Female sexual function and pelvic floor disorders

Abstract

Objective: To investigate the hypothesis that pelvic floor disorders are associated with female sexual problems, independently of other related factors.

Methods: The study population included 301 adult women seeking outpatient gynecologic and urogynecologic care. Pelvic floor disorders were assessed with the Pelvic Floor Disorders Inventory-20 (PFDI-20) and the pelvic organ prolapse quantification examination. Sexual function was assessed with the Personal Experiences Questionnaire. Using ordinal regression analysis, we identified characteristics and conditions associated with decreased libido, infrequent orgasm, decreased arousal, and dyspareunia.

Results: Sexual function was poorer among 78 women (26%) without a current sexual partner than among 223 with a partner (P<.01). Among the 223 with a current partner, women with a high Pelvic Floor Disorders Inventory score were significantly more likely to report decreased arousal (P<.01), infrequent orgasm (P<.01), and increased dyspareunia (P<.01). A similar pattern was observed for the urinary, colorectal-anal, and prolapse scales of the Pelvic Floor Disorders Inventory, although some associations were marginally significant. Stage III-IV prolapse was significantly associated with infrequent orgasm (P=.02), but other sexual complaints were not more common with increasing prolapse stage.

Conclusion: Pelvic floor symptoms are significantly associated with reduced sexual arousal, infrequent orgasm, and dyspareunia. We conclude that sexual function is worse in women with symptomatic prolapse but not in women with asymptomatic prolapse.

Level of evidence: II.

Figure 1

Four domains of sexual function, among 223 women with a current sexual partner (dark grey bars) and 78 women without a partner (light grey bars). The Y axis shows the proportion of women endorsing each response. A. Libido and B. orgasm are rated on a 6-point ordinal scale, with higher scores representing better sexual function. C. The arousal score is an average of two items, with a higher score representing better function. D. Dyspareunia is measured on a 5-point ordinal scale, with the highest score representing the worst function (most dyspareunia).