Sexuality of Female Spina Bifida Patients: Predictors of a Satisfactory Sexual Function

Motta, Guilherme Lang; Bujons, Anna; Quiróz, Yesica; Llorens, Erika; Zancan, Maira; Rosito, Tiago Elias

doi:10.1055/s-0041-1732464

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev. Bras. Ginecol. Obstet. 43 (06) • June 2021 • https://doi.org/10.1055/s-0041-1732464 copy

Sexuality of Female Spina Bifida Patients: Predictors of a Satisfactory Sexual Function

Sexualidade feminina em pacientes com espinha bífida: preditores de uma função sexual satisfatória

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To assess the sexual function of women with spina bifida (SB), and to verify the factors that influence their sexual function.

Methods

A cross-sectional study in which a validated female-specific questionnaire was applied to 140 SB female patients from four different cities (Porto Alegre, Brazil; and Barcelona, Madrid, and Málaga, Spain) between 2019 and 2020. The questionnaires collected data on the clinical characteristics of SB, and female sexual function was assessed using the 6-item version of the Female Sexual Function Index (FSFI-6) validated to Portuguese and Spanish.

Results

Half of the patients had had sexual activity at least once in the life, but most (57.1%) did not use any contraception method. Sexual dysfunction was present in most (84.3%) patients, and all sexual function domains were impaired compared those of non-neurogenic women. The presence of urinary and fecal incontinence significantly affected the quality of their sexual activity based on the FSFI-6.

Conclusion

The specific clinical aspects of the SB patients, such as urinary and fecal incontinence, should be properly addressed by their doctors, since they are associated with reduced sexual activity and lower FSFI-6 scores in the overall or specific domains. There is also a need to improve gynecological care among sexually-active SB patients, since most do not use any contraceptive methods and are at risk of inadvertent pregnancy.

Keywords:
sexuality; spina bifida; sexual dysfunction; urinary incontinence; myelomeningocele

Characteristic	n (%)
Gynecological examination
Irregular visits	95(67.9)
Regular visits	25(17.9)
Has never undergone a gynecological examination	20(14.3)
Sexual activity
No	70(50)
Yes	70(50)
Contraceptive method ^a,b
No	40(57.1)
Yes	30(42.9)
Pregnancy
No	134(95.7)
Yes	6(4.3)
Sexual dysfunction ^a
No	11(15.7)
Yes	59(84.3)

	Sexual activityn = 140		Sexual dysfunction*n = 70
	No	Yes	No	Yes
Body mass index (Kg/m²)
≤ 20	4(50)	4(50)	3(75)	1(25%)
20–25	18(41.9)	25(58.1)	1(4)	24(96%)
25–30	35(52.2)	32 (47.8)	6(18.8)	26(81.2%)
≥ 30	13(59.1)	9(40.9)	1(11.1)	8(88.9)
p-value	0.572^a		0.004^b
Myelomeningocele	64(50)	64 (50)	11(17.2)	53(82.8)
Meningocele/Others (includes spina bifida occulta)	6(50)	6(50)	0(0)	6(100)
p-value	1^a		0.580^b
Spinal cord level
Lumbar or lumbosacral	64(50)	64(50)	10(15.6)	54(84.4)
Thoracic or Thoracolumbar	6(50)	6(50)	1(16.7)	5(83.3)
p-value	1^a		1^b
Hydrocephalus
No	13(54.2)	11(45.8)	2(18.2)	9(81.8)
Yes	57(49.1)	59(50.9)	9(15.3)	50(84.7)
p-value	0.654^a		1^b
Deambulation
Deambulates	52(48.1)	56(51.9)	9(16.1)	47(83.9)
Wheelchair	18(56.3)	14(43.7)	2(14.3)	12(85.7)
p-value	0.421^a		1^b
Urinary incontinence
No	5(21.7)	18(78.3)	9(50)	9(50)
Yes	65(55.6)	52(44.4)	2(3.8)	50(96.2)
p-value	0.003^a		< 0.001^b
Fecal incontinence
No	23(46)	27(54)	7(25.9)	20(74.1)
Yes	47(52.2)	43(47.8)	4(9.3)	39(90.7)
p-value	0.480^a		0.092^b
Psychological disorder
No	59(50.4)	58(49.6)	8(13.8)	50(86.2)
Yes	11(47.8)	12(52.%)	3(25)	9(75)
p-value	0.820^a		0.386^b

	Desire	Arousal	Lubrication	Orgasm	Satisfaction	Pain	Overall
Type of lesion
Myelomeningocele	3(2–3)	2(1–3)	2(2–3)	2(1–3)	2(1–3)	4(3–4)	14.5(11.25–18)
Meningocele/Others (includes spina bifida occulta)	2(2–3)	2(1.75–3.25)	2(1.75–3.25)	2(1.75–3)	1.5(1–2.25)	4.5(3–5)	15.5(11.75–17.5)
p-value*	0.542	0.655	0.786	0.761	0.345	0.247	0.891
Spinal cord level
Lumbar or lumbosacral	3(2–3)	2(1–3)	2(2–3)	2(1–3)	2(1–3)	4(3–4)	15(11.25–18)
Thoracic or thoracolumbar	1.5(1–4)	2(2–3.5)	2(1–4)	2(2–2.5)	1(1–3.5)	4(3.75–5)	14.3(11.75–20.75)
p-value*	0.322	0.349	0.761	0.573	0.430	0.221	0.908
Hydrocephalus
No	2(1–3)	2(1–3)	2(2–3)	3(2–4)	1(1–2)	4(4–5)	15(12–18)
Yes	3(2–3)	2(1–3)	2(2–3)	1(1–3)	2(1–3)	4(3–4)	14(11–18)
p-value*	0.303	0.802	0.701	0.015	0.328	0.241	0.703
Deambulation
Deambulates	2.5(2–3)	2(1–3)	2(2–3)	2(1.25–3)	2(1–3)	4(3–4)	15(11.25–18)
Wheelchair	3(2–4)	2(0.75–3)	2.5(1.5–3)	1(0.75–2.25)	2(1–3.25)	4(2.25–4)	13.5(11.5–16.25)
p-value*	0.067	0.843	0.524	0.136	0.062	0.232	0.534
Urinary incontinence
No	3.5(3–4)	3(3–3.25)	4(3–4)	3(2–3)	3.5(3–4)	4(3–4)	19.5(18–23)
Yes	2(1.25–3)	2(1–2)	2(1.25–3)	2(1–3)	1.5(1–2)	4(3–4)	13(11–15.75)
p-value*	< 0.001	< 0.001	< 0.001	0.037	< 0.001	0.381	< 0.001
Fecal incontinence
No	3(2–4)	3(2–3)	3(2–4)	3(2–3)	3(2–4)	4(3–4)	18(13–21)
Yes	2(1–3)	2(1–2)	2(2–3)	2(1–2)	2(1–2)	4(3–5)	13(11–16)
p-value*	0.007	0.009	0.017	0.006	0.004	0.065	0.003
Psychological disorder
No	3(2–3)	2(1–3)	2(2–3)	2(1–3)	2(1–3)	4(3–4)	14.5(11.75–18)
Yes	3(2–3)	2(2–3)	2(2–3)	3(1.25–3)	2(1–3.75)	4(3–4.75)	15.5(11.5–21.75)
p-value*	0.802	0.374	0.866	0.194	0.903	0.993	0.547

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[1] Address for correspondence Guilherme Lang Motta, MD, MSc, PhD, Avenida Roraima 1000, 97105-900, Santa Maria, Rio Grande do Sul, RS, Brasil (e-mail: glangmotta@gmail.com).