Cross-sectional study about sexual health of women attended in an urogynaecology unit of a tertiary university hospital started in 2022. The first consultation of women visited to assess and treat pelvic floor dysfunctions (urinary incontinence [IU], anal incontinence [IA], pelvic organ prolapsed [POP]) were selected consecutively. Exclusion criteria included women with language barriers, unable to understand questionnaires or who reject to fill-in the sexual questionnaire. The study was approved by the Ethics Committee and written informed consent was obtained from all the participants.
Women attended in our urogynaecology unit, follow a standardized health care procedure: a first telematic visit performed by the urogynaecologist and, afterwards, a “pack LUTS” presential appointment which involve 2 visits (urogynaecologist and urogynaecology specialized nurse) and 2 test (urodynamics and pelvic floor ultrasound) scheduled the same day.
Women reported demographical data and 4 Spanish validated questionnaires. To evaluated urinary, anal and prolapse symptoms we used: the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF) which evaluates frequency, severity and impact on quality of life, range 0-21 (no UI = 0; mild UI = 1-5, moderate UI = 6-12, severe UI = 13-18, more severe UI = 19-21). Moreover, it includes 8 questions regarding the type of UI (just descriptive data, no scoring). The Bladder Control Self-Assessment Questionnaire (B-SAQ) has 8 items to assess symptoms of urgency, frequency, nocturia and UI and the associated bother, based on a 4-points Likert-scale: 0 (not at all), 1 (a little), 2 (moderately), 3 (a great deal), range 0-12 (REF). The Pelvic Floor Distress Inventory-20 (PFDI-20) involves 3 subscales: Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6), Colorectal Anal Distress Inventory 8 (CRADI-8) and Urinary Distress Inventory 6 (UDI 6) is 100, range 0-100 (each subscale) or 0-300 (overall). Based on reported symptoms, we performed a pelvic floor dysfunction clinical diagnosis: 1) IU: ICIQ>0 + BSAQ Q4 symptoms>0 + PFDI-20 Q16 o Q17>0; 2) POP: PFDI-20 Q3>0; 3) IA: PFDI-20 Q9 o Q10 o Q11 >0. To evaluate sexual activity and function we used: the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire IUGA Revised (PISQ-IR), a condition-specific questionnaire for assessing sexuality in both sexually active (SA) and non-sexually active (NSA) patients according to Q1. It includes 14 items (6 subscales) addressed to SA patients and 5 items (4 subscales) for NSA. The scores were calculated with the mean calculation method. Higher scores in SA patients indicate better sexual function, while in NSA patients, these indicate a greater impact on sexual function. Global sexual function was analyzed according to the single summary score of PISQ-IR only available for SA women. We considered dyspareunia for both SA and NSA women: when the SA patient reported sometimes, usually or always to Q11 or coital activity avoidance due to pain, and when NSA women reported pain as a cause of inactivity (Q2e). We considered satisfactory sexual life the answer “1” or “2” to the Q4a (NSA) or Q19a (SA).
At the presential appointment a systematic pelvic examination was performed to all the participants. In the present study we exclusively analyzed: the stage of POP based on POPQ and the pelvic floor muscle function based on the modified Oxford-scale.
Data analysis:
All analyses were performed using the IBM SPSS Statistics 23.0 software (IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.) Data were summarized as frequency and percentage for categorical variables and mean and standard deviation (SD) for quantitative ones. Chi-squared test and Student’s t test were used for comparisons. The statistical significance level was established at p-value<0.05.