Sexual Function in Adult Patients With Spina Bifida and its Impact on Quality of Life

Division of Urology, Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104-4399, USA.
The Journal of Urology (Impact Factor: 4.47). 11/2007; 178(4 Pt 2):1611-4. DOI: 10.1016/j.juro.2007.03.162
Source: PubMed


We evaluated sexual function in adult patients with spina bifida and its impact on quality of life.
Between March 2005 and May 2006, 76 adult patients with spina bifida, including 34 women and 42 men, with a mean age of 24.4 years (range 18 to 37) were seen for followup at our institution. Following institutional review board approval data were collected from medical records and validated questionnaires were completed, including the Watts Sexual Function Questionnaire to assess sexual function and SF-36 to assess quality of life.
Of the 76 patients 18 (24%), including 9 women and 9 men, achieved sexual intercourse at least once in the last 2 months. There was no difference regarding gender distribution and mean age +/- SD in sexually active vs not sexually active patients (25.8 +/- 4.2 vs 24 +/- 4.5 years, p = 0.13). All levels (thoracic to sacral) of myelomeningocele were seen in the 2 groups with significant higher lesions of neurological impairment in not sexually active than in sexually active patients. No difference was seen in relation to ambulatory status and urinary incontinence. Overall total Watts Sexual Function Questionnaire scores in sexually active patients were similar in men and women. When comparing the 4 domain scores on desire, arousal, orgasm and satisfaction, women scored similar to men. Only 2 men tried to achieve paternity but failed and 1 woman gave birth. When evaluating SF-36 for quality of life, there was no significant difference in physical health (42.4 +/- 11.9 vs 38.7 +/- 7.2, p = 0.11) and mental health (54.1 +/- 11.3 vs 58.6 +/- 10.7, p = 0.12) subscores in sexually active vs not sexually active patients.
In our cohort 24% of adult patients with spina bifida were sexually active. Sexual activity was not related to gender, level of urinary incontinence or extent of physical disability but it was more likely in patients with more caudal levels of neurological impairment. Sexual function seems not to affect health related quality of life in these patients.

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    • "Masturbation or autoerotism was practised by 42% of them and 29% of them had experience of unwanted sexual contact [18]. Lassmann et al. reported that patients with an S1 lesion or lower were more sexually active than patients with a higher level lesion, as a reflection of their neurological and physical impairment [19]. Several studies have verified that urinary continence is a crucial predictor of successful sexual partnering. "
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    ABSTRACT: ObjectifsÉvaluer la sexualité des jeunes femmes adultes ayant un spina-bifida avec une myéloméningocèle. Matériel et méthodesUne étude transversale a été réalisée auprès de 44 femmes spina-bifida avec une myéloméningocèle âgées en moyenne de 27,66 ± 5,89 ans. Un autoquestionnaire a été envoyé par courrier postal. Il comprenait le bref index de la fonction sexuelle féminine (BISF-W) et des questions portant sur le mode mictionnel, les symptômes urinaires, l’aisance matérielle, le lieu de vie et le statut marital. Parallèlement, un recueil de données provenant des dossiers médicaux de chirurgie pédiatrique des patientes ayant répondu aux questionnaires a été effectué. RésultatsLe taux de réponse était de 56,8 %. L’ensemble des domaines de la sexualité féminine était altéré (pensées et désir sexuels, excitation sexuelle, fréquence, réceptivité et initiative, orgasme, satisfaction relationnelle, gêne dans la vie sexuelle). Le principal facteur de cette altération était l’incontinence urinaire et sa sévérité reflétée par la nécessité ou non de porter des protections. En effet, elle s’associait à une diminution du désir, de l’excitation sexuelle, de l’initiative et de la réceptivité, et la nécessité de porter des protections constituait un frein à la sexualité. ConclusionLes jeunes femmes adultes spina-bifida avec une myéloméningocèle ont une altération de l’ensemble des domaines de la sexualité. La présence d’une incontinence urinaire est associée à des scores de désir, de pensées, d’initiative, de réceptivité et d’excitation sexuelle plus faibles. Ces résultats plaident pour une prise en charge précoce de l’incontinence urinaire afin d’améliorer la sexualité de ces femmes. ObjectivesTo assess young spina-bifida women with myelomeningocele sexual function. Material and methodsA cross-sectional study was performed in 44 women, mean age 27.66 ± 5.89 years, with spinabifida and myelomeningocele. A self-administrated questionnaire was mailed. It included the Brief Index of Sexual Functioning for Women and questions about the mode of micturition, urinary symptoms, social and economic status, lifestyle and marital status. In parallel, data from the paediatric surgery records of the patients who responded to the questionnaire were collected. ResultsThe response rate was 56.8 %. All domains of the female sexual function (thoughts and desires, arousal, frequency of sexual activity, receptivity and initiation, pleasure and orgasm, relationship satisfaction) were altered. Urinary incontinence was the main factor of sexual function alteration. It was associated with lower thoughts and desires, arousal and receptivity and initiation scores. Moreover, wearing pads constituted a limitation to achieve intimacy. ConclusionSexual function of young women with spinabifida and myelomeningocele is poor. Urinary incontinence induced poor desires, arousal, receptivity and initiative. These plead to an early management of urinary incontinence in order to improve female sexuality. Mots clésSpina-bifida–Myéloméningocèle–Fonction sexuelle–Neuro-urologie–BISF-W KeywordsSpina-bifida–Myelomeningocele–Neurourology–Sexual function–BISF-W
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