As pregnancy progresses, women report poorer sexual function.

Objectives Describe the relationship between genital hiatus (GH) and perineal body (PB) measurements with increasing pelvic organ prolapse stage in a large cohort of women referred to Urogynecology clinic for pelvic floor disorders. Methods Retrospective chart review of all new patients seen in an academic Urogynecology clinic between 1/2007 and 9/2011. Data were extracted from a standardized intake form. All patients underwent a Pelvic Organ Prolapse Quantification (POPQ) exam. Descriptive statistics compared the study population. Analysis of variance (ANOVA) was used to compare GH and PB measurements by prolapse stage. Fishers least significant differences was used for post hoc comparisons of means between prolapse stages. Pearson's correlations were used to evaluate the associations between GH and PB measurements and patient characteristics. Results 1595 women with POPQ exams comprised the study population. The mean age was 55.3 ±14.8 years with a BMI 30.3 ± 7.6 kg/m2, most women were parous (90%), 40% were Hispanic, 33% had undergone prior hysterectomy for indications exclusive of pelvic organ prolapse. Woman with any prior prolapse repair were excluded, 6.5% had a prior incontinence procedure. PB measurements were slightly larger for Stage 2 pelvic organ prolapse (POP), but overall did not vary across other prolapse stages (all P >0.05). In contrast, GH measurements increased through stage 3 POP, GH measurements decreased for stage 4 POP. Conclusions Mean PB measurements did not demonstrate large changes over prolapse stage, while GH measurements increased through stage 3 POP. GH serves as an important marker for underlying pelvic muscle damage.

Introduction We describe pelvic floor function in nulliparous pregnant women. Materials/Methods Nulliparous midwifery patients completed the Incontinence Severity Index (ISI), Pelvic Floor Impact Questionnaire (PFIQ-7), Wexner Fecal Incontinence Scale (W), and answered questions about sexual activity and perineal pain at baseline during the first (T1), second (T2), or third trimester (T3) and repeated in late T3. They also underwent a Pelvic Organ Prolapse Quantification (POPQ) exam at their baseline visit. Data were compared across trimesters. ANOVA and logistic regression accounted for repeated measures and was controlled for age and education. Results We recruited 627 women. In T1, 124 women gave baseline data and completed questionnaires, 403 in T2, and 96 in early T3 (496 repeated questionnaires in later T3). Besides an increase in genital hiatus and perineal body (all adjusted p < .05), physical exam measures did not differ between trimesters. As pregnancy progressed, urinary incontinence (UI) (T1=33, T2=44, T3=69% women with ISI >0, all comparisons p<.02) and IIQ-7 scores increased. Fecal incontinence (FI) increased (T1=8, T2=15, T3=16% from T2 to T3, p=.04), while CRAIQ-7 scores did not increase. Perineal pain increased (T1=17, T2=18 and T3 = 40%, all adjusted p <.001), and sexual activity decreased as pregnancy progressed (T1= 94, T2 = 90, T3 = 77% sexually active, T1 vs T3 and T2 vs T3, p <.001). Conclusions During pregnancy, women experience worsening UI, FI and perineal pain. UI symptoms are associated with a negative impact on quality of life. Sexual activity decreases and POPQ stage does not change.

Objective The aim of the study was to compare the prevalence of adverse childhood experiences (ACEs) in women with overactive bladder (OAB) or interstitial cystitis/bladder pain syndrome (IC/BPS) to age-matched controls. Methods This case-control study compared numbers and types of ACEs in women with OAB or IC/BPS compared with controls based on the Center for Disease Control’s Behavioral Risk Factor Surveillance System ACE Module. Participants completed demographic forms, condition-specific symptom questionnaires, and the ACE Module (11 questions summarizing traumatic exposures occurring before the age of 18 years). Cases and controls were compared using χ2 and t tests, significance level P < 0.05. Results Three hundred twenty-two women were enrolled from April 2018 to March 2019; OAB = 91 cases and 91 controls, IC/BPS = 70 cases and 70 controls. Overactive bladder group’s mean age was 56 ± 13 years, and IC/BPS was 46 ± 13 years. Compared with controls, OAB and IC/BPS cases differed in race/ethnicity and education (P < 0.02), history of substance abuse (P ≤ 0.03), and median numbers of ACEs (OAB 3, controls 1; IC/BPS 4, controls 2, P < 0.01). Cases had increased odds of having 4 or more ACEs, a parameter known to be associated with poor health and longevity, and increased greater than 2-fold in OAB and greater than 7-fold in IC/BPS. Interstitial cystitis/bladder pain syndrome cases had notably increased odds of exposure to abuse (physical/emotional/sexual) and witnessed domestic violence (all P < 0.01). Conclusions Overactive bladder and IC/BPS cases reported increased ACE exposures; more than one-third of OAB and more than IC/BPS cases reported 4 or more ACES, a threshold associated with poor health outcomes. Recognition of increased childhood adversity in OAB and IC/BPS has important treatment and health implications.

Objective The primary objective of this study was to describe patient compliance with pelvic floor physical therapy (PFPT) for high-tone pelvic floor disorders (HTPFD) and to compare patients who are compliant with prescribed therapy to those who are not. The secondary objective is to describe second-line treatments offered for HTPFD for returning patients. Methods This is a retrospective cohort study of women with a HTPFD who were prescribed PFPT at a tertiary care referral center. Patients were excluded if they had a primary diagnosis of urinary incontinence, had undergone prior PFPT, or if PFPT was part of preoperative planning. Noncompliance with PFPT was defined as not being formally discharged from therapy by the treating therapist. Results Data on PFPT compliance were available for 662 patients (87.3%). A total of 128 patients (19.4%) were fully compliant. Noncompliant patients were more likely to smoke and to have mental health disease compared with compliant patients (18% vs 8.7%, P = 0.01, and 50.4% vs 37.5%, P = 0.009, respectively). A total of 285 patients (43.1%) returned to their prescribing provider. Noncompliant patients were less likely to return to their provider: 63.4% versus 29.7%, P = <0.0001. Of the patients who returned, 183 (64.2%) were offered second-line treatment. Conclusions Only 1 in 5 patients referred to PFPT for management of a high-tone pelvic floor disorder is compliant with the recommended therapy. Patients who are noncompliant are less likely to return to their prescribing provider, and less than half of referred patients return. Sixty percent of patients who return are offered second-line treatment.