Factors Associated with Sexual Activity for Women with Pelvic Floor Dysfunction - A Cross-Sectional Study

Macêdo, Sandra Rebouças; Vasconcelos Neto, José Ananias; Tamanini, José Tadeu Nunes; Bezerra, Leonardo; Castro, Rodrigo Aquino

doi:10.1055/s-0040-1713805

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article, Sexuality • Rev. Bras. Ginecol. Obstet. 42 (08) • Aug 2020 • https://doi.org/10.1055/s-0040-1713805 copy

Factors Associated with Sexual Activity for Women with Pelvic Floor Dysfunction - A Cross-Sectional Study

Fatores associados à atividade sexual de mulheres com distúrbios do assoalho pélvico - Um estudo transversal

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To examine women with pelvic floor dysfunction (PFDs) and identify factors associated with sexual activity (SA) status that impacts quality of life (QoL).

Methods

We conducted a cross-sectional study that includedwomen> 18 years old who presented with at least one PFD symptom (urinary incontinence [UI] and/or pelvic organ prolapse [POP]), in outpatient clinics specializing in urogynecology and PFD in Fortaleza, state of Ceará, Brazil, using a service evaluation form and QoL questionnaires.

Results

The analysis of 659 women with PFD included 286 SA (43.4%) women and 373 non-sexually active (NSA) (56.6%) women, with a mean age of 54.7 (±12) years old. The results revealed that age (odds ratio [OR]= 1.07, 95% confidence interval [CI] 1.03-1.12) and post-menopausal status (OR= 2.28, 95% CI 1.08-4.8) were negatively associated with SA. Being married (OR= 0.43, 95% CI 0.21-0.88) was associated with SA. Pelvic organ prolapse (OR= 1.16, 95% CI 0.81-1.68) and UI (OR= 0.17, 95% CI 0.08-0.36) did not prevent SA. SF-36 Health Survey results indicated that only the domain functional capacity was significantly worse in NSA women (p= 0.012). Two King’s Health Questionnaire domains in NSA women, impact of UI (p= 0.005) and personal relationships (p< 0.001), were significantly associated factors. Data from the Prolapse Quality-of-life Questionnaire indicated that NSA women exhibited compromised QoL.

Conclusion

Postmenopausal status and age negatively affected SA. Being married facilitated SA. Presence of POP and UI did not affect SA. However, NSAwomen with POP exhibited compromised QoL.

Keywords:
sexual activity; pelvic floor dysfunction; urinary incontinence; pelvic organ prolapsed

Demographic and clinical characteristics of patients	Sexually active	Non-sexually active	p-value
Age (Md ± SD) (n = 642)	47 ± 9	61 ± 12	< 0.00^aa aa Mann-Whitney U test.
Marital status, n (%) (n = 627)			< 0.00^bb bb Pearson's Chi-square test.
Single	37 (38.1)	60 (61.9)
Married	215 (57.5)	159 (42.5)
Divorced	22 (35.5)	40 (64.5)
Widowed	9 (9.6)	85 (90.4)
Education^b b Years of study. (Md ± SD) (n = 608)	7 ± 4	6 ± 4	< 0.00^aa aa Mann-Whitney U test.
Family income (Md ± SD) (n = 519)	1.243 ± 812	1.293 ± 1365	0. 045^aa aa Mann-Whitney U test.
Number of deliveries (Md ± SD) (n = 647)	3 ± 2	5 ± 4^a	< 0.001^aa aa Mann-Whitney U test.
Diabetes, n (%) (n = 659)			0.967^aa aa Mann-Whitney U test.
No	280 (43.4)	365 (56.5)
Yes	6 (42.9)	8 (57.1)
SAH, n (%) (n = 659)			0.021^aa aa Mann-Whitney U test.
No	257 (45.2)	312 (54.8)
Yes	29 (32.2)	61 (67.8)
Obesity, n (%) (n = 659)			0.004^aa aa Mann-Whitney U test.
No	251 (41.7)	351 (58.3)
Yes	35 (61.4)	22 (38.6)
BMI (Md ± SD) (n = 491)	29.5 ± 4.9	28.3 ± 5.1^c	0.007^bb bb Pearson's Chi-square test.
Menopause, n (%) (n = 564)			< 0.001^aa aa Mann-Whitney U test.
No	100 (66.1)	82 (33,9)
Yes	82 (23.4)	268 (76.5)
Do not know (Hysterectomized)	17 (53.1)	15 (46.9)
Smoking, n (%) (n = 636)			0.003^aa aa Mann-Whitney U test.
Never smoked	174 (46.9)	197 (53.1)
Previously smoked	67 (32.5)	139 (67.5)
Currently smoking	28 (47.5)	31 (52.5)

PFD	Sexually active	Non-sexually active	p-value
UI (n = 521)	239 (45.9)	282 (54.1)	< 0.001^aa aa Pearson's Chi-square test.
POP stage, n (%) (n = 640)			< 0.001^aa aa Pearson's Chi-square test.
POP stage <II	248 (50.7)	241 (49.3)
POP stage ≥II	28 (18.5)	123 (81.5)
TVL, (Md ± SD) (n = 634)	10 ± 1	9 ± 2	< 0.001^bb bb Mann-Whitney U test.
GH (Md ± SD) (n = 635)	4 ± 1	4 ± 2	0.678^bb bb Mann-Whitney U test.
PB (Md ± SD) (n = 636)	4 ± 1	3 ± 1	< 0.001^bb bb Mann-Whitney U test.

