Fecal Incontinence Decreases Sexual Quality of Life, But Does Not Prevent Sexual Activity in Women
1Department of Surgery, University of California, San Francisco-East Bay, Oakland, California 2Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California 3Division of Research, Kaiser Permanente Northern California, Oakland, California 4Departments of Family and Community Medicine, University of California San Francisco, San Francisco, California 5Department of Surgery, University of California San Francisco, San Francisco, California 6Department of Medicine, University of California San Francisco, San Francisco, California.Diseases of the Colon & Rectum (Impact Factor: 3.75). 10/2012; 55(10):1059-1065. DOI: 10.1097/DCR.0b013e318265795d
BACKGROUND:: The impact of anal incontinence on women's sexual function is poorly understood. OBJECTIVE:: The aim of this study was to investigate the relationship between anal incontinence and sexual activity and functioning in women. DESIGN:: This is a cross-sectional study. SETTINGS:: This investigation was conducted in a community-based integrated health care delivery system. PATIENTS:: Included were 2269 ethnically diverse women aged 40 to 80 years. MAIN OUTCOME MEASURES:: Self-administered questionnaires assessed accidental leakage of gas (flatal incontinence) and fluid/mucus/stool (fecal incontinence) in the past 3 months. Additional questionnaires assessed sexual activity, desire and satisfaction, as well as specific sexual problems (difficulty with arousal, lubrication, orgasm, or pain). Multivariable logistic regression models compared sexual function in women with 1) isolated flatal incontinence, 2) fecal incontinence (with or without flatal incontinence), and 3) no fecal/flatal incontinence, controlling for potential confounders. RESULTS:: Twenty-four percent of women reported fecal incontinence and 43% reported isolated flatal incontinence in the previous 3 months. The majority were sexually active (62% of women without fecal/flatal incontinence, 66% with isolated flatal incontinence, and 60% with fecal incontinence; p = 0.06). In comparison with women without fecal/flatal incontinence, women with fecal incontinence were more likely to report low sexual desire (OR: 1.41 (CI: 1.10-1.82)), low sexual satisfaction (OR: 1.56 (CI: 1.14-2.12)), and limitation of sexual activity by physical health (OR: 1.65 (CI: 1.19-2.28)) after adjustment for confounders. Among sexually active women, women with fecal incontinence were more likely than women without fecal/flatal incontinence to report difficulties with lubrication (OR: 2.66 (CI: 1.76-4.00)), pain (OR: 2.44 (CI: 1.52-3.91)), and orgasm (OR: 1.68 (CI: 1.12-2.51)). Women with isolated flatal incontinence reported sexual functioning similar to women without fecal/flatal incontinence. LIMITATIONS:: The cross-sectional design prevented evaluation of causality. CONCLUSIONS:: Although most women with fecal incontinence are at high risk for several aspects of sexual dysfunction, the presence of fecal incontinence does not prevent women from engaging in sexual activity. This indicates that sexual function is important to women with anal incontinence and should be prioritized during therapeutic management.
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ABSTRACT: Introduction and hypothesis: To determine whether fecal incontinence (FI) is associated with sexual activity and to compare sexual function in women with and without FI. Methods: We conducted a retrospective chart review of all new patients seen in an academic urogynecology clinic. Women who reported fecal incontinence, as defined by loss of fecal material on the Wexner scale, were compared with those without fecal incontinence. We compared sexual activity and Pelvic Organ Prolapse Incontinence Sexual Questionnaire-12 (PISQ-12) scores between groups. Results: In our population of women with pelvic floor disorder, 588 women reported FI compared with 527 who did not. On multivariate analysis, FI was not associated with sexual activity status, but was associated with worsened PISQ-12 scores (p < 0.001). PISQ-12 item analysis found that women with FI reported more dyspareunia, fear, and avoidance of sexual activity with greater partner problems (all p <0.05) than women without FI. Conclusions: Women with FI were as likely to engage in sexual relations as women without FI; however, sexually active women with FI had poorer sexual function than those without FI.International Urogynecology Journal 02/2013; 24(9). DOI:10.1007/s00192-013-2044-8 · 1.96 Impact Factor
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ABSTRACT: To examine relationships among parity, mode of delivery, and other parturition-related factors with women's sexual function later in life. Self-administered questionnaires examined sexual desire, activity, satisfaction, and problems in a multiethnic cohort of women aged 40 years and older with at least one past childbirth event. Trained abstractors obtained information on parity, mode of delivery, and other parturition-related factors from archived records. Multivariable regression models examined associations with sexual function controlling for age, race or ethnicity, partner status, diabetes, and general health. Among 1,094 participants, mean (standard deviation) age was 56.3 (±8.7) years, 568 (43%) were racial or ethnic minorities (214 African American, 171 Asian, and 183 Latina), and 963 (88%) were multiparous. Fifty-six percent (n=601) reported low sexual desire; 53% (n=577) reported less than monthly sexual activity, and 43% (n=399) reported low overall sexual satisfaction. Greater parity was not associated with increased risk of reporting low sexual desire (adjusted odds ratio [OR] 1.08, confidence interval [CI] 0.96-1.21 per each birth), less than monthly sexual activity (adjusted OR 1.05, CI 0.93-1.20 per each birth), or low sexual satisfaction (adjusted OR 0.96, CI 0.85-1.09 per each birth). Compared with vaginal delivery alone, women with a history of cesarean delivery were not significantly more likely to report low desire (adjusted OR 0.71, CI 0.34-1.47), less than monthly sexual activity (adjusted OR 1.03, CI 0.46-2.32), or low sexual satisfaction (adjusted OR 0.57, CI 0.26-1.22). Women with a history of operative-assisted delivery were more likely to report low desire (adjusted OR 1.38, CI 1.04-1.83). Among women with at least one childbirth event, parity and mode of delivery are not major determinants of sexual desire, activity, or satisfaction later in life. LEVEL OF EVIDENCE:: II.Obstetrics and Gynecology 10/2013; 122(5). DOI:10.1097/AOG.0b013e3182a7f3fc · 5.18 Impact Factor
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ABSTRACT: To evaluate the association between different types of anal incontinence (AI) and Quality of Life (QoL) in late pregnancy. Cross-sectional study. Two maternity units in Norway 2009-2010. Primiparae aged 18 or over. Participants answered questions about AI during the last 4 weeks of pregnancy on the St. Mark's score and impact of QoL in the Fecal Incontinence QoL score. Socioeconomic data were obtained from hospital records. Self-reported AI and impact on QoL. 1571 primiparae responded; 573 (37%) had experienced AI during the last 4 weeks of pregnancy. One third of the incontinent women reported reduced QoL in the domain 'Coping'. 'Women experiencing urgency alone reported markedly better QoL compared to any other AI symptoms. AI appeared to have the strongest impact on the domains 'Coping' and 'Embarrassment'. Depression was only associated with experiencing the combination of all three symptoms [odds ratio (OR) 13; 95%confidence interval (CI) 3.2-51]. Experiencing flatus alone weekly or more was associated with the highest impact on 'Embarrassment' (OR 20; 95%CI 6.4-61) compared with all other symptoms or combination of AI symptoms, except the combination of all three AI symptoms. Between 3 and 10% of the primiparae in this material experienced AI to such a extent that it affected QoL. The greatest impact was seen in the QoL domain 'Coping'. These findings highlight the importance of an increased awareness of AI in late pregnancy among health professionals and the need to implement routine discussions about AI with expectant and new mothers.BJOG An International Journal of Obstetrics & Gynaecology 03/2014; 121(8). DOI:10.1111/1471-0528.12643 · 3.45 Impact Factor
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