Introduction Little is known about the impact of surgery for stress urinary incontinence (SUI) on female sexual function, and results are conflicting. Aims We aimed to clarify the impact of surgery for SUI on female sexual function. Methods We analyzed data collected from two studies evaluating sexual function in women after placement of the tension-free vaginal tape, tension-free vaginal tape obturator, or transobturator suburethral tape. A nonvalidated sexual questionnaire developed by Lemack, translated into Dutch, was mailed to all patients 3–12 months after the procedure. Main Outcome Measures Pre- and postoperative results of a nonvalidated sexual questionnaire. Results A total of 136 sexually active women completed the questionnaires. Compared with preoperative responses, we observed no significant changes postsurgical regarding frequency of sexual intercourse or satisfaction of sexual intercourse, although a significant postoperative decrease in urinary coital incontinence (P ≤ 0.001) was found. Postoperatively, 29 women (21.3%) reported improved sexual intercourse, and eight women (5.9%) complained of a worsening. There was a significant higher rate of preoperative coital incontinence (86.2% women with coital incontinence) in the group of women who reported improved intercourse (P = 0.01). Conclusion Women with coital incontinence show a significant higher improvement in sexual function after surgery for SUI compared to women without coital incontinence. Our results suggest that improvement in coital incontinence results in improvement of sexual function. Therefore, coital incontinence is a prognostic factor for improvement of sexual function following incontinence surgery.

Introduction Vaginal sling procedures may have a negative effect on sexual function due to damage to vascular and/or neural genital structures. Even though autonomic innervation of the clitoris plays an important role in female sexual function, most studies on the neuroanatomy of the clitoris focus on the sensory function of the dorsal nerve of the clitoris (DNC). The autonomic and somatic pathways in relationship to sling surgery have up to the present not been described in detail. Aim The aim of this study is to reinvestigate and describe the neuroanatomy of the clitoris, both somatic and autonomic, in relation to vaginal sling procedures for stress urinary incontinence. Method Serially sectioned and histochemically stained pelves from 11 female fetuses (10–27 weeks of gestation) were studied, and three-dimensional reconstructions of the neuroanatomy of the clitoris were prepared. Fourteen adult female hemipelves were dissected, after a tension-free vaginal tape (TVT) (7) or tension-free vaginal tape-obturator (TVT-O) (7) procedure had been performed. Main Outcome Measures Three-dimensional (3-D) reconstruction and measured distance between the clitoral nerve systems and TVT/TVT-O. Results The DNC originates from the pudendal nerve in the Alcock’s canal and ascends to the clitoral bodies. In the dissected adult pelves, the distance of the TVT-O to the DNC had a mean of 9 mm. The cavernous nerves originate from the vaginal nervous plexus and travel the 5 and 7 o’clock positions along the urethra. There, the autonomic nerves were found to be pierced by the TVT needle. At the hilum of the clitoral bodies, the branches of the cavernous nerves medially pass/cross the DNC and travel further alongside it. Just before hooking over the glans of the clitoris, they merge with DNC. Conclusions The DNC is located inferior of the pubic ramus and was not disturbed during the placement of the TVT-O. However, the autonomic innervation of the vaginal wall was disrupted by the TVT procedure, which could lead to altered lubrication-swelling response.

Introduction Female sexual dysfunction (FSD) is a highly prevalent and often underestimated problem. There is a strong association between urological complaints and FSD. Aims The purpose of this survey was to evaluate how Dutch urologists address FSD in their daily practice. Methods We performed an anonymous survey study. A 17-item anonymous questionnaire was mailed to all 405 registered members of the Dutch Urology Association (urologists and residents in urology). Main Outcome Measures The survey results. Results One hundred eighty-six complete surveys of eligible respondents were returned (45.9% response rate). Ten respondents (5.5%) stated that they ask each female patient for sexual function; 87.1% stated that they ask for sexual function when a patient complains about lower abdominal pain (87.2%), incontinence (75.8%), urgency or frequency (70.5%), or urinary tract infections (65.8%). Many respondents (40.3%) do not think that FSD is meaningful in a urological practice. The majority of respondents (91%) underestimate the frequency of FSD in a urological clinic. Respondents who believe the frequency of FSD to be at least 30% tend to ask more often for sexual function than the rest of the group (P = 0.08). Conclusion Overall, many urologists do not consistently ask each female patient for sexual function and underestimate the prevalence of FSD. For the majority of the members of the Dutch Urological Association, FSD is not part of routine urological practice. There is, therefore, a need for better implementation of education and training at both undergraduate and postgraduate levels.

surveillance scheme (demographic characteristics, a validated visual analogue scale, and validated subset of questions on sexual function and performance derived from QLQ-BLS-24). The results were compared with those from an age-and gender-matched healthy population. RESULTSThe response rate was 95% (142/150); 61% (87/142) of the respondents were sexually active in the previous 4 weeks after diagnosis, 66% (70/105) of men and 46% (17/37) of women. Although libido was not negatively affected, 54% (47/87) of the patients had a sexual dysfunction, and 23% (17/73) were afraid to inflict harm on their partner by sexual contact. Sexually active patients perceived a higher state of general health ( P = 0.03). CONCLUSIONSThe prevalence of sexual dysfunction in patients with NMI UC is very high (54%) compared with an age-and gender-matched healthy population (20-45%). No predictors for sexual dysfunction were found. These patients and partners would benefit from proper sexual information in the outpatient clinic.

Introduction Several studies show that urinary incontinence (UI) impairs women’s sexual functioning and sexual satisfaction. However, there is no scientific knowledge about the effects of UI on sexual functioning of the male partners. Aim To analyze sexual functioning of the male partners of females with UI. Methods During a period of 2.5 years all new female patients and their partners (both groups aged 18 years and older), who presented at our outpatient clinic for urological evaluation, were asked for demographic characteristics, medical history, and referral indication including the main urological complaint. In addition they were asked to fill in the Golombok Rust Inventory of Sexual Satisfaction questionnaires about sexual functioning. Main Outcome Measures Sexual function measured by the Golombok Rust Inventory of Sexual Satisfaction questionnaire. Results A total of 189 sexually active couples completed the questionnaires. Eighty-one (42.9%) of the women had UI as main urological complaint. Differences were found between women with UI and those without. Women with UI have a lower overall sexual function (P = 0.02), lower frequency of intercourse (P = 0.02), more problems with communication (P = 0.036), and more often show avoidable behavior with regard to sexual activity. (P = 0.002) Men with partners with UI showed a diminished overall sexual function (6.66 ± 1.53) compared with men with women without UI (5.95 ± 1.22, P = 0.001). Furthermore, comparisons of subscales also demonstrate a lower frequency of intercourse (5.62 ± 2.00, 6.49 ± 1.96), less satisfaction (8.08 ± 2.79, 9.69 ± 3.63), and more erectile problems (6.01 ± 2.28, 6.87 ± 3.23) in men with partners with UI. (P = 0.03, P = 0.001, P = 0.037) Conclusions This study shows that female urinary incontinence correlates with their partners’ overall sexual functioning and sexual satisfaction. In addition, significant differences were found with regard to the satisfaction with one’s sex life between a woman with UI and her partner.