Female Sexual Function and the Pelvic Floor

Sarit O. Aschkenazi;   Roger P. Goldberg


Expert Rev of Obstet Gynecol. 2009;4(2):165-178. 

In This Article

Female Sexual Function & the Pelvic Floor

Sexual complaints are common in women with PFDs. Studies have shown inconsistent results, partially owing to great variability in the study-population race, age, menopause and relationship with the sexual partner. One study examined women planning hysterectomy for benign disease. Subjects with concomitant urinary symptoms prior to the hysterectomy had significantly more dyspareunia and decreased libido[53]. However, a community-based study revealed no difference in sexual activity and/or satisfaction among women with PFD[54]. Another cross-sectional study on 301 women older than 40 years found that pelvic floor symptoms were associated with low sexual arousal, infrequent orgasm and dyspareunia[55]. Women with advanced anatomic prolapse (stage 3-4) were more likely to report infrequent orgasm but not other sexual problems. Mild prolapse alone (stage 2) was not associated with sexual dysfunction. Age, education, menopause, vaginal dryness, depression and lack of 'passionate love' for their partner did not confound the association between pelvic floor symptoms and sexual function. In another community-based study, the authors sought to determine the effects of therapy on sexual function in women with urinary incontinence and POP[56]. A total of 343 women of 45 years or older with urinary incontinence or advanced POP were enrolled prospectively. Sexual function was assessed by completing a standardized urogynecologic evaluation and the PISQ-12 at baseline and after therapy. Those with incontinence were stratified to receive estrogen therapy, behavioral therapy or surgical therapy. Women with prolapse were randomized in a surgical trial. The results showed that subjects with prolapse or detrusor overactivity stated that their pelvic floor symptoms were a cause for not being sexually active more often than women with other PFDs. Women who underwent surgical correction of SUI or behavioral therapy reported that they were worried about leaking during intercourse compared with before therapy less often. Following surgical prolapse repair, fewer women reported that their symptoms interfered with sexual activity compared with before treatment. At 6 months, the overall sexual satisfaction remained similar to baseline in all the therapeutic groups. The authors concluded that when compared with incontinence, prolapse is more likely to adversely affect sexual activity and that overall sexual satisfaction is not affected by presence of or treatment for incontinence or prolapse.


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