Female Pelvic Medicine & Reconstructive Surgery:
Obstetrics & Gynecology, Duke University Medical Center, Durham, NC
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Nazema Siddiqui:Astellas USA Inc.:Research Grant:Principal Investigator (no salary support).
There are limited data regarding the effect of pelvic organ prolapse on sexual partners of patients. Our objective was to compare sexual function amongst patients with symptomatic prolapse and their partners.
MATERIALS AND METHODS:
This is a cross-sectional study in sexually active patients with symptomatic stage two or greater prolapse and their sexual partners. Women completed four validated questionnaires: 1) Index of Sexual Satisfaction (ISS), which can be used in both men and women, 2) Pelvic Organ Prolapse - Urinary Incontinence Sexual Function Questionnaire (PISQ), 3) Pelvic Floor Distress Inventory (PFDI-20), and 4) Pelvic Floor Impact Questionnaire (PFIQ-7). Sexual partners completed the ISS. Using the validated threshold of 30, ISS scores were dichotomized into good (0–30) and poor (31–100) sexual function. ISS scores were compared within couples using the intraclass correlation coefficient (ICC). In order to determine predictors for good versus poor sexual function, ISS scores were compared to baseline variables using chi-square, Fisher's exact, or Student's t-test, as appropriate.
A total of 41 couples were included. All were white, and all except two were married for more than five years. Men had a mean age of 59.4 ± 10.2 years with mean body mass index (BMI) of 29.2 ± 6.2. Women had a mean age of 57.7 ± 9.5 years with mean BMI of 27.7 ± 5.7, and median parity of two. For patients, 34% had undergone a prior hysterectomy, 7% had prior surgery for prolapse or incontinence, and 46% had advanced (stage 3 or 4) prolapse. Mean pelvic floor questionnaire scores were 90 ± 10 (PISQ), 100 ± 49 (PFDI), and 43 ± 50 (PFIQ). Based on the ISS threshold of 30, 26/41 (63%) of women and 34/41 (83%) of men reported good sexual function. ISS scores correlated poorly within couples, with a correlation coefficient of 0.32. None of the following factors were associated with good versus poor sexual function: age, parity, BMI, education, employment, Charlson Comorbidity Index, advanced prolapse, prior pelvic surgery, psychiatric medications, PFDI, and PFIQ scores. Women with good sexual function reported significantly higher PISQ scores compared to those with poor function (mean 93 ± 10 vs. 84 ± 8, P = 0.004). There were no differences in frequency of intercourse in women reporting good versus poor sexual function. However, men reporting poor sexual function were more likely to report having intercourse less than once per week (P = 0.05).
In this unique study of sexual partners, sexual function correlates poorly between women with prolapse and their partners. In women, poor sexual function correlates with lower PISQ scores while poor sexual function in men is associated with lower frequency of intercourse.