A Prospective Study of the Impact of Bladder Incontinence Surgery on Sexual Satisfaction
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A Prospective Study of the Impact of Bladder Incontinence Surgery on Sexual Satisfaction K. Witzke, DO, Gregory McIntosh, DO, FACOS, Jeffrey Schock, DO, FACOS, and Amy Brode DO Department of Urology, Michigan State University College of Osteopathic Medicine and Mt. Clemens Regional Medical Center
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A Prospective Study of the Impact of Bladder Incontinence Surgery on Sexual Satisfaction. K. Witzke, DO , Gregory McIntosh, DO, FACOS, Jeffrey Schock, DO, FACOS, and Amy Brode DO - PowerPoint PPT Presentation
Transcript of A Prospective Study of the Impact of Bladder Incontinence Surgery on Sexual Satisfaction
A Prospective Study of the Impact of Bladder
Incontinence Surgery on Sexual Satisfaction
A Prospective Study of the Impact of Bladder
Incontinence Surgery on Sexual Satisfaction
K. Witzke, DO, Gregory McIntosh, DO, FACOS, Jeffrey Schock, DO, FACOS, and Amy Brode DO
Department of Urology, Michigan State University College of Osteopathic Medicine and Mt. Clemens Regional Medical Center
K. Witzke, DO, Gregory McIntosh, DO, FACOS, Jeffrey Schock, DO, FACOS, and Amy Brode DO
Department of Urology, Michigan State University College of Osteopathic Medicine and Mt. Clemens Regional Medical Center
IntroductionIntroduction
• There is limited research done in the field of women’s sexual health.
• Women’s sexual dysfunction is age-related, progressive and common affecting up to 50% of women.1
• Women with lower urinary tract symptoms or incontinence have a deteriorating sexual life noted to be as high as 26-47%.2
1 A. Salonia, European Urology, 45 (2004), 642-6482 Dalpiaz O, et al, BJU Int. 2008, Mar;101 (6)717-21
• There is limited research done in the field of women’s sexual health.
• Women’s sexual dysfunction is age-related, progressive and common affecting up to 50% of women.1
• Women with lower urinary tract symptoms or incontinence have a deteriorating sexual life noted to be as high as 26-47%.2
1 A. Salonia, European Urology, 45 (2004), 642-6482 Dalpiaz O, et al, BJU Int. 2008, Mar;101 (6)717-21
Introduction:Introduction:
• Recent studies have addressed the overall lack of consideration in the area of sexual health for female patients undergoing pelvic surgery. 3,4
• There very few studies which incorporate patient’s partners and their sexual health.
3: Nappi R, et al, Clinical Biologic Pathophysiologiy of Women’s Sexual Dysfunction, J Sex Med 2005; 2:4-25.
4: Althof SE, et al, Current Perspectives on the clinical assessment and diagnosis of female sexual dysfunction and clinical studies of potential therapies: A statement of concern. J Sex Med 2005; 2,146-53.
• Recent studies have addressed the overall lack of consideration in the area of sexual health for female patients undergoing pelvic surgery. 3,4
• There very few studies which incorporate patient’s partners and their sexual health.
3: Nappi R, et al, Clinical Biologic Pathophysiologiy of Women’s Sexual Dysfunction, J Sex Med 2005; 2:4-25.
4: Althof SE, et al, Current Perspectives on the clinical assessment and diagnosis of female sexual dysfunction and clinical studies of potential therapies: A statement of concern. J Sex Med 2005; 2,146-53.
PurposePurpose
• It is our goal to survey female patients and their male partners both before and after incontinence surgery. We would like to identify if this surgery altered patients and/or their partners sexual satisfaction.
• It is our goal to survey female patients and their male partners both before and after incontinence surgery. We would like to identify if this surgery altered patients and/or their partners sexual satisfaction.
Materials and MethodsMaterials and Methods• Prospective pilot study from April 2007-2009 including female surgical patients and their monogamous male partners for one year duration.• Surgery included: Cystocele, Rectocele, Periurethral Injections, Sling Procedures, and Interstim insertion.
• Participants were 18-80 years of age.
• Four Validated questionnaires were utilized• Two for female patients
•Female Sexual Function Index (FSFI)•Sexual Distress Scale (SDS)
• Two for male partners:•International Index of Erectile Function (IIEF)•Sexual Distress Scale (SDS)
• Prospective pilot study from April 2007-2009 including female surgical patients and their monogamous male partners for one year duration.• Surgery included: Cystocele, Rectocele, Periurethral Injections, Sling Procedures, and Interstim insertion.
