Objectives To assess risk factors and outcome of different grades of obstetric anal sphincter injuries (OASIS) after

The aim of this study was to assess the correlation between St. Mark's incontinence score (SMIS) for anal incontinence and impact on quality of life (QoL), following primary repair of obstetric anal sphincter injuries (OASIS). Three hundred sixty-eight women who sustained OASIS completed a Manchester Health Questionnaire (MHQ) and the clinician calculated a SMIS. Spearman's correlation coefficients were calculated, and Mann-Whitney U test was used to compare different severity subgroups. Mean follow-up was 10 weeks and mean age was 30 years. Mean SMIS was 1.35. All MHQ QoL domains showed statistically significant positive correlation with SMIS. When comparing SMIS subgroups (0-4, 5-8, >8), mean QoL domain scores were higher with increasing SMIS. This shows that the objective assessment of severity of anal incontinence, using the SMIS, correlates to its impact on QoL in a relatively young population with low severity of symptoms and can, therefore, be used in women who sustain OASIS.

AIM: To determine the accuracy and predictive value of transperineal (TPU) and endovaginal ultrasound (EVU) in the detection of anal sphincter defects in women with obstetric anal sphincter injuries and/or postpartum symptoms of faecal incontinence.MATERIALS AND METHODS: One hundred and sixty-five women were recruited, four women were excluded as they were seen years after their last delivery. TPU and EVU, followed by endonanal ultrasound (EAU), were performed using the B&K Viking 2400 scanner. Sensitivity and specificity, as well as predictive values with 95% confidence intervals, for detecting anal sphincter defects were calculated for EVU and TPU, using EAU as the reference standard.RESULTS: On EAU a defect was found in 42 (26%) women: 39 (93%) had an external (EAS) and 23 (55%) an internal anal sphincter (IAS) defect. Analysable images of one level of the EAS combined with an analysable IAS were available in 140 (87%) women for EVU and in 131 (81%) for TPU. The sensitivity and specificity for the detection of any defect was 48% (30e67%) and 85% (77e91%) for EVU and 64% (44e81%) and 85% (77e91%) for TPU, respectively. CONCLUSION: Although EAU using a rotating endoprobe is the validated reference standard in the identification of anal sphincter defects, it is not universally available. However while TPU and/or EVU with conventional ultrasound probes can be useful in identifying normality, for clinical purposes they are not sensitive enough to identify an underlying sphincter defect.

Introduction Sexual function of women suffering from pelvic organ prolapse (POP) and/or urinary incontinence (UI) is adversely affected. However, our current understanding of the exact relationship between female sexual dysfunction and POP and/or UI is incomplete. A qualitative study can improve our understanding by describing what women themselves perceive as the real problem. Aim To gain a more in-depth understanding of the impact of POP and/or UI on the different categories of female sexual dysfunction by way of a qualitative study. Methods Qualitative semistructured interviews were conducted in 37 women scheduled for pelvic floor surgery, and one was excluded from analysis due to incomplete recordings. Main Outcome Measures The impact of POP and/or UI on female sexual function. Results Only 17% of women were completely positive about their sex life. Both POP and UI had a negative effect on body image. Women with POP had a negative image of their vagina, which caused them to be insecure about their partner's sexual experience, while women with UI were embarrassed about their incontinence and pad use, and feared smelling of urine. Worries about the presence of POP during sexual activity, discomfort from POP, and reduced genital sensations were the most important reasons for decreased desire, arousal, and difficulty reaching an orgasm in women with POP. Fear of incontinence during intercourse affected desire, arousal, and orgasm and could be a cause for dyspareunia in women with UI. Desire was divided into two main elements: “drive” and “motivation.” Although “drive,” i.e., spontaneous sexual interest, was not commonly affected by POP and/or UI, a decrease in “motivation” or the willingness to engage in sexual activity was the most common sexual dysfunction mentioned. Conclusions Body image plays a key role in the sexual functioning of women with POP and/or UI with the biggest impact on women's “motivation.”