Arabic validation of the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR)

Abstract

Introduction and hypothesis

Our aim was to translate then assess the reliability of the culturally adapted Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire, International Urogynecological Association (IUGA)-Revised (PISQ-IR) to assess sexual health among Arabic-speaking women with pelvic floor disorders.

Methods

PISQ-IR was modified to consider cultural characteristics of the Middle East. The final reliability study included 172 women with urinary incontinence (UI) and/or pelvic organ prolapse (POP). Participants completed the questionnaire twice: at enrollment and 2 weeks later.

Results

Among sexually active women, good internal consistency was observed for five of the six scales in the adapted instrument: Global Quality (Cronbach’s coefficient α = 0.86), Condition Impact (α = 0.87), Desire (α = 0.82), Condition Specific (α = 0.74), and Partner Related (α = 0.75). Internal consistency was acceptable for the Arousal Orgasm subscale (α = 0.66). However, among not sexually active women, internal consistency was poor (α <0.6) for all four scales. Lin’s concordance correlation coefficient measuring agreement between test and retest measurements [Lin’s concordance correlation coefficient (CCC); a value of 1 represents perfect agreement] ranged from 0.81 to 0.87 for the not sexually active scales, except for condition impact (CCC = 0.63.) For sexually active women, CCC was typically stronger, ranging from 0.85 to 0.96.

Conclusions

PISQ-IR questionnaire is easy to administer and reliable for assessing sexual function in sexually active Arabic women with POP and UI, but internal consistency is poor for Arabic women not sexually active.

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Abbreviations

FSD:

Female sexual dysfunction

POP:

Pelvic organ prolapse

QoL:

Quality of life

PISQ-IR:

Pelvic Organ Prolapse Incontinence Sexual Function Questionnaire, IUGA-Revised

IUGA:

International Urogynecological Association

UI:

Urinary incontinence

SA:

Sexually active

NSA:

Not sexually active

CCC:

Concordance Correlation Coefficient

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Acknowledgments

Special appreciation to IUGA R&D and IUGA Sexual Function Group for assisting with the translation process. This work was partially supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant UL1 TR000153.

Financial disclaimers/Conflicts of interest

A.S. El-Azab, M.D.: None

G.M. Ghoniem, M.D.: Uroplasty; research grant ROSE Registry (HS: 2011-8420)

S.Y. Leu, Ph.D.: None

D.V. Nguyen, Ph.D.: None

Authors’ contributions

A.S. El-Azab: data collection, manuscript writing, study conception and design

G.M. Ghoniem, M.D., FACS: study conception and design, manuscript writing

S.Y. Leu, Ph.D.: statistical analysis and interpretation, manuscript writing

D.V. Nguyen, Ph.D.: statistical analysis and interpretation, manuscript writing

Author information

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Authors

Corresponding author

Correspondence to Gamal M. Ghoniem.

Appendix

Appendix

Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR): Sexual function for women with pelvic organ prolapse, urinary Incontinence, and/or fecal incontinence

  1. Q1

    Which of the following best describes you?

    1. a.

      Not sexually active at all → Go to item Q2 - Not Active Section

    2. b.

      Sexually active normally with husband → Go to item Q7 - Sexually Active Section

    Sexualy inactive section (Q2 thru 6)

  2. Q2

    The following are reasons why you might not be sexually active with your husband. For each one, please indicate how strongly your agree or disagree with it as a reason that you are not sexual active

      Strongly agree Somewhat agree Somewhat disagree Strongly disagree
    a. Husband absent (traveling, divorced, passed away) 1 2 3 4
    b. No Interest 1 2 3 4
    c. Due to bladder or bowel problems (urinary or fecal incontinence) or due to prolapse 1 2 3 4
    d. Because of my other health problems 1 2 3 4
    e. Pain 1 2 3 4
  3. Q3

    How much does the fear of leaking urine and/or stool and/or a bulging in the vagina (either the bladder, rectum, or uterus falling out) cause you to avoid or restrict your sexual activity?

    1. 1.

      Not at all

    2. 2.

      A little

    3. 3.

      Some

    4. 4.

      A lot

  4. Q4

    For each of the following, please circle the number between 1 and 5 that best represents how you feel about your sex life.

