Skip to main content

Female Sexuality in Pelvic Floor Disorders

  • Chapter
  • First Online:
Non-Neurogenic Bladder Dysfunctions

Abstract

Women with pelvic floor disorders (PFDs) report rates of sexual activity that are similar to those of women without PFDs. Nonetheless, rates of sexual dysfunction are thought to be higher than in the general population. The contribution of pelvic floor disorders to sexual dysfunction is unknown, but women with more symptomatic pelvic floor disorders report poorer sexual functioning than those reporting less pelvic floor dysfunction. In general, sexual activity and function are positively impacted by treatment of pelvic floor disorders, although few women report severe deterioration of their sexual health following surgery. Evaluation of sexual activity and function prior to and following intervention is critical to a complete workup of women with pelvic floor disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 59.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rogers GR, Villarreal A, Kammerer-Doak D, Qualls C. Sexual function in women with and without urinary incontinence and/or pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(6):361–5.

    Article  CAS  PubMed  Google Scholar 

  2. Hayes R, Dennerstein L. The impact of aging on sexual function and sexual dysfunction in women: a review of population-based studies. J Sex Med. 2005;2(3):317–30.

    Article  PubMed  Google Scholar 

  3. Fashokun TB, Harvie HS, Schimpf MO, Olivera CK, Epstein LB, Jean-Michel M, et al. Sexual activity and function in women with and without pelvic floor disorders. Int Urogynecol J. 2013;24(1):91–7.

    Article  PubMed  Google Scholar 

  4. Hayes RD, Bennett CM, Fairley CK, Dennerstein L. What can prevalence studies tell us about female sexual difficulty and dysfunction? J Sex Med. 2006;3(4):589–95.

    Article  PubMed  Google Scholar 

  5. Pauls RN, Segal JL, Silva WA, Kleeman SD, Karram MM. Sexual function in patients presenting to a urogynecology practice. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(6):576–80.

    Article  PubMed  Google Scholar 

  6. Elsamra S, Nazmy M, Shin D, Fisch H, Sawczuk I, Fromer D. Female sexual dysfunction in urological patients: findings from a major metropolitan area in the USA. BJU Int. 2010;106(4):524–6.

    Article  PubMed  Google Scholar 

  7. Handa VL, Cundiff G, Chang HH, Helzlsouer KJ. Female sexual function and pelvic floor disorders. Obstet Gynecol. 2008;111(5):1045–52.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Rogers RG, Pauls RN, Thakar R, Morin M, Kuhn A, Petri E, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction. Int Urogynecol J. 2018;29(5):647–66.

    Article  PubMed  Google Scholar 

  9. Panman CM, Wiegersma M, Talsma MN, Kollen BJ, Berger MY, Lisman-Van Leeuwen Y, et al. Sexual function in older women with pelvic floor symptoms: a cross-sectional study in general practice. Br J Gen Pract. 2014;64(620):e144–50.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Berman L, Berman J, Felder S, Pollets D, Chhabra S, Miles M, et al. Seeking help for sexual function complaints: what gynecologists need to know about the female patient’s experience. Fertil Steril. 2003;79(3):572–6.

    Article  PubMed  Google Scholar 

  11. Pauls RN, Kleeman SD, Segal JL, Silva WA, Goldenhar LM, Karram MM. Practice patterns of physician members of the American Urogynecologic Society regarding female sexual dysfunction: results of a national survey. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(6):460–7.

    Article  PubMed  Google Scholar 

  12. WHO. CD-10: International statistical classification of diseases and related health problems. WHO; 2018.

    Google Scholar 

  13. APA. DSM 5: Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Press; 2013.

    Google Scholar 

  14. Abrams P, Cardozo L, Wagg A, Wein A. Proceedings of the 6th international consultation on incontinence; 2017.

    Google Scholar 

  15. Rogers RG, Kammerer-Doak D, Villarreal A, Coates K, Qualls C. A new instrument to measure sexual function in women with urinary incontinence or pelvic organ prolapse. Am J Obstet Gynecol. 2001;184(4):552–8.

