Female Pelvic Medicine & Reconstructive Surgery:
Rutledge, T. L.; Heckman, S.; Muller, C.; Rogers, R. G.
OB/GYN, University of New Mexico, Albuquerque, NM
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: None.
Our objectives were to: 1) To assess the prevalence of and bother caused by pelvic floor disorders in gynecologic cancer survivors and compare this to women who are cancer-free. 2) To assess sexual activity and function in gynecologic cancer survivors and compare this to women who are cancer-free.
MATERIALS AND METHODS:
We surveyed gynecologic cancer survivors (survivors) and cancer free women presenting for routine gynecologic care (GYN) over the age of 30. All survivors were disease and treatment-free for ≥one year. Patient characteristics, past medical, cancer treatment and surgery history were collected. UI was assessed using the Sandvik Incontinence severity index with a score >3 indicating moderate to severe UI, AI was assessed with the Wexner scale with a score ≥0 indicating AI, POP was assessed with Question #35 from the Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ), with an affirmative answer indicating POP. Sexual function was assessed using the Pelvic Organ Prolapse/Urinary Incontinence Sexual questionnaire (PISQ-12). Two hundred and fifty survivors and 100 gynecologic patients were required to detect a 20% difference in rates of urinary incontinence between groups with an alpha error of 0.05 and a beta of 80%. Student's t and Fisher's exact tests were used to compare groups. Multivariable logistic regression analysis was used to control for confounding.
One hundred and seven GYN and 225 survivor questionnaires were completed. Survivors were older (57 +/− 10 vs 47 +/− 12 years, P < 0.001) and more likely to have had a hysterectomy (87 vs 26%, P < 0.001) and oophorectomy (81vs 14%, P < 0.001). Survivors were also more likely to be in a committed relationship (47 vs 34%, P = 0.03). Parity was similar between GYN and the survivor groups with a mean number of children in both groups of 2. All differences were controlled for in multivariable analyses. A high prevalence of PFDs was observed in both groups; 56% of controls and 70% of survivors reported moderate to severe UI, and 13 vs 9% reported prolapse symptoms (both p > 0.05). Survivors were more likely to report anal incontinence than GYN patients (42 vs. 32%, P = .02). Survivors were not less likely to be sexually active than GYN patients (70 vs 45%, P = .06) although survivors reported less desire (79 vs 57%, P = .04, always, usually or sometimes feels sexual desire) more infrequent ability to climax (80 vs 59%, P = .04 always, usually or sometimes climaxes with sexual activity) and less satisfaction with their variety of sexual activity (82 vs 60%, P = .02 always, usually or sometimes feels satisfied) despite no differences in rates of dyspareunia (18 vs 12%, p > 0.05).
Gynecologic cancer survivors report similar high rates of urinary incontinence when compared to GYN patients. Fecal incontinence occurred more commonly in gynecologic cancer survivors than in GYN controls. Sexual dysfunction is more common among gynecologic cancer survivors than GYN patients; survivors report less sexual desire, less ability to climax, and lower sexual satisfaction, even when controlling for baseline patient differences.