Skip to main content

Advertisement

SpringerLink
Log in

Pathophysiology of sexual dysfunction as related to pelvic floor disorders

  • IUGA Female Sexual Dysfunction Roundtable 2008
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Female sexual dysfunction must be evaluated in the context of age, marital status, and general health status of the woman. Questionnaires evaluating the four domains of female sexual dysfunction can be used as a screening tool to evaluate the effect of pelvic floor disorders and coital leakage, as well as the effect of surgical methods and medical treatment on sexual function. Sexual problems are seldom volunteered symptoms, and only recording whether the woman has dyspareunia and frequency of sexual activity must be considered end-point parameters of a complex function. These parameters cannot explain the pathophysiological causes of the problem. There is a paucity of validated, easily accessible methods and parameters to objectively assess female sexual function.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fayyad A, Hill S, Gurung V, Prashar S, Smith A (2007) How accurate is symptomatic and clinical evaluation of prolapse prior to surgical repair. Int Urogynecol J 18:1179–1183

    Article  Google Scholar 

  2. Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler MA, Bent AE (2001) Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol 185:1332–1338

    Article  PubMed  CAS  Google Scholar 

  3. Mouritsen L, Larsen JP (2003) Symptoms, bother and POPQ in women referred with pelvic organ prolapse. Int Urogynecol J 14:122–127

    Article  Google Scholar 

  4. Swift SE (2000) The distribution of pelvic organ support in a population of women presenting for routine gynecologic healthcare. Am J Obstet Gynecol 180:277–285

    Article  Google Scholar 

  5. Altman D, Mellgren A, Kierkegaard J, Zetterström J, Falconer C, Lopez A (2004) Diagnosis of cystocele—the correlation between clinical and radiological evaluation. Int Urogynecol J Pelvic Floor Dysfunct 15(1):3–9

    Article  PubMed  Google Scholar 

  6. Kelleher CJ, Cardozo L, Khullar V, Salvatore S (1997) A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol 104:1374–1379

    PubMed  CAS  Google Scholar 

  7. Uebersax JS, Wyman Jf, Shumaker SA, McClish DK, Fantl JA (1995) Short form to assess life quality and symptom distress for urinary incontinence in women: the incontinence impact questionnaire and the urogenital distress inventory. Neurourol Urodun 14:131–139

    Article  CAS  Google Scholar 

  8. Shumaker SA, Wyman JF, Uebersax D (1994) Health related quality of life measures for women with urinary incontinence: the incontinence impact questionnaire and the urogenital distress inventory. Qual Life Res 3:291–306

    Article  PubMed  CAS  Google Scholar 

  9. Barber MD, Kuchhibhatla MN, Piper, Bump RC (2001) Psychometric evaluation of 2 comprehensive condition specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol 185:1388–1395

    Article  PubMed  CAS  Google Scholar 

  10. Milani R, Salvatore S, Soligo M, Pifarotti P, Meschia M, Cortese M (2005) Functional and anatomical outcome of anterior and posterior vaginal prolapse repair with prolene mesh. Br J Obstet Gynaecol 112:107

    Google Scholar 

  11. Davis TL, Lukacz E, Luber KM, Nager CW (2004) Determinants of patient satisfaction after the tension-free vaginal tape procedure. Am J Obstet Gynecol 191:176–181

    Article  PubMed  Google Scholar 

  12. Elkary EA, Kenton KS, Fitzgerald MP, Shott S, Brubaker L (2003) Patient-selected goals: a new perspective on surgical outcome. Am J Obstet Gynecol 189:1551–1558

    Article  Google Scholar 

  13. Kenton K, Pham T, Mueller E, Brubaker L (2007) Patient preparedness: an important predictor of surgical outcome. Am J Obstet Gynecol 197:654 e1–e6

    PubMed  Google Scholar 

  14. Lowenstein L, Kenton K, Pierce K, FitzGerald MP, Mueller E, Brubaker L (2007) Patient goals change after initial urogynecologic consultation. Am J Obstet Gynecol 197:640 e1–e3

    Article  PubMed  Google Scholar 

  15. Hullfish KL, Bovbjerg VE, Gibson J, Steers W (2002) Patient-centered goals for pelvic floor dysfunction surgery: what is success, and is it achieved? Am J Obstet Gynecol 187:88–92

    Article  PubMed  Google Scholar 

  16. Lowenstein L, FitzGerald MP, Kenton K, Dooley Y, Templehof M, Mueller ER, Brubaker L (2008) Patient selected goals: the fourth dimension in assessment of pelvic floor disorders. Int Urogynecol J 19:81–84

    Article  Google Scholar 

  17. Bitzer J, Platano G, Tschudin S, Alder J (2007) Sexual counselling for women in the context of physical diseases—a teaching model for physicians. J Sex Med 4:29–37