Physical exam	Sexually active	Non-sexually active	p-value
Perineal sensitivity, n (%) (n = 555)			0.568^a a Pearson's Chi-square test.
No	10 (50)	10 (50)
Yes	231 (43.2)	304 (56.8)
Anal reflex, n (%) (n = 534)			0.247^a a Pearson's Chi-square test.
No	42 (41.2)	60 (58.8)
Yes	187 (43.3)	245 (56.7)
Muscle strength^* * Oxford scale. (Md ± SD) (n = 368)	1.9 ± 1.3	1.6 ± 1.3	0.079^b b Mann-Whitney U test.
Endurance^# # Sustained contraction time in seconds. (Md ± SD) (n = 368)	3.4 ± 2.8	2.9 ± 2.7	0.097^b b Mann-Whitney U test.

Variables	Univariate logistic regressionOR (CI 95%)	p-value	Multivariate logistic regression^* * Multivariable logistic regression model. OR (CI 95%)	p-value
Age (Md ± SD) (n = 642)	1.12 (1.09–1.14)	< 0.001	1.07 (1.03–1.12)	< 0.001
Marital status, n (%) (n = 627)
Single^f f Variable reference used for variables with more than two response options.	–	–	–	–
Married	0.45 (0.28–0.72)	< 0.001	0.43 (0.21–0.88)	0.021
Divorced	1.12 (0.57–2.17)	0.735	1.03 (0.39–2.74)	0.941
Widowed	5.82 (2.61–12.96)	< 0.001	2.66 (0.69–10.3)	0.155
Education^d d Years of study. (Md ± SD) (n = 608)	0.94 (0.91–0.98)	0.003	1.05 (0.98–1.13)	0.116
Number of deliveries (n = 647)	1.17 (1.10–1.25)	< 0.001	1.06 (0.94–1.19)	0.342
Menopause (n = 564)
Yes^e e Versus no menopause.	6.32 (4.40–9.08)	< 0.001	2.28 (1.08–4.8)	0.030
Obesity (n = 659)	0.44 (0.25–0.78)	0.005	1.39 (9.54–3.58)	0.489
Smoking (n = 636)Never smoked^f f Variable reference used for variables with more than two response options.	–	–	–	–
Previously smoked	1.83 (1.28–2.61)	< 0.001	1.06 (0.59–1.93)	0.826
Currently smoking	0.97 (0.56–1.69)	0.936
BMI (n = 491)	0.95 (0.92–0.98)	0.010	0.97 (0.91–1.03)	0.411
TVL (n = 634)	0.74 (0.66–0.82)	< 0.001	0.81 (0.66–0.99)	0.041
PB(n = 636)	0.75 (0.65–0.86)	< 0.001	1.01 (0.78–1.31)	0.912
UI (n = 521)	0.17 (0.08–0.36)	< 0.001	0.000	0.999
POP stage, n (%) (n = 640)
POP stage <II	1.19 (0.84–1.69)	0.322	0.55 (0.17–1.75)	0.316

Quality of life questionnaire	Sexually active	Non-sexually active	p-value ^a
SF 36 Med (25th–75th percentile) (n = 494)
GHP score	52 (32–72)	57 (35–72)	0.254
Functional capacity	60 (35–85)	50 (25–75)	0.012^* * p < 0.20.
Daily activities limitations	25 (0–100)	0 (0–100)	0.495
Emotional limitations	33 (0–100)	33 (0–100)	0.559
Social limitations	75 (50–100)	75 (37.5–100)	0.811
Vitality	50 (30–70)	52.5 (30–80)	0.467
Pain	51 (31–62)	51 (32–72)	0.234
Mental health	60 (44–80)	64 (44–80)	0.371
KHQ Med (25th–75th percentile) (n = 568)
GHP score	50 (25–75)	75 (25–75)	0.028
UI impact	66.6 (33.3–100)	100 (66.6–100)	0.005^* * p < 0.20.
Daily activities limitations	50 (16.6–66.6)	50 (16.6–83.3)	0.345
Physical limitations	50 (16.6–83.3)	50 (16.6–100)	0.174
Social limitations	22.2 (0–44.4)	33.3 (0–55.5)	0.100
Personal relationships	33.3 (0–66.6)	0 (0–33.3)	< 0.001^* * p < 0.20.
Emotions	44.4 (22.2–77.7)	49.9 (22.2–88.8)	0.334
Sleep and disposition	33.3 (16.6–66.6)	50 (0–83.3)	0.370
Measure of gravity	53.3 (33.3–73.3)	46.6 (33.3–73.3)	0.733
PQol Med (25th–75th percentile) (n = 640)
GHP score	50 (25–75)	50 (50–75)	0.202
Impact prolapsed	33.3 (33.3–100)	100 (33.3–100)	< 0.001^* * p < 0.20.
Impact on daily activities	16.6 (0–66)	50 (0–100)	< 0.001^* * p < 0.20.
Physical limitations	16.6 (0–50)	33.3 (0–83.3)	0.003^* * p < 0.20.
Social limitations	0 (0–22.2)	11.1 (0–44.4)	< 0.001^* * p < 0.20.
Personal relationships	33.3 (0–50)	0 (0–50)	0.009^* * p < 0.20.
Emotions	33.3 (11.1–66.6)	44.4 (22.2–88.8)	0.203
Sleep/energy	16.6 (0–50)	16.6 (0–50)	0.490
Severity	25 (8.3–37.4)	33.3 (16.6–50)	0.003^* * p < 0.20.
Total PISQ 12 score	28 (22–34)	–	–

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[1] Address for correspondence Sandra Rebouças Macêdo, Master, Rua Adolfo Gurgel 133, Cocó, Fortaleza, CE, 60192-345, Brazil (e-mail: sandrarmacedo@yahoo.com.br).