Pelvic Floor Dysfunction: Women’s Sexual Concerns Unraveled

Abstract

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.”

Coital incontinence: a factor for deteriorated health-related quality of life and sexual function in women with urodynamic stress urinary incontinence

“…This further shows that age and psychological factors such as self-perceived body image have a decisive impact on the quality of sexual function [3, 18, 23, 24]. Sexual function in women with urinary incontinence and POP has also been reported to be comparable with that in healthy women, and that the percentage of sexually active women is similar in both groups [18, 23].…”

“…This finding may be explained by the fact that women with better education, considering these symptoms unacceptable, use preventive strategies more effectively. The mechanisms of coping with CI include urinating prior to sexual intercourse, deferring intercourse, interrupting intercourse prematurely, avoiding certain positions, hurrying through sex, and avoiding orgasm [21, 24]. A large impact on QoL in women with urinary incontinence has been shown to be associated with lower educational level [29].…”

Impact of Urinary Incontinence on Sexual Functioning in Community-Dwelling Older Women

“…Sexual function in older community‐dwelling women with urinary incontinence has not been frequently studied [25,26]. In our population, ≥99% of the participants agreed to fill in the questionnaire about sexual activity, thereby providing robust data.…”

Experience of pelvic floor muscle exercises among women in Taiwan: a qualitative study of improvement in urinary incontinence and sexuality

“…As Roos et al . () showed, UI is related to women's body image and is an important factor influencing their sex lives. This finding is aligned with fear of incontinence during intercourse causing women to feel less attractive and insecure about their partner's sexual experience.…”