    Article  PubMed  Google Scholar 

  18. Tannenbaum C, Corcos J, Assalian P (2006) The relationship between sexual activity and urinary incontinence in older women. J Am Geriatr Soc 54:1220–1224

    Article  PubMed  Google Scholar 

  19. Leiblum S, Bachman G, Kemmann E (1983) Vaginal atrophy in the postmenopausal woman. JAMA 249:2195–2198

    Article  PubMed  CAS  Google Scholar 

  20. Sander P, Andersen JT, Mouritsen L (1996) Den åbne tværfaglige inkontinensklinik på Hvidovre Hospital. Ugeskr Laeger 158:5762–5767

    PubMed  CAS  Google Scholar 

  21. Rosen R, Lane R, Menza M (1999) Effects of SSRIs on sexual function: A critical Review. J Clin Psychopharmacol 19:67–85

    Article  PubMed  CAS  Google Scholar 

  22. Berman JR, Berman LA, Werbin TJ, Flaherty EE, Leahy NM, Goldstein I (1999) Clinical evaluation of female sexual function: effects of age and estrogen status on subjective and physiologic sexual responses. Int J Impot Res Suppl 1:S31–S38

    Article  Google Scholar 

  23. Sarrel PMn, Dobay B, Wiita B (1998) Estrogen and estrogen–androgen replacement in postmenopausal women dissatisfied with estrogen only therapy: sexual behaviour and neuroendocrine responses. J Reprod Med 43:847–855

    PubMed  CAS  Google Scholar 

  24. Suckling J, Lethaby A, Kennedy R (2003) Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev 4:CD001500

    PubMed  Google Scholar 

  25. Bolour S, Braunstein G (2005) Testosterone therapy in women: a review. Int J Impot Res 17:399–408

    Article  PubMed  CAS  Google Scholar 

  26. Laan E, van Lunsen RH, Evereaerd W (2001) The effect of tribolone on vaginal blood flow, sexual desire and arousability in postmenopausal women. Climacteric 4:28–41

    Article  PubMed  CAS  Google Scholar 

  27. Laan E, van Driel E, van Lunsen RHW (2003) Sexual responses of women with sexual arousal disorder to visual sexual stimuli. Tijdschr Seksual 27:1–13

    Google Scholar 

  28. Van Lunsen E, Rik HW, Laan E (2004) Genital vascular responsiveness and sexual feelings in midlife women: psychophysiology, brain, and genital imaging studies. Menopause 11(6, part 2):741–748

    Article  PubMed  Google Scholar 

  29. Laan E, Everaerd W, Evers A (1995) Assessment of female sexual arousal: response specificity and construct validity. Psychophysiology 32:476–485

    Article  PubMed  CAS  Google Scholar 

  30. Maas CP, ver Kuilen MM, Laan E, Tuijnman CC, Weijenborg PT, Trimbos JB, Kenter GG (2004) Objective assessment of sexual arousal in women with a history of hysterectomy. BJOG 111:456–462

    Article  PubMed  CAS  Google Scholar 

  31. Caruso S, Rugolo S, Bandiera S, Mirabella D, Cavallo A, Cianci A (2007) Clitoral blood flow changes after surgery for stress urinary incontinence: pilot study on TVT versus TOT procedures. Urology 70:554–557

    Article  PubMed  Google Scholar 

  32. Suh DD, Yang CC, Cao Y, Heiman JR, Garland PA, Maravilla KR (2004) MRI of female genital and pelvic organs during sexual arousal. J Psychosom Obstet Gynaecol 25:153–162

    Article  PubMed  CAS  Google Scholar 

  33. Basson R (2008) Womens’s sexual function and dysfunction: current uncertainties, future directions. Int J Impot Res 20:466–478

    Article  PubMed  CAS  Google Scholar 

  34. Pauls RN, Segal J, Silva WA, Kleeman SD, Karram M (2006) Sexual function inpatients presenting to a urogynecology practice. Int Urogynecol J 17:576–580

    Article  Google Scholar 

  35. Shaw C (2002) A systematic review of the literature on the prevalence of sexual impaiment in women with urinary incontinence and the prevalence of urinary leakage during sexual activity. Eur Urol 42:432–440

    Article  PubMed  Google Scholar 

  36. Hilton P (1988) Urinary incontinence during sexual intercourse: a common but rarely volunteered symptom. Br J Obstet Gynaecol 95:377–381

