Purpose-We compared the impact of mixed, stress and urge urinary incontinence on quality of life in middle-aged or older women.Materials and Methods-We analyzed cross-sectional data from a population based cohort of 2,109 ethnically diverse middle-aged or older women. Among participants reporting weekly incontinence, clinical type of incontinence was assessed by self-reported questionnaires and disease specific quality of life impact was evaluated using the Incontinence Impact Questionnaire. Multivariable logistic regression was used to compare the odds of greater quality of life impact from incontinence, defined as an Incontinence Impact Questionnaire score in the 75th percentile or greater in women with stress, urge and mixed incontinence.Results-More than 28% (598) of women reported weekly incontinence, including 37% with stress, 31% with urge and 21% with mixed incontinence. Unadjusted Incontinence Impact Questionnaire scores were higher for women with mixed vs urge or stress incontinence (median score 29 vs 17 and 13, respectively, p <0.01). Adjusting for age, race/ethnicity, health status and clinical incontinence severity, women with mixed incontinence were more likely to report a greater overall quality of life impact compared to those with stress incontinence (OR 2.5, 95% CI 1.4-4.3), as well as a greater specific impact on travel (OR 2.2, 95% CI 1.3-3.7) and emotional (OR 1.8, 95% CI 1.0 -3.4) Incontinence Impact Questionnaire domains. The overall impact of urge incontinence did not differ significantly from that of stress (urge vs stress OR 1.6, 95% CI 0.9 -2.7) or mixed incontinence (mixed vs urge OR 1.6, 95% CI 0.9 -2.8) in adjusted models.Conclusions-In middle-aged or older women mixed incontinence is associated with a greater quality of life impact than stress incontinence independent of age, race, health or incontinence severity. Identification of women with mixed incontinence symptoms may be helpful in discovering which women are most likely to experience functional limitations and decreased well-being from incontinence. Urinary incontinence is a common problem in middle-aged or older women, with up to 25% of reproductive age women and 50% of postmenopausal women reporting at least weekly incontinence. 1 While incontinence does not lead to death it can have a profound effect on quality of life 2,3 comparable to that of stroke, arthritis and chronic obstructive pulmonary disease. 4 In addition, incontinence accounts for more than $20 billion in annual expenditures in the United States, an amount greater than the annual direct costs of breast, ovarian, cervical and uterine cancers combined. 5 KeywordsTo date, most studies examining the impact of incontinence on quality of life have not distinguished among stress, urge and mixed incontinence. Additionally, many prior studies have been limited by a focus on specialized clinical populations 3,6,7 or the use of quality of life instruments that are not disease specific 6,8 and, thus, are less sensitive in measuring the specific impact of incont...

Higher serum levels of bioavailable testosterone are associated with lower risks of ER-negative breast cancer in postmenopausal women.

OBJECTIVES-To examine factors influencing sexual activity and functioning in racially-and ethnically-diverse, middle-aged and older women. Author Contributions: Dr. Huang contributed significantly to the design of this study, analysis and interpretation of the data, drafting and revision of the article, and final approval of the version to be published. Dr. Subak, Dr. Thom, Dr. Kuppermann, and Dr. Brown contributed significantly to the design of the study, analysis and interpretation of data, critical revision of the article, and approval of the version to be published. Dr. Van Den Eeden and Ms. Ragins contributed significantly to acquisition of the data, analysis and interpretation of data, critical revision of the article, and final approval of the version to be published. Ms. Shen contributed significantly to analysis and interpretation of the data, critical revision of the article, and final approval of the version to be published. DESIGN-Cross-sectional cohort study SETTING-Integrated Conflict of Interest:The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper.Dr. Huang has received support for research related to vaginal atrophy via contracts with the University of California, San Francisco from Bionovo, Inc. and Pfizer, Inc. Dr. Subak has received support for research related to urinary incontinence via contracts with the University of California, San Francisco from Pfizer, Inc. Dr. Kuppermann is a consultant to Boehringer-Ingelheim Pharmaceuticals, Inc., where she is providing input into the development of a measure of hypoactive sexual desire disorder. Dr. Brown has received support for research related to urinary incontinence via contracts with the University of California, San Francisco from Pfizer, Inc.Sponsor's Role: The views expressed in this paper are those of the authors and do not necessarily represent those of the NIH or any other organization. No funders had any role in the design or conduct of this study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. As primary author, Dr. Huang had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript MEASUREMENTS-Self-administered questionnaires assessed sexual desire, activity, satisfaction, and problems.RESULTS-Of the 1,977 participants (including 876 White, 388 African American, 347 Latina, and 351 Asian women), 43% reported at least moderate sexual desire, and 60% were sexually active in the previous 3 months. Half of sexually active participants (n=969) described their overall sexual satisfaction as moderate to high. Among sexually inactive women, the most common reason for inactivity was lack of interest in sex (39%), followed by lack of a partner (36%...

