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Sexual Function Before and After Nonsurgical Treatment of Stress Urinary Incontinence

Handa, Victoria L. MD, MHS*; Whitcomb, Emily MD; Weidner, Alison C. MD; Nygaard, Ingrid MD§; Brubaker, Linda MD; Bradley, Catherine S. MD, MSCE; Paraiso, Marie Fidela R. MD#; Schaffer, Joseph MD**; Zyczynski, Halina M. MD††; Zhang, Min PhD‡‡; Richter, Holly E. PhD, MD§§for the Pelvic Floor Disorders Network

Female Pelvic Medicine & Reconstructive Surgery: January-February 2011 - Volume 17 - Issue 1 - p 30-35
doi: 10.1097/SPV.0b013e318205e263
Original Articles

Objectives: (1) To describe sexual function in women seeking treatment of stress urinary incontinence (SUI), (2) to compare the impact on sexual function of 3 SUI treatments, and (3) to investigate whether nonsurgical treatment of SUI is associated with improved sexual function.

Methods: Women with SUI were randomized to continence pessary, behavioral therapy (pelvic floor muscle training and continence strategies), or combination therapy. Sexual function was assessed at baseline and 3 months using short forms of the Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire and the Personal Experiences Questionnaire. Successful treatment of SUI was assessed with a patient global impression of improvement. Analysis of variance was used to compare scores between groups.

Results: At baseline, sexual function was worse among women with mixed incontinence compared with those with pure SUI. After therapy, successful treatment of SUI was associated with greater improvement in the Pelvic Organ Prolapse-Urinary Incontinence Sexual Function Questionnaire score (2.26 ± 3.24 vs 0.48 ± 3.76, P = 0.0007), greater improvement in incontinence with sexual activity (0.45 ± 0.84 vs 0.01 ± 0.71, P = 0.0002), and greater reduction in restriction in sexual activity related to fear of incontinence (0.32 ± 0.76 vs −0.06 ± 0.78, P = 0.0008). Among those successfully treated for SUI, improvement in continence during sexual activity was greater in both the combined therapy group (P = 0.019) and the behavioral group (P = 0.02) compared with the pessary group.

Conclusions: Successful nonsurgical treatment of SUI is associated with improvements in incontinence-specific measures of sexual function. Behavioral therapy may be preferred to pessary for treatment of SUI among women whose incontinence interferes with sexual function.

In a randomized trial of nonsurgical therapy for stress incontinence, women who experienced improvement in incontinence also experienced improvements in certain aspects of sexual function.

From the *Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD; †Department of Obstetrics and Gynecology, Kaiser Permanente San Diego Medical Center, San Diego, CA; ‡Department of Obstetrics and Gynecology, Duke University, Durham, NC; §University of Utah School of Medicine, Salt Lake City, UT; ∥Stritch School of Medicine. Loyola University Chicago, Maywood, IL; ¶Departments of Obstetrics and Gynecology and Epidemiology, University of Iowa, Iowa City, IA; #Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH; **Department of Ob/Gyn, University of Texas Southwestern Medical Center, Dallas, TX; ††Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA; ‡‡Department of Biostatistics, University of Michigan, Ann Arbor, MI; and §§Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL.

Reprints: Victoria L. Handa, MD, MHS, Department of Gynecology and Obstetrics, Johns Hopkins University, 4940 Eastern Ave, Baltimore, MD 21224. E-mail: Vhanda1@jhmi.edu.

Supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD045806, U10HD41261, U10 HD 41250, U10 HD54136, U10 HD41249, U10 HD41267, U10 HD41248, U10 HD41268, U10 HD41263, U10 HD54214, U10 HD54241, and U10 HD54215), the National Institute of Diabetes and Digestive and Kidney Diseases, and National Institutes of Health Office of Research on Women's Health.

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