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Stress urinary incontinence and LUTS in women—effects on sexual function

  • Review Article
  • Published:

From Nature Reviews Urology

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Key Points

  • The evaluation of sexual function in women with incontinence is often biased owing to association with other pelvic floor disorders

  • Three validated questionnaires are recommended by the International Continence Society for the assessment of sexual function in women with pelvic floor disorders: ICIQ-FLUTSsex, PISQ 31 and PISQ 12

  • Pelvic floor muscle training has been shown to improve sexual function in women with urinary incontinence

  • Polypropylene mesh midurethral slings are the standard of care for the surgical treatment of stress urinary incontinence; after surgery, sexual function tends to improve or remain unchanged

  • Insufficient data are currently available to recommend any particular type of midurethral sling over another in terms of sexual function

  • Cure of coital urinary incontinence is correlated with postoperative sexual satisfaction

Abstract

The sexual impact of urinary incontinence in women depends on a host of parameters, including physical, psychological, social and cultural dimensions. Evaluation of the effects of stress urinary incontinence (SUI) and lower urinary tract symptoms on sexual function is often biased by their common association with other pelvic floor disorders, such as pelvic organ prolapse, which also affect sexual satisfaction. Indeed, these complexities are reflected in the literature, which shows considerable disparity in sexual functional characteristics in women with incontinence both before and after treatment. This discordance is further emphasized by heterogeneity in study design, quality and analysis. Here, we describe the nature of sexual dysfunction in women with incontinence, including coital incontinence. The various treatments for SUI, which include transvaginal tape surgeries, can also affect sexual function, positively or negatively. Coital incontinence seems to be a good predictor of an improvement in postoperative sexual parameters: its cure, achieved by >90% of women, to a large extent explains the sexual benefits reported in several studies. By contrast, deterioration in sexual function is sometimes reported after surgery, with de novo or worsened dyspareunia being the most common cause. The literature does not contain any convincing arguments for one treatment or another on the basis of sexual functional outcome.

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Figure 1: Normal urethral support.
Figure 2: Tension-free vaginal tape.72
Figure 3: The transobturator procedure.77

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Authors and Affiliations

  1. Gynecology Department, Urogynecology Unit, University Hospital of Nîmes, CHU Caremeau, Place du Professeur Robert Debré, 30029, Nîmes Cedex 9, France

    Brigitte Fatton & Renaud de Tayrac

  2. Urology Department, University Hospital of Nîmes, CHU Caremeau, Place du Professeur Robert Debré, 30029, Nîmes Cedex 9, France

    Pierre Costa

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  1. Brigitte Fatton
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  2. Renaud de Tayrac
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  3. Pierre Costa
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B.F. researched the data for the article and wrote the manuscript. All authors reviewed and edited the manuscript before submission.

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Correspondence to Brigitte Fatton.

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Competing interests

B.F. declares that she has served as a consultant for: Allergan, Astellas, Rottapharm and Boston Scientific. R.d.T. declares he has served as a consultant for Boston Scientific, and has a parternship with Aspide Medical, Coloplast Sofradim-Covidien and Sanofi. P.C. declares that he has served as a consultant for AMS, Allergan, Astellas and Boston Scientific.

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Fatton, B., de Tayrac, R. & Costa, P. Stress urinary incontinence and LUTS in women—effects on sexual function. Nat Rev Urol 11, 565–578 (2014). https://doi.org/10.1038/nrurol.2014.205

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