IMPORTANCE Among women and men with severe obesity, evidence for improvement in urinary incontinence beyond the first year after bariatric surgery-induced weight loss is lacking.OBJECTIVES To examine change in urinary incontinence before and after bariatric surgery and to identify factors associated with improvement and remission among women and men in the first 3 years after bariatric surgery. DESIGN, SETTING, AND PARTICIPANTSThe Longitudinal Assessment of Bariatric Surgery 2 is an observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Participants were recruited between February 21, 2005, and February 17, 2009. Adults undergoing first-time bariatric surgical procedures as part of clinical care by participating surgeons between March 14, 2006, and April 24, 2009, were followed up for 3 years (through October 24, 2012).INTERVENTION Participants undergoing bariatric surgery completed research assessments before the procedure and annually thereafter. MAIN OUTCOMES AND MEASURESThe frequency and type of urinary incontinence episodes in the past 3 months were assessed using a validated questionnaire. Prevalent urinary incontinence was defined as at least weekly urinary incontinence episodes, and remission was defined as change from prevalent urinary incontinence at baseline to less than weekly urinary incontinence episodes at follow-up. RESULTSOf 2458 participants, 1987 (80.8%) completed baseline and follow-up assessments. At baseline, the median age was 47 years (age range, 18-78 years), the median body mass index was 46 kg/m 2 (range, 34-94 kg/m 2 ), and 1565 of 1987 (78.8%) were women. Urinary incontinence was more prevalent among women (49.3%; 95% CI, 46.9%-51.9%) than men (21.8%; 95% CI, 18.2%-26.1%) (P < .001). After a mean 1-year weight loss of 29.5% (95% CI, 29.0%-30.1%) in women and 27.0% (95% CI, 25.9%-28.6%) in men, year 1 urinary incontinence prevalence was significantly lower among women (18.3%; 95% CI, 16.4%-20.4%) and men (9.8%; 95% CI, 7.2%-13.4%) (P < .001 for all). The 3-year prevalence was higher than the 1-year prevalence for both sexes (24.8%; 95% CI, 21.8%-26.5% among women and 12.2%; 95% CI, 9.0%-16.4% among men) but was substantially lower than baseline (P < .001 for all). Weight loss was independently related to urinary incontinence remission (relative risk, 1.08; 95% CI, 1.06-1.10 in women and 1.07; 95% CI, 1.02-1.13 in men) per 5% weight loss, as were younger age and the absence of a severe walking limitation.CONCLUSIONS AND RELEVANCE Among women and men with severe obesity, bariatric surgery was associated with substantially reduced urinary incontinence over 3 years. Improvement in urinary incontinence may be an important benefit of bariatric surgery.