    Article  CAS  PubMed  Google Scholar 

  16. Omotosho TB, Rogers RG. Shortcomings/strengths of specific sexual function questionnaires currently used in urogynecology: a literature review. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(Suppl 1):S51–6.

    Article  PubMed  Google Scholar 

  17. Rogers RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C. A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(3):164–8; discussion 8.

    Article  PubMed  Google Scholar 

  18. Rogers RG, Rockwood TH, Constantine ML, Thakar R, Kammerer-Doak DN, Pauls RN, et al. A new measure of sexual function in women with pelvic floor disorders (PFD): the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Int Urogynecol J. 2013;24(7):1091–103.

    Article  CAS  PubMed  Google Scholar 

  19. Rust J, Golombok S. The Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Br J Clin Psychol. 1985;24(Pt 1):63–4.

    Article  PubMed  Google Scholar 

  20. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208.

    Article  CAS  PubMed  Google Scholar 

  21. Serretti A, Chiesa A. Sexual side effects of pharmacological treatment of psychiatric diseases. Clin Pharmacol Ther. 2011;89(1):142–7.

    Article  CAS  PubMed  Google Scholar 

  22. Raina R, Pahlajani G, Khan S, Gupta S, Agarwal A, Zippe CD. Female sexual dysfunction: classification, pathophysiology, and management. Fertil Steril. 2007;88(5):1273–84.

    Article  PubMed  Google Scholar 

  23. Weber AM, Walters MD, Schover LR, Mitchinson A. Sexual function in women with uterovaginal prolapse and urinary incontinence. Obstet Gynecol. 1995;85(4):483–7.

    Article  CAS  PubMed  Google Scholar 

  24. Handa VL, Harvey L, Cundiff GW, Siddique SA, Kjerulff KH. Sexual function among women with urinary incontinence and pelvic organ prolapse. Am J Obstet Gynecol. 2004;191(3):751–6.

    Article  PubMed  Google Scholar 

  25. Barber MD, Visco AG, Wyman JF, Fantl JA, Bump RC. Sexual function in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol. 2002;99(2):281–9.

    PubMed  Google Scholar 

  26. Kuhn A, Bapst D, Stadlmayr W, Vits K, Mueller MD. Sexual and organ function in patients with symptomatic prolapse: are pessaries helpful? Fertil Steril. 2009;91(5):1914–8.

    Article  PubMed  Google Scholar 

  27. Meriwether KV, Komesu YM, Craig E, Qualls C, Davis H, Rogers RG. Sexual function and pessary management among women using a pessary for pelvic floor disorders. J Sex Med. 2015;12(12):2339–49.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Jha S, Gray T. A systematic review and meta-analysis of the impact of native tissue repair for pelvic organ prolapse on sexual function. Int Urogynecol J. 2015;26(3):321–7.

    Article  PubMed  Google Scholar 

  29. Komesu YM, Rogers RG, Kammerer-Doak DN, Barber MD, Olsen AL. Posterior repair and sexual function. Am J Obstet Gynecol. 2007;197(1):101.e1–6.

    Article  Google Scholar 

  30. Schiavi MC, D’Oria O, Faiano P, Prata G, Di Pinto A, Sciuga V, et al. Vaginal native tissue repair for posterior compartment prolapse: long-term analysis of sexual function and quality of life in 151 patients. Female Pelvic Med Reconstr Surg. 2018;24(6):419–23.

    Article  PubMed  Google Scholar 

  31. Vollebregt A, Fischer K, Gietelink D, van der Vaart CH. Effects of vaginal prolapse surgery on sexuality in women and men; results from a RCT on repair with and without mesh. J Sex Med. 2012;9(4):1200–11.

    Article  PubMed  Google Scholar 

  32. Milani AL, Withagen MI, The HS, Nedelcu-van der Wijk I, Vierhout ME. Sexual function following trocar-guided mesh or vaginal native tissue repair in recurrent prolapse: a randomized controlled trial. J Sex Med. 2011;8(10):2944–53.

