Women's Health

Women who are incontinent are more likely to complain about sexual problems than those with pelvic organ prolapse

Pelvic floor disorders, including urinary incontinence (UI) and pelvic organ prolapse, affect nearly one-third of adult women. Women who have UI are twice as likely as other women to have certain sexual problems, but pelvic prolapse is not associated with these problems, according to a recent study by researchers at Johns Hopkins University. With support from the Agency for Healthcare Research and Quality (HS06865), they investigated a possible association between pelvic floor disorders and sexual complaints using data from the Maryland Women's Health Study of women scheduled to undergo hysterectomy for benign gynecologic disorders.

Victoria L. Handa, M.D., and her colleagues analyzed data collected in 1992-1993 from in-home interviews of 1,299 women scheduled to undergo hysterectomy in the near future. Most of the women were between the ages of 30 and 50. The researchers studied whether UI or pelvic organ prolapse was associated with four sexual complaints: decreased libido, vaginal dryness, difficult or painful sexual intercourse (dyspareunia), and inability to achieve orgasm (anorgasmia). Among these women who were already planning to undergo hysterectomy, 38 percent had evidence of pelvic floor disorders. Sexual complaints were significantly more common among women with pelvic floor disorders than those without such disorders (53 vs. 40 percent). UI was associated with twice the likelihood of low libido, vaginal dryness, and dyspareunia, independent of a woman's age, education, and race.

In contrast, pelvic organ prolapse was not associated with any sexual complaint, even though worse sexual impairment has been associated with worsening prolapse in some prior studies. The women in this study may have had relatively mild prolapse that did not affect sexual function. Questions remain about the association between UI and sexual dysfunction. If UI causes sexual dysfunction (for example, through altered self-esteem or embarrassment), then sexual function should be restored by treatments that cure incontinence. On the other hand, some studies have found that successful UI treatment may not improve sexual function.

For more information, see "Sexual function among women with urinary incontinence and pelvic organ prolapse," by Dr. Handa, Lynn Harvey, B.S., Geoffrey W. Cundiff, M.D., and others, in the September 2004 American Journal of Obstetrics and Gynecology 191, pp. 751-756.

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