    PubMed  CAS  Google Scholar 

  37. Moran PA, Dwyer PL, Ziccone SP (1999) Urinary leakage during coitus in women. J Obstet Gynaecol 19:286–288

    Article  PubMed  CAS  Google Scholar 

  38. Khan Z, Bhola A, Starer P (1988) Urinay incontinence during orgasm. Urology 31:279–282

    Article  PubMed  CAS  Google Scholar 

  39. Salonia A, Zanni G, Nappi RE, Briganti A, Deho F, Fabbri F, Colombo R, Guazzoni G, Girolamo VD, Rigatti P, Montorsi F (2004) Sexual dysfunction is common in women with lower urinary tract symptoms and urinary incontinence: results of cross sectional study. Eur Urol 45:642–648

    Article  PubMed  Google Scholar 

  40. Coyne KS, Margolis MK, Jumadilova Z, Bavendam T, Mueller E, Rogers R (2007) Overactive bladder and women’s sexual health: what is the impact? J Sex Med 4:656–666

    Article  PubMed  Google Scholar 

  41. Coyne KS, Margolis MK, Jumadilova Z, Bavendam T, Mueller E, Rogers R (2007) Evaluating the impact of overactive bladder on sexual health in women: what is relevant? J Sex Med 4:124–136

    Article  PubMed  Google Scholar 

  42. Rogers R, Bachmann G, Jumadilova Z, Sun F, Morrow JD, Guan Z, Bavendam T (2008) Efficacy of tolterodine on overactive bladder symptoms and sexual and emotional quality of life in sexually active women. Int Urogynecol J 19:1551–1557

    Article  Google Scholar 

  43. Serati M, Salvatore S, Uccella S, Cromi A, Khullar V, Cardozo L, Bolis P (2008) Urinary incontinence at orgasm: relation to detrusore overactivity and treatment efficacy. Eur Urol 54:911–915

    Article  PubMed  Google Scholar 

  44. Mous M, Muller SA, de Leeuw JW (2008) Long-term effects of anal sphincter rupture during vaginal delivery: faecal incontinence and sexual complaints. BJOG 115:234–238

    Article  PubMed  CAS  Google Scholar 

  45. Thowbridge ER, Morgan D, Throwbridge MJ, DeLancey JOL, Fenner DE (2006) Sexual function, quality of life, and severity of anal incontinence after anal sphincteroplasty. Am J Obstet Gynecol 195:1753–1757

    Article  Google Scholar 

  46. Pendergrass PB, Reeves CA, Beloviecz MW, Molter DJ, White JH (1996) The shape and dimensions of the human vagina as seen in three-dimensional vinyl polysiloxane casts. Gynecol Obstet Invest 42:178–182

    Article  PubMed  CAS  Google Scholar 

  47. Handa VL, Harvey L, Cundiff GW, Siddique SA, Kjerulff KH (2004) Sexual function among women with urinary incontinence and pelvic organ prolapse. Am J Obstet Gynecol 191(3):751–756

    Article  PubMed  Google Scholar 

  48. Rogers GR, Villareal A, Kammerer-Doak, Qualls C (2001) Sexual function in women with and without urinary incontinence and/or pelvic organ prolapse. Int Urogynecol J 12:361–365

    Article  CAS  Google Scholar 

  49. Handa VL, Cundiff G, Chang HH, Helzlsouer KJ (2008) Female sexual function and pelvic floor disorders. Obstet Gynecol 111(5):1037–1038

    Google Scholar 

  50. Weber AM, Walters MD, Schover LR, Mitchinson A (1995) Sexual function in women with uterovaginal prolapse and urinary incontinence. Obstet Gynecol 85:483–487

    Article  PubMed  CAS  Google Scholar 

  51. Barber M, Visco AG, Wyman JF, Fantl JA, Bump RC (2002) Sexual function in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol 99:281–289

    Article  PubMed  Google Scholar 

  52. Nieminen K, Hiltunen R, Heiskanen E, Takala T, Niemi K, Merikari M, Heinonen PK (2008) Symptom resolution and sexual function after anterior vaginal wall repair with or without polypropylene mesh. Int Urogynecol J 19:1611–1616

    Article  Google Scholar 

  53. Achtari C, Dwyer PL (2005) Sexual function and pelvic floor disorders. Best Pact Res Clin Obstet Gynaecol 19:993–1008

    Article  Google Scholar 

  54. Rogers R, Kammerer-Doak D, Darrow A, Murray K, Olsen A, Barber M, Qualls C (2004) Sexual function after surgery for stress urinary incontinence and/or pelvic organ prolapse: a multicenter prospective study. Am J Obstet Gynecol 191:206–210

    Article  PubMed  Google Scholar 

  55. Weber AM, Walters MD, Piedmonte MA (2000) Sexual function and vaginal anatomy in women before and after surgery for pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 182:1610–1615

    Article  PubMed  CAS  Google Scholar 

  56. Abranov Y, Gandhi S, Botos SM, Goldberg RP, Sherman W, Rurak M, Sand PK (2005) Do alterations in vaginal dimensions after reconstructive pelvic surgeries affect the risk of Dyspareunia? Am J Obstet Gynecol 192:1573–1577

