The effect of suburethral sling on sexual functioning has been studied, but results on coital incontinence (CI) are still poor. Aim of this study was to prospectively evaluate the impact of surgical procedure of transobturator vaginal tape (TVT-O) implant on CI concomitant with stress urinary incontinence (SUI).

TVT-O was performed on sexually active women diagnosed with urodynamic (UD) SUI, who also experienced CI with penetration and/or orgasm. At baseline patients underwent to detailed history, vaginal inspection, UD, and VAS scale to assess the impact of CI on Quality of Life (QoL; 0= worse; 10= best). The patient-reported success rate on CI was assessed by the International Coital Incontinence- Questionnaire (IFCI-Q). To date, this is the only validated tool to assess CI. (1, 2) The changes of IFCI-Q scores before and after the surgery were compared. Patients underwent to 3 and 6 months follow- up with the ultrasound evaluation of post- void residual volume (PVR), the IFCI-Q and VAS scale.  Objective success was defined by a negative stress test in cline and orthostatism with a 200 and 300 ml of bladder filling. Patients with pelvic organ prolapse >=2, OAB symptoms, intrinsic sphincter deficiency, and neurogenic bladder were excluded. Paired t test was used to compare the pre- and post-operative questionnaire scores. The statistical analyses were performed with SPSS version 12.0 (SPSS, Chicago, IL, USA). P < .05 was considered to be statistically significant.

From January 2022 to January 2023, 37 women with UD SUI complaining of CI at baseline were enrolled. Mean (± SD) age was 52.8 ± 10.2 years. Patients underwent TVT-O procedure. At 6- month follow-up, success rate was 91.3%. All pre-operative sexually active women reported resumption of sexual activity after sling surgery. Comparison of pre- and post-operative IFCI scores revealed a significant improvement of the total IFCI score (p< 0.00). At baseline, 30/37 (81.1%) women complained of CI at penetration and 7/37 (18.9%) referred both types of CI (IFCI [mean ± SD]: 8.1 ± 0.8, moderate CI). According to the IFCI scores, at 3 and 6- month follow- up, a decrease in frequency of CI, has been demonstrated a decrease in frequency of CI, an improvement in quality of intercourse, and in the psychological status of patients (p< 0.00). The majority of the women (34/37, 91.89%) at 3 and 6- month follow- up reached the resolution of SUI and CI (IFCI score: 0), while the remaining (3/37, 8.1%) patients complaining of mild SUI and the persistence of CI at penetration, at 3 and 6- month follow-up (IFCI: 5.8±0.3, mild CI; p< 0.00).VAS score improved from 5.1 ± 0.7 to 7.6 ± 1.7 (p< 0.01). No statistical increase of PVR was observed at 3 and 6- month follow- up.

CI is an under-reported symptom causing embarrassment. Most questionnaires used in urology and urogynecology practices also do not comprehensively assess CI. For this reason, it is essential to use a validated questionnaire specific for CI, such as the IFCI-Q. To date this is the first study evaluating the efficacy of surgical procedure of TVT-O on CI, directly with a specific and standardized tool on CI. Our clinical results of success rate after TVT-O procedure are in line with literature. Treatment of CI provides women with better sexual arousal, increases women's' self-confidence with reference to their partner.

This study demonstrate that TVT-O procedure is an effective and secure treatment not only for SUI but also for CI. TVT-O procedure provides significant improvement in the sexual lives of women. This is the first time that CI has been evaluated before and after the surgery by a validated questionnaire specific to CI.

Gubbiotti M. Giannantoni A, Rubilotta E, et al. The International Female Coital Incontinence Questionnaire (IFCI-Q): Development, Validation and Reliability Study. J Sex Med. 2022 Jan;19(1):158-163
Mahfouz W, Moussa A, Serati M, et al. Linguistic translation and validation of the Arabic version of International Female Coital Incontinence Questionnaire (IFCI-Q). Arab J Urol . 2023 Aug 1;22(1):48-53.