using a number of related terms including FSD, POP, SUI, surgical repair, graft augmentation, complications, and dyspareunia.Main Outcome MeasuresReview 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.ResultsFSD 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.ConclusionsSexual 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. Wehbe SA, Kellogg S, and Whitmore K. Urogenital complaints and female sexual dysfunction (part 2).     

Collagen content of nonsupport tissue in pelvic organ prolapse and stress urinary incontinence

OBJECTIVE: Reduction in the collagen content of the pelvic floor tissue of the patients with pelvic organ prolapse and/or stress urinary incontinence has been documented previously. However, this is less clear for nonsupport tissue. We aimed to compare the collagen content of the uterine cervix, a nonsupport tissue, of women who had pelvic organ prolapse with and without stress urinary incontinence against those without these problems. STUDY DESIGN: Cervical collagen content was compared between 14 women who had pelvic organ prolapse with and without stress urinary incontinence and 17 controls without these conditions. Specimens were obtained after surgery for benign gynecologic conditions. RESULTS: Groups were similar with respect to age, parity, body mass index, and tobacco use. Women who had pelvic organ prolapse with and without stress urinary incontinence possessed significantly less collagen compared with the controls (8.10%+/-3.43% vs 12.35%+/-4.72%, P=.0104). Furthermore age, parity, body mass index, or tobacco use had no significant relationship to collagen content. CONCLUSION: Cervical collagen content is significantly decreased in women who have pelvic organ prolapse with and without stress urinary incontinence regardless of age, parity, body mass index, or tobacco use.     

北京郊区女性尿失禁及盆腔脏器脱垂发病情况及其对生活质量影响的抽样调查

目的 调查北京郊区女性尿失禁及盆腔器官脱垂发病情况及其对生活质量的影响。方法 按照整群抽样的方法，选取生活在北京市房山区某自然村18岁以上的常住已婚女性，进行问卷调查，并行妇科检查和B超检查。结果 全村符合调查的女性202人，回收问卷190份，应答率94．1％。调查结果显示，尿失禁的患病率为67例（35．3％）。子宫脱垂49例（25．8％），阴道前壁膨出79例（41．6％），阴道后壁膨出61例（32．1％）。尿失禁对女性日常生活、情绪和性生活的影响率分别为29．9％、23．9％、29．9％，尿失禁以轻度尿失禁为主（占82．1％），尿失禁合并子宫脱垂占31．3％，合并阴道前壁膨出59．7％，合并阴道后壁膨出44．8％。结论 整群抽样调查显示，北京郊区女性尿失禁及盆腔脏器脱垂均较常见，尿失禁患者多合并盆腔脏器脱垂，尤其是阴道前壁膨出，并对生活质量有较大影响。     

Anal sphincter injury in women with pelvic floor disorders

OBJECTIVE: 1) To estimate the rate of anal incontinence and anal sphincter injury in a group of women with pelvic floor disorders; 2) to evaluate the relationship between anal incontinence and anal sphincter injury as demonstrated by endoanal ultrasonography; 3) to explore any associations between operative vaginal delivery and anal sphincter injury in this population. METHODS: A cohort of 100 women with stage II or greater pelvic organ prolapse and/or urinary incontinence completed the Rockwood-Thompson Fecal Incontinence Severity Index Questionnaire (FISI). Pelvic organ prolapse was recorded using the Pelvic Organ Prolapse Quantification system. Multichannel cystometry and endoanal ultrasonography were performed. Categorical data were compared using the chi(2) statistic. The FISI scores were correlated with degree of anal sphincter injury using the Pearson correlation coefficient (r). RESULTS: Fifteen women with pelvic organ prolapse only, 28 with urinary incontinence only, and 57 with both were evaluated. Mean age (+/- standard deviation) and body mass index were 57.1 +/- 13.2 years and 29.8 +/- 6.8 kg/m(2), respectively. Median parity was 3. Fifty-four percent of those studied had anal incontinence, and 52% had anal sphincter defects. Anal incontinence was significantly associated with sphincter injury (odds ratio 36.4, 95% confidence interval 12-114, P <.001). The FISI scores were positively correlated with increasing degrees of anal sphincter disruption (r = 0.81, P <.001). A history of operative vaginal delivery was significantly associated with anal sphincter injury (P =.023). CONCLUSION: Anal incontinence and anal sphincter injury are common in women with other pelvic floor disorders and are significantly related. Operative vaginal delivery may contribute to unrecognized anal sphincter trauma in this population. LEVEL OF EVIDENCE: III     

Sexual Function is Related to Body Image Perception in Women with Pelvic Organ Prolapse

IntroductionA previous study demonstrated that women seeking treatment for advanced pelvic organ prolapsed (POP) reported decreased self-perceived body image and decreased quality of life.AimsTo determine the relationship between: (i) sexual function and POP, (ii) self-perceived body image and POP; and (iii) sexual function and self-perceived body image in women with prolapse.MethodsAfter IRB approval, consecutive women with POP stage II or greater presenting for urogynecologic care at one of eight academic medical centers in the United States were invited to participate. In addition to routine urogynecologic history and physical examination, including pelvic organ prolapse quantification (POPQ), consenting participants completed three validated questionnaires: Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) to assess sexual function; Modified Body Image Perception Scale (MBIS) to assess self-perceived body image; Prolapse subscale of Pelvic Floor Distress Inventory (POPDI-6) to assess condition specific bother from POP.Pearson's correlations were used to investigate the relationship between independent variables.Main Outcome MeasuresSexual function and modified body image score and its correlation with symptoms of POP.ResultsThree hundred eighty-four participants with a mean age of 62 ± 12 years were enrolled. Median POPQ stage was 3 (range 2–4). 62% (N = 241) were sexually active and 77% (N = 304) were post-menopausal. Mean PISQ-12, MBIS, and POPDI scores were (33 ± 7, 6 ± 5, 39 ± 23, respectively). PISQ-12 scores were not related to stage or compartment (anterior, apical, or posterior) of POP (P > 0.5). Worse sexual function (lower PSIQ-12 scores) correlated with lower body image perception (higher MBIS scores) (rho = ?0.39, P < 0001) and more bothersome POP (higher POPDI scores) (rho = ?0.34, P < 0001).ConclusionsSexual function is related to a woman's self-perceived body image and degree of bother from POP regardless of vaginal topography. Sexual function may be more related to a woman's perception of her body image than to actual topographical changes from POP. Lowenstein L, Gamble T, Deniseiko Sanses TV, van Raalte H, Carberry C, Jakus S, Kambiss S, McAchran S, Pham T, Aschkenazi S, Hoskey K, and Kenton K. Sexual function is related to body image perceptionin women with pelvic organ prolapse. J Sex Med 2009;6:2286–2291.