    Article  PubMed  Google Scholar 

  33. Schimpf MO, Abed H, Sanses T, White AB, Lowenstein L, Ward RM, et al. Graft and mesh use in transvaginal prolapse repair: a systematic review. Obstet Gynecol. 2016;128(1):81–91.

    Article  PubMed  Google Scholar 

  34. Holley RL, Varner RE, Gleason BP, Apffel LA, Scott S. Sexual function after sacrospinous ligament fixation for vaginal vault prolapse. J Reprod Med. 1996;41(5):355–8.

    CAS  PubMed  Google Scholar 

  35. Colombo M, Milani R. Sacrospinous ligament fixation and modified McCall culdoplasty during vaginal hysterectomy for advanced uterovaginal prolapse. Am J Obstet Gynecol. 1998;179(1):13–20.

    Article  CAS  PubMed  Google Scholar 

  36. Lukacz ES, Warren LK, Richter HE, Brubaker L, Barber MD, Norton P, et al. Quality of life and sexual function 2 years after vaginal surgery for prolapse. Obstet Gynecol. 2016;127(6):1071–9.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Hefni MA, El-Toukhy TA. Long-term outcome of vaginal sacrospinous colpopexy for marked uterovaginal and vault prolapse. Eur J Obstet Gynecol Reprod Biol. 2006;127(2):257–63.

    Article  PubMed  Google Scholar 

  38. Paraiso MF, Jelovsek JE, Frick A, Chen CC, Barber MD. Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial. Obstet Gynecol. 2011;118(5):1005–13.

    Article  PubMed  Google Scholar 

  39. Gupta P, Payne J, Killinger KA, Ehlert M, Bartley J, Gilleran J, et al. Analysis of changes in sexual function in women undergoing pelvic organ prolapse repair with abdominal or vaginal approaches. Int Urogynecol J. 2016;27(12):1919–24.

    Article  PubMed  Google Scholar 

  40. Siddiqui NY, Fulton RG, Kuchibhatla M, Wu JM. Sexual function after vaginal versus nonvaginal prolapse surgery. Female Pelvic Med Reconstr Surg. 2012;18(4):239–42.

    Article  PubMed  Google Scholar 

  41. Detollenaere RJ, Kreuwel IA, Dijkstra JR, Kluivers KB, van Eijndhoven HW. The impact of sacrospinous hysteropexy and vaginal hysterectomy with suspension of the uterosacral ligaments on sexual function in women with uterine prolapse: a secondary analysis of a randomized comparative study. J Sex Med. 2016;13(2):213–9.

    Article  PubMed  Google Scholar 

  42. Nager CW, Visco AG, Richter HE, Rardin CR, Rogers RG, Harvie HS, et al. Effect of vaginal mesh hysteropexy vs vaginal hysterectomy with uterosacral ligament suspension on treatment failure in women with uterovaginal prolapse: a randomized clinical trial. JAMA. 2019;322(11):1054–65.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Costantini E, Porena M, Lazzeri M, Mearini L, Bini V, Zucchi A. Changes in female sexual function after pelvic organ prolapse repair: role of hysterectomy. Int Urogynecol J. 2013;24(9):1481–7.

    Article  PubMed  Google Scholar 

  44. Zucchi A, Costantini E, Mearini L, Fioretti F, Bini V, Porena M. Female sexual dysfunction in urogenital prolapse surgery: colposacropexy vs. hysterocolposacropexy. J Sex Med. 2008;5(1):139–45.

    Article  PubMed  Google Scholar 

  45. Walters MD, Taylor S, Schoenfeld LS. Psychosexual study of women with detrusor instability. Obstet Gynecol. 1990;75(1):22–6.

    CAS  PubMed  Google Scholar 

  46. Salonia A, Zanni G, Nappi RE, Briganti A, Deho F, Fabbri F, et al. Sexual dysfunction is common in women with lower urinary tract symptoms and urinary incontinence: results of a cross-sectional study. Eur Urol. 2004;45(5):642–8; discussion 8.