    Rating
    a. Satisfied 1 2 3 4 5 Dissatisfied
    b. Adequate 1 2 3 4 5 Inadequate
  5. Q5

    How strongly do you agree or disagree with each of the following statements:

      Strongly agree Somewhat agree Somewhat disagree Strongly disagree
    a. I feel frustrated by my sex life 1 2 3 4
    b. I feel sexually inferior because of my incontinence and/or prolapse 1 2 3 4
    c. I feel angry because of the impact that incontinence and/or prolapse has on my sex life 1 2 3 4
  6. Q6

    Overall, how bothersome is it to you that you are not sexually active?

    1. 1.

      Not at all

    2. 2.

      A little

    3. 3.

      Some

    4. 4.

      A lot

    Sexually active section (Q7–20)

  7. Q7

    How often do you feel sexually aroused (physically excited or turned on) during sexual activity with your husband:

    1. 1.

      Never

    2. 2.

      Rarely

    3. 3.

      Sometimes

    4. 4.

      Usually

    5. 5.

      Always

  8. Q8

    When you are involved in sexual activity, how often do you feel each of the following?

      Never Rarely Sometimes Usually Almost always
    a. Fulfilled 1 2 3 4 5
    c. Shame 1 2 3 4 5
    d. Fear 1 2 3 4 5
  9. Q9

    How often do you leak urine and/or stool with any type of sexual activity?

    1. 1.

      Never

    2. 2.

      Rarely

    3. 3.

      Sometimes

    4. 4.

      Usually

    5. 5.

      Always

  10. Q10

    Compared to orgasms you have had in the past, how intense are your orgasms now?

    1. 1.

      Much less intense

    2. 2.

      Less intense

    3. 3.

      Same intensity

    4. 4.

      More intense

    5. 5.

      Much more intense

  11. Q11

    How often do you feel pain during sexual intercourse?

    1. 1.

      Never

    2. 2.

      Rarely

    3. 3.

      Sometimes

    4. 4.

      Usually

    5. 5.

      Always

  12. Q12

    What is the duration of your marriage?

  13. Q13

    How often does your husband have a problem during sexual intercourse (lack of arousal, desire, erection, etc.) that limits your sexual activity?

    1. 1.

      All of the time

    2. 2.

      Most of the time

    3. 3.

      Some of the time

    4. 4.

      Hardly ever/rarely

  14. Q14

    In general, would you say that your husband has a positive or negative impact on each of the following:

      Very positive Somewhat positive Somewhat negative Very negative
    a. Your sexual desire 1 2 3 4
    b. The frequency of your sexual activity 1 2 3 4
  15. Q15

    When you are involved in sexual activity with your husband, how often do you feel that you want more?

    1. 1.

      Never

    2. 2.

      Rarely

    3. 3.

      Sometimes

    4. 4.

      Usually

    5. 5.

      Always

  16. Q16

    How frequently do you have sexual desire? This may include wanting to have sex, having sexual thoughts or fantasies, etc.

    1. 1.

      Daily

    2. 2.

      Weekly

    3. 3.

      Monthly

    4. 4.

      Less often than once a month

    5. 5.

      Never

  17. Q17

    How would you rate your level (degree) of sexual desire or interest?

    1. 1.

      Very high

    2. 2.

      High

    3. 3.

      Moderate

    4. 4.

      Low

    5. 5.

      Very low or none at all

  18. Q18

    How much does the fear of leaking urine, stool, and/or a bulging in the vagina (prolapse) cause you to avoid sexual activity?

    1. 1.

      Not at all

    2. 2.

      A little

    3. 3.

      Some

    4. 4.

      A lot

  19. Q19

    For each of the following, please circle the number between 1 and 5 that best represents how you feel about your sex life.

    Rating
    a. Satisfied 1 2 3 4 5 Dissatisfied
    b. Adequate 1 2 3 4 5 Inadequate
    c. Confident 1 2 3 4 5 Not confident
  20. Q20

    How strongly do you agree or disagree with each of the following statements:

      Strongly agree Somewhat agree Somewhat disagree Strongly disagree
    a. I feel frustrated by my sex life 1 2 3 4
    b. I feel sexually inferior because of my incontinence and/or prolapse 1 2 3 4
    c. I feel embarrassed about my sex life 1 2 3 4
    d. I feel angry because of the impact that incontinence and/or prolapse has on my sex life 1 2 3 4

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El-Azab, A.S., Ghoniem, G.M., Leu, S. et al. Arabic validation of the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Int Urogynecol J 26, 1229–1237 (2015). https://doi.org/10.1007/s00192-015-2678-9

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Keywords

  • Questionnaire
  • Quality of life
  • Prolapse
  • Sexual dysfunction
  • Urinary incontinence
  • Fecal incontinence