Pelvic Floor Disorders and Sexuality 1: Urinary Incontinence

Urinary incontinence (UI) affects a quarter of female population. UI during sexual activity affects from 2 to 60% of women and negatively impacts their sexuality. Therefore, this symptom should be specifically addressed in the gynecologic visits. Women with UI present higher risk of sexual inactivity (5–38% of patients with UI are sexually inactive and 25–38% of sexually active women would restrict their sexual activity due to UI). Sexual dysfunction rate ranges from 23 to 56%, with women with mixed UI being the most affected. Different aspects of sexual response may be affected: lack of interest or arousal or lubrication, orgasmic disorder, lower sexual satisfaction, and poorer self-image and self-esteem, with dyspareunia being the more prevalent (8–44%). Most of the women with UI reported coping strategies regarding both partnered and solo sex. Therefore, health care professionals should investigate deeply into it to better understand the real impact of UI on women’s sexuality. There are different options to manage UI, which may also impact female sexuality. Overall, women’s sexuality improves after pelvic floor muscle training, pharmacological treatment, mid-urethral slings, bulking agents, sacral neuromodulation, and cognitive behavioral therapy in incontinent women. However, a subgroup of women can maintain, worsen, or develop a sexual dysfunction after those treatments. Further high-quality studies to understand the impact on sexual function of intravaginal devices, traditional surgeries, and energy-based therapies for SUI are needed. Health care professionals should be aware of treatments’ role to provide proper counseling to each patient considering their expectations on future sexual activity and function. A multidisciplinary biopsychosocial approach within the shared decision-making process to treat UI should be offered to all affected women.