    Article  PubMed  Google Scholar 

  47. Brubaker L, Chiang S, Zyczynski H, Norton P, Kalinoski DL, Stoddard A, et al. The impact of stress incontinence surgery on female sexual function. Am J Obstet Gynecol. 2009;200(5):562.e1–7.

    Article  Google Scholar 

  48. Yip SK, Chan A, Pang S, Leung P, Tang C, Shek D, et al. The impact of urodynamic stress incontinence and detrusor overactivity on marital relationship and sexual function. Am J Obstet Gynecol. 2003;188(5):1244–8.

    Article  PubMed  Google Scholar 

  49. Caruso S, Brescia R, Matarazzo MG, Giunta G, Rapisarda AMC, Cianci A. Effects of urinary incontinence subtypes on women’s sexual function and quality of life. Urology. 2017;108:59–64.

    Article  PubMed  Google Scholar 

  50. Clark A, Romm J. Effect of urinary incontinence on sexual activity in women. J Reprod Med. 1993;38(9):679–83.

    CAS  PubMed  Google Scholar 

  51. Jha S, Strelley K, Radley S. Incontinence during intercourse: myths unravelled. Int Urogynecol J. 2012;23(5):633–7.

    Article  PubMed  Google Scholar 

  52. Moran PA, Dwyer PL, Ziccone SP. Urinary leakage during coitus in women. J Obstet Gynaecol. 1999;19(3):286–8.

    Article  CAS  PubMed  Google Scholar 

  53. El-Azab AS, Yousef HA, Seifeldein GS. Coital incontinence: relation to detrusor overactivity and stress incontinence. Neurourol Urodyn. 2011;30(4):520–4.

    Article  PubMed  Google Scholar 

  54. Beji NK, Yalcin O, Erkan HA. The effect of pelvic floor training on sexual function of treated patients. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(4):234–8; discussion 8.

    Article  PubMed  Google Scholar 

  55. Bo K, Talseth T, Vinsnes A. Randomized controlled trial on the effect of pelvic floor muscle training on quality of life and sexual problems in genuine stress incontinent women. Acta Obstet Gynecol Scand. 2000;79(7):598–603.

    CAS  PubMed  Google Scholar 

  56. Zahariou AG, Karamouti MV, Papaioannou PD. Pelvic floor muscle training improves sexual function of women with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(3):401–6.

    Article  PubMed  Google Scholar 

  57. Wadie BS, Mansour A, El-Hefnawy AS, Nabeeh A, Khair AA. Minimum 2-year follow-up of mid-urethral slings, effect on quality of life, incontinence impact and sexual function. Int Urogynecol J. 2010;21(12):1485–90.

    Article  PubMed  Google Scholar 

  58. Szell N, Komisaruk B, Goldstein SW, Qu XH, Shaw M, Goldstein I. A meta-analysis detailing overall sexual function and orgasmic function in women undergoing midurethral sling surgery for stress incontinence. Sex Med. 2017;5(2):e84–93.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Bekker MD, Hogewoning CR, Wallner C, Elzevier HW, DeRuiter MC. The somatic and autonomic innervation of the clitoris; preliminary evidence of sexual dysfunction after minimally invasive slings. J Sex Med. 2012;9(6):1566–78.

    Article  PubMed  Google Scholar 

  60. Naumann G, Steetskamp J, Meyer M, Laterza R, Skala C, Albrich S, et al. Changes in sexual function and quality of life after single-incision mid-urethral sling for treatment of female stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol. 2013;168(2):231–5.

    Article  PubMed  Google Scholar 

  61. Tommaselli GA, D'Afiero A, Di Carlo C, Formisano C, Fabozzi A, Nappi C. Tension-free vaginal tape-O and -Secur for the treatment of stress urinary incontinence: a thirty-six-month follow-up single-blind, double-arm, randomized study. J Minim Invasive Gynecol. 2013;20(2):198–204.

    Article  PubMed  Google Scholar 

  62. Naumann G, Steetskamp J, Meyer M, Laterza R, Skala C, Albrich S, et al. Sexual function and quality of life following retropubic TVT and single-incision sling in women with stress urinary incontinence: results of a prospective study. Arch Gynecol Obstet. 2013;287(5):959–66.