• Participants were 18-80 years of age.
• Four Validated questionnaires were utilized• Two for female patients
•Female Sexual Function Index (FSFI)•Sexual Distress Scale (SDS)
• Two for male partners:•International Index of Erectile Function (IIEF)•Sexual Distress Scale (SDS)
Materials and MethodsMaterials and Methods
• Each were instructed to answer the questionnaires in private at 3 intervals: pre-operatively, at 6 months, and 1 year.
• The initial questionnaire was filled out on the day of informed consent, the follow-up questionnaires were mailed out and sent back by self-addressed envelope.
• Each were instructed to answer the questionnaires in private at 3 intervals: pre-operatively, at 6 months, and 1 year.
• The initial questionnaire was filled out on the day of informed consent, the follow-up questionnaires were mailed out and sent back by self-addressed envelope.
ParticipantsParticipants
• 14 total participants (11 patients and 3 partners) were enrolled in this pilot study from April 2007-2009.• 6 patients and 1 partner were excluded from the study:• One patient did not have surgery.• Five patients and one partner withdrew from the study after obtaining only pre-operative surveys. (2 interstim, 2 TOT, 1 cystocele)
• 5 patients and 2 partners were included:• Two patients and one partner withdrew after obtaining 6 month follow-up data. (TOT, periurethral injection)
• Two patients returned only their 1 year questionnaire. (Cystocele and TOT)
• One couple completed all questionnaires. (Periurethral injection)
• 14 total participants (11 patients and 3 partners) were enrolled in this pilot study from April 2007-2009.• 6 patients and 1 partner were excluded from the study:• One patient did not have surgery.• Five patients and one partner withdrew from the study after obtaining only pre-operative surveys. (2 interstim, 2 TOT, 1 cystocele)
• 5 patients and 2 partners were included:• Two patients and one partner withdrew after obtaining 6 month follow-up data. (TOT, periurethral injection)
• Two patients returned only their 1 year questionnaire. (Cystocele and TOT)
• One couple completed all questionnaires. (Periurethral injection)
Data for PatientsData for Patients• The 19 question, FSFI data was scored using 6 domains• Higher scores indicate high satisfaction in each domain:• Desire (1.2-6.0)• Arousal (0-6.0) • Lubrication (0-6.0) • Orgasm (0-6.0)• Satisfaction (0-6.0)• Pain (0-6.0)
• The 19 question, FSFI data was scored using 6 domains• Higher scores indicate high satisfaction in each domain:• Desire (1.2-6.0)• Arousal (0-6.0) • Lubrication (0-6.0) • Orgasm (0-6.0)• Satisfaction (0-6.0)• Pain (0-6.0)
FSFI: 6 month dataFSFI: 6 month data
4.8
2.83.2
3.52.9
3.5
1.61.5
2.22.42.52.5
0.51
1.52
2.53
3.54
4.55
5.56
Pre-Op 6 months
A: Desire B: Arousal C: LubricationD: Orgasm E: Satisfaction F: Pain
FSFI: 6 month findingsFSFI: 6 month findings
•Desire: 54% decrease •Arousal: 21% decrease•Lubrication: 17% decrease•Orgasm: 18% decrease•Satisfaction: 6% decrease•Pain: 16% increase
•Desire: 54% decrease •Arousal: 21% decrease•Lubrication: 17% decrease•Orgasm: 18% decrease•Satisfaction: 6% decrease•Pain: 16% increase
FSFI: 1 year dataFSFI: 1 year data
2.6
1.72.02.0
3.0
2.0
3.2
4.0
3.2
4.94.3
3.6
0.51
1.52
2.53
3.54
4.55
5.56
Pre-Op 1 year
A: Desire B: Arousal C: LubricationD: Orgasm E: Satisfaction F: Pain
FSFI: 1 year findings
FSFI: 1 year findings
•Desire: 10% increase •Arousal: 38% increase•Lubrication: 20% increase•Orgasm: 49% increase•Satisfaction: 22% increase•Pain: 27% decrease
•Desire: 10% increase •Arousal: 38% increase•Lubrication: 20% increase•Orgasm: 49% increase•Satisfaction: 22% increase•Pain: 27% decrease
Data for Patients (SDS)
Data for Patients (SDS)
• The 12 question Sexual Distress Scale (SDS) was analyzed using total numbers. (0-48)
• Lower numbers are associated with less sexual distress
• Higher numbers indicate a more significant degree of sexual distress.