    Article  Google Scholar 

  57. Rane A, Lim YN, Withey G, Muller R (2004) Magnetic Resonance imaging findings following three different vaginal vault prolapse repair procedures: a randomised study. Aust Z J Obstet Gynecol 44:135–139

    Article  Google Scholar 

  58. Foon R, Toozs-Hobson P, Latthe PM (2008) Adjuvant materials in anterior vaginal wall prolapse surgery: a systematic review of effectiveness and complications. Int Urogynecol J 19:1697–1706

    Article  Google Scholar 

  59. Sentilhes L, Berthier A, Sergent F, Verspyck E, Descamps P, Marpeau L (2008) Sexual function in women before and after transvaginal mesh repair for pelvic organ prolapse. Int Urogynecol J 19:763–772

    Article  Google Scholar 

  60. Novi JM, Bradley CS, Mahmoud NN, Morgan MA, Arya LA (2007) Sexual function after rectocele repair with acellular porcine dermis graft versus vs site-specific rectovaginal fascia repair. Int Urogynecol J 18:1163–1169

    Article  Google Scholar 

  61. Dwyer PL, O’Reilly BA (2004) Transvaginal repair of anterior and posterior compartment prolapse with atrium polypropylene mesh. Br J Obstet Gynaecol 111:821–836

    Google Scholar 

  62. Sand PK, Koduri S, Lobel RW, Winkler HA, Tomezsko J, Culligan PJ (2001) Prospective randomized trial polyglactin 910 mesh to prevent recurrence of cystoceles and rectoceles. Am J Obstet Gynecol 184:1357–1362

    Article  PubMed  CAS  Google Scholar 

  63. Achtari C, McKenzie BJ, Hiscock R, Rosamilia A, Schierlitz L, Briggs CA, Dwyer PL (2006) Anatomical study of the obturator forarmen and dorsal nerve of the clitoris and their relationship tominimally invasive slings. Int Urogynecol J 17:330–334

    Article  Google Scholar 

  64. Bohrer J, Chen CC, Walters MD (2008) Pudendal neuropathy involving the perforating cutaneous nerve after cystocele repair with graft. Obstet Gynecol 112:496–498

    PubMed  Google Scholar 

  65. Labat J, Riant T, Robert R, Amarenco G, Lefaucher J, Rigaud J (2008) Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment. Neurourol Urodyn 27:306–310

    Article  PubMed  Google Scholar 

  66. Benson JT, McClellan E (1993) The effect of vaginal dissection on the pudendal nerve. Obstet Gynecol 82:387–389

    PubMed  CAS  Google Scholar 

  67. Connell K, Guess MK, Combe J, Wang A, Powers K, Lazarou G, Mikhail M (2005) Evaluation of the role of pudendal nerve integrity in female sexual function using non-invasive techniques. Am J Obstet Gynecol 192:1712–1717

    Article  PubMed  Google Scholar 

  68. Rosenbaum TY (2007) Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: a literature review. J Sex Med 4:4–13

    Article  PubMed  Google Scholar 

  69. der Zalm PJ, Lycklama a Nijeholt GAB, Elzevier HW, Putter H, Pelger RCM (2008) Diagnostic investigation of the pelvic floor: a helpful tool in the approach in patients with complaints of micturition, defecation, and/or sexual dysfunction. J Sex Med 5:864–871

    Article  Google Scholar 

  70. Both S, Laan E (2007) Simultaneous measurement of pelvic floor muscle activity and vaginal blood flow: a pilot study. J Sex Med 4:690–701

    Article  PubMed  Google Scholar 

  71. Gravina GL, Brandetti F, Martini P, Carosa E, Stasi SM, Morano S, Lenzi A, Jannini EA (2008) Measurement of the thickness of the urethrovaginal space in women with and without orgasme. J Sex Med 5:610–618

    Article  PubMed  Google Scholar 

  72. Zahariou A, Karamouti MV, Papaioannou PD (2008) Pelvic floor muscle training improves sexual function of women with stress urinary incontinence. Int Urogynecol J 19:401–406

    Article  Google Scholar 

  73. Bo K, Talseth T, Vinsnes A (2000) 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 79:598–603

    Article  PubMed  CAS  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Glostrup, Denmark

    Lone Mouritsen

Authors
  1. Lone Mouritsen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lone Mouritsen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mouritsen, L. Pathophysiology of sexual dysfunction as related to pelvic floor disorders. Int Urogynecol J 20 (Suppl 1), 19–25 (2009). https://doi.org/10.1007/s00192-009-0831-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-009-0831-z

Keywords

Search

Navigation