Objective To develop a self-report questionnaire assessing the impact of vaginal dryness, soreness, itching, irritation, and pain on functioning and well-being in postmenopausal women. Methods Structured self-report items were developed to address the impact of vaginal symptoms on functioning and wellbeing based on findings from focus groups with racially/ethnically diverse, symptomatic postmenopausal women. Items were refined after cognitive interview pre-testing and then field-tested among symptomatic postmenopausal women enrolled in a multiethnic cohort study in California. Exploratory (SAS PROC VARCLUS) and confirmatory factor analyses evaluated factor structure and eliminate poorly fitting items. Additional evidence of construct validity was obtained via examination of correlations with other measures of related constructs. Internal consistency and test-re-test reliability were assessed using Cronbach’s alpha and correlation coefficients, respectively. Results Of the 745 postmenopausal women completing the draft questionnaire, mean (SD) age was 56.2 (8.5) years, and 66% were racial/ethnic minorities. The refined questionnaire included four multi-item scales addressing symptom impact on: 1) activities of daily living, 2) emotional well-being, 3) sexual functioning, and 4) self-concept and body image. The four factor model provided good approximate fit (comparative fit index = 0.987, standardized root-mean-square residual = 0.038). Correlations with other measures of symptom bothersomeness, sexual function, depression, and anxiety conformed to hypotheses. Cronbach’s alpha ranged from 0.82 to 0.93. Intra-class coefficients ranged from 0.47 to 0.72. Conclusions The Day-to-Day Impact of Vaginal Aging (DIVA) questionnaire is a new multidimensional self-report measure designed to facilitate evaluation of the impact of vaginal symptoms in postmenopausal women of diverse backgrounds.

Objective To identify factors associated with greater impact of vaginal symptoms on functioning and well-being in postmenopausal women. Methods Postmenopausal women who reported vaginal dryness, itching, irritation, or pain with sexual activity completed the multidimensional Day-to-day Impact of Vaginal Aging (DIVA) questionnaire and underwent assessment of multiple socio-demographic and clinical factors having the potential to influence the impact of vaginal symptoms. Multivariable linear regression analyses examined relationships between selected participant characteristics and DIVA scale scores assessing symptom impact on activities of daily living, emotional well-being, self-concept/body image, and sexual functioning. Results Among the 745 symptomatic participants, mean age was 56 (±9) years, and 66% were racial/ethnic minorities. Women with comorbid depression reported greater impact of vaginal symptoms on all dimensions of functioning and well-being measured by DIVA (11%–22% estimated increase in impact scores associated with each 3-point increase in Hospital and Anxiety Depression Scale scores). Women with urinary incontinence also reported greater impact of vaginal symptoms on activities of daily living, emotional well-being, and self-concept/body image (27%–37% estimated increase in impact scores). Age, partner status, sexual activity frequency, general health, and body mass index also predicted greater impact in at least one domain. Conclusions Findings suggest that special efforts should be made to identify and treat vaginal symptoms in postmenopausal women known to have depression or urinary incontinence, as these women may experience greater impact of vaginal symptoms on multiple domains of functioning and quality of life.

Clinicians seeking to evaluate the impact of incontinence on women's lives should assess not only the clinical severity of their symptoms but also the specific context in which symptoms occur. The prevalence of treatment seeking for incontinence is low across all ethnic groups, even when women have clinically severe symptoms and access to a health provider.

Objective To examine the feasibility, efficacy, and safety of a group-based yoga therapy intervention for middle-aged and older women with urinary incontinence. Methods We conducted a pilot randomized trial of ambulatory women aged 40 years and older with stress, urgency, or mixed-type incontinence. Women were randomized to a 6-week yoga therapy program (N=10) consisting of twice weekly group classes and once weekly home practice or a waitlist control group (N=9). All participants also received written pamphlets about standard behavioral self-management strategies for incontinence. Changes in incontinence were assessed by 7-day voiding diaries. Results Mean (±SD) age was 61.4 (±8.2) years, and mean baseline frequency of incontinence was 2.5 (±1.3) episodes/day. After 6 weeks, total incontinence frequency decreased by 66% (1.8 [±0.9] fewer episodes/day) in the yoga therapy versus 13% (0.3 [±1.7] fewer episodes/day) in the control group (P=0.049). Participants in the yoga therapy group also reported an average 85% decrease in stress incontinence frequency (0.7 [±0.8] fewer episodes/day) compared to a 25% increase in controls (0.2 [± 1.1] more episodes/day) (P=0.039). No significant differences in reduction in urgency incontinence were detected between the yoga therapy versus control groups (1.0 [±1.0] versus 0.5 [±0.5] fewer episodes/day, P=0.20). All women starting the yoga therapy program completed at least 90% of group classes and practice sessions. Two participants in each group reported adverse events unrelated to the intervention. Conclusions Findings provide preliminary evidence to support the feasibility, efficacy, and safety of a group-based yoga therapy intervention to improve urinary incontinence in women.