• The 12 question Sexual Distress Scale (SDS) was analyzed using total numbers. (0-48)
• Lower numbers are associated with less sexual distress
• Higher numbers indicate a more significant degree of sexual distress.
Patient SDS: 6 month and 1 year
Patient SDS: 6 month and 1 year
9.315.3
0.05.0
10.015.020.025.030.035.040.045.050.0
Pre-Op 6 month
SDS Total 6 month
16.0 14.3
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
Pre-Op 1 year
SDS Total 1 year
•SDS total 6 month: 13% increase in distress•SDS total 1 year: 3% decrease in distress
Data for PartnersData for Partners
• The 15 question, IIEF data was scored using 5 domains:
• A higher score indicates higher level of satisfaction.
•Erectile function (0-30) •Orgasm (0-10)•Desire (0-10) •Intercourse Satisfaction (0-15)•Overall Satisfaction (0-10)
• The 15 question, IIEF data was scored using 5 domains:
• A higher score indicates higher level of satisfaction.
•Erectile function (0-30) •Orgasm (0-10)•Desire (0-10) •Intercourse Satisfaction (0-15)•Overall Satisfaction (0-10)
IIEF: 6 month dataIIEF: 6 month data
22.5
9 8
1310
22
8 8
1310
0
5
10
15
20
25
30
Pre-Op 6 month
A: Erectile Function B: OrgasmC: Desire D: IntercourseE: Overall Satisfaction
IIEF: 6 month findingsIIEF: 6 month findings
• Erectile function: 2% decrease
• Orgasm: 10% decrease• Desire: no change
• Intercourse Satisfaction: no change
• Overall Satisfaction: no change
• Erectile function: 2% decrease
• Orgasm: 10% decrease• Desire: no change
• Intercourse Satisfaction: no change
• Overall Satisfaction: no change
IIEF: 1 year dataIIEF: 1 year data
28
106
15
10
27
8 8
15
10
0
5
10
15
20
25
30
Pre-Op 1 year
A: Erectile Function B: OrgasmC: Desire D: IntercourseE: Overall Satisfaction
IIEF: 1 year findingsIIEF: 1 year findings
• Erectile function: 3% decrease
• Orgasm: 20% decrease• Desire: 20% increase• Intercourse Satisfaction: no change
• Overall Satisfaction: no change
• Erectile function: 3% decrease
• Orgasm: 20% decrease• Desire: 20% increase• Intercourse Satisfaction: no change
• Overall Satisfaction: no change
Partner SDS: 6 month and 1 year
Partner SDS: 6 month and 1 year
8.5 10.0
0.05.0
10.015.020.025.030.035.040.045.050.0
Pre-Op 6 month
SDS Total 6 month
9.012.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
Pre-Op 1 year
SDS Total 1 year
•SDS total 6 month: 3% increase in distress•SDS total 1 year: 6% increase in distress
SummarySummaryPatients • An overall decrease in sexual satisfaction was noted in the 6 month group.
• An overall increase in sexual satisfaction was noted in the 1 year group.
Partners• An overall decrease in sexual satisfaction was found in the 6 month group.
• No definite trend in sexual satisfaction was found for the 1 year group.
Patients • An overall decrease in sexual satisfaction was noted in the 6 month group.
• An overall increase in sexual satisfaction was noted in the 1 year group.
Partners• An overall decrease in sexual satisfaction was found in the 6 month group.
• No definite trend in sexual satisfaction was found for the 1 year group.
Conclusion:Conclusion:
• The small amount of patients enrolled in this pilot study make it difficult to postulate any definitive conclusions.
• The intimate nature of these questions can be difficult for patients to answer, and may have attributed to our 50% drop-out rate.
• A larger number of participants, as well as a control group, would be recommended for further studies of this important topic.
• The small amount of patients enrolled in this pilot study make it difficult to postulate any definitive conclusions.
• The intimate nature of these questions can be difficult for patients to answer, and may have attributed to our 50% drop-out rate.
• A larger number of participants, as well as a control group, would be recommended for further studies of this important topic.