    Article  PubMed  Google Scholar 

  63. Rogers RG, Bachmann G, Scarpero H, Jumadilova Z, Sun F, Morrow JD, et al. Effects of tolterodine ER on patient-reported outcomes in sexually active women with overactive bladder and urgency urinary incontinence. Curr Med Res Opin. 2009;25(9):2159–65.

    Article  CAS  PubMed  Google Scholar 

  64. Gubbiotti M, Giannantoni A, Cantaluppi S, Coluccia AC, Ghezzi F, Serati M. The impact of mirabegron on sexual function in women with idiopathic overactive bladder. BMC Urol. 2019;19(1):7.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Zachariou A, Mamoulakis C, Filiponi M, Dimitriadis F, Giannakis J, Skouros S, et al. The effect of mirabegron, used for overactive bladder treatment, on female sexual function: a prospective controlled study. BMC Urol. 2018;18(1):61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Khunda A, McCormick C, Ballard P. Sacral neuromodulation and sexual function: a systematic review and meta-analysis of the literature. Int Urogynecol J. 2019;30(3):339–52.

    Article  PubMed  Google Scholar 

  67. Kershaw V, Khunda A, McCormick C, Ballard P. The effect of percutaneous tibial nerve stimulation (PTNS) on sexual function: a systematic review and meta-analysis. Int Urogynecol J. 2019;30(10):1619–27.

    Article  PubMed  Google Scholar 

  68. Miotla P, Cartwright R, Skorupska K, Bogusiewicz M, Markut-Miotla E, Futyma K, et al. Impact of intravesical onabotulinumtoxinA on sexual function in women with OAB. Neurourol Urodyn. 2017;36(6):1564–9.

    Article  CAS  PubMed  Google Scholar 

  69. Cichowski SB, Komesu YM, Dunivan GC, Rogers RG. The association between fecal incontinence and sexual activity and function in women attending a tertiary referral center. Int Urogynecol J. 2013;24(9):1489–94.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Imhoff LR, Brown JS, Creasman JM, Subak LL, Van den Eeden SK, Thom DH, et al. Fecal incontinence decreases sexual quality of life, but does not prevent sexual activity in women. Dis Colon Rectum. 2012;55(10):1059–65.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Trowbridge ER, Morgan D, Trowbridge MJ, Delancey JO, Fenner DE. Sexual function, quality of life, and severity of anal incontinence after anal sphincteroplasty. Am J Obstet Gynecol. 2006;195(6):1753–7.

    Article  PubMed  Google Scholar 

  72. Lewicky CE, Valentin C, Saclarides TJ. Sexual function following sphincteroplasty for women with third- and fourth-degree perineal tears. Dis Colon Rectum. 2004;47(10):1650–4.

    Article  PubMed  Google Scholar 

  73. Andy UU, Amundsen CL, Honeycutt E, Markland AD, Dunivan G, Dyer KY, et al. Sacral neuromodulation versus OnabotulinumtoxinA for refractory urgency urinary incontinence: impact on fecal incontinence symptoms and sexual function. Am J Obstet Gynecol. 2019;221(5):513.e1–15.

    Article  CAS  Google Scholar 

Download references

Disclosures

Gabriela E. Halder: Nothing to disclose.

Rebecca G. Rogers: Royalties from Uptodate, Travel and stipend from IUGA, ABOG and ACOG.

Amanda B. White: Nothing to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gabriela E. Halder .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Halder, G.E., White, A.B., Rogers, R.G. (2021). Female Sexuality in Pelvic Floor Disorders. In: Balzarro, M., Li Marzi, V. (eds) Non-Neurogenic Bladder Dysfunctions. Urodynamics, Neurourology and Pelvic Floor Dysfunctions. Springer, Cham. https://doi.org/10.1007/978-3-030-57393-5_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-57393-5_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-57392-8

  • Online ISBN: 978-3-030-57393-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics