THE IMPACT OF URINARY INCONTINENCE ON SEXUAL FUNCTION

S.M. Botros, Y. Abramov, J.J. Miller, P.K. Sand, A. Nickolov, S. Gandhi, R.P. Goldberg

Evanston Continence Center, Evanston, IL; Northwestern University, Feinberg School of Medicine, Chicago, IL

OBJECTIVE:  Previous studies have investigated the effect of stress and urge urinary incontinence on sexual function with conflicting results.  We sought to evaluate the effects of urinary incontinence on sexual function based on an identical twin sister study design controlling for genetic differences.

MATERIALS AND METHODS:  A comprehensive survey consisting of demographic, historical, symptomatic assessment with Likert scales as well as several quality of life questionnaires including the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), Pelvic Floor Distress Inventory (PFDI) and the short form of the Incontinence Impact Questionnaire (IIQ-7) was administered to 576 twin sisters.  276 sexually active, identical twin sisters were analyzed using demographic, environmental, historical and symptom assessment for effect on PISQ-12 scores. We utilized bivariate regression models to account for correlated data within twin pairs.  All analyses were performed in SAS. 

RESULTS: Mean (SD) of PISQ-12 scores was 99.3(11.7).  Mean (SD) of age was 44.7 (11.7).  Median (range) of parity was 2 (0-5) and mean (SD) of BMI was 25.3 (5.3).  91% were Caucasian, 7% were African American, and 37% were menopausal. 52% reported SUI and 33% reported UUI.  UDI-6 and IIQ-7 scores correlated with degree of urinary incontinence symptom bother and Likert scale assessment in a prior analysis.  The univariate analysis revealed that parity (mean score difference -7.2 for 1 birth and -5.8 for >=2 births, 0 births is baseline, p<0.001), age >= 50(-5.4, p=0.002), menopause (-4.6, p=0.006), history of stress (-3.3, p=0.022) or urge (-5.9, p<0.001) incontinence, > 5 episodes of leakage/week  for UUI (-14.9, p=0.039), and fecal incontinence (-5.7, p=0.048) all significantly decreased PISQ-12 scores.  Prior hysterectomy, whether or not incontinence was bothersome and > 5 episodes of leakage/week for SUI were not associated with a significant decrease in PISQ-12 scores. The multivariate analysis revealed that a history of urge urinary incontinence (p=0.009) or parity (p=0.006 for 1 birth, p=0.001 for >=2 births, 0 births is baseline) significantly decreased sexual function scores.

CONCLUSIONS:  This study indicates that along with parity, urge urinary incontinence may be the most significant urogynecologic symptom to negatively affect sexual function.  Further studies evaluating the effects of urge urinary incontinence on sexual function need to be performed.

Disclosure - Consultant: R. Goldberg, Watson; Speakers Bureau: P.K. Sand, Alza/Ortho-McNeil, Watson, American Medical Systems; Advisory Board: P.K. Sand, Alza/Ortho-McNeil, Watson, American Medical Systems, Indevus, Yamanouchi, Roche, Pfizer, Bioform, Lilly, Boeringer-Ingelheim, Mentor, Novasys; Grant/Research: P.K. Sand, Alza/Ortho-McNeil, Watson, American Medical Systems, Indevus, Yamanouchi, Roche, Pfizer, Bioform, Lilly, Boeringer-Ingelheim, Mentor, Novasys.