Shortcomings/strengths of specific sexual function questionnaires currently used in urogynecology: a literature review

Validation of the Serbian version of the Pelvic Organ Prolapse/Urinary Incontinence/Sexual Questionnaire short form (PISQ-12)

INTRODUCTION AND HYPOTHESIS

Urinary incontinence (UI) and pelvic organ prolapse (POP) significantly decrease quality of life and sexual health. This study aimed to evaluate the reliability and validity of a Serbian adaptation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) used in assessing sexual function in women with UI and/or POP.

METHODS

This study included 416 women, 310 (74.5%) with UI and/or POP and 106 (25.5%) without UI and/or POP. The adaptation of the PISQ-12 to Serbian language was performed via back-translation. The content validity of the questionnaire was conducted by experts in the field. The reliability and validity of the PISQ-12 were analyzed. Evaluation of the data was performed using Content Validity Index (CVI), Cronbach's alpha, test-retest reliability, item total correlation and confirmatory factor analysis.

RESULTS

Content validity of the Serbian PISQ-12 was 1.00 (100%). Item total correlations were between 0.459 and 0.819 (P < 0.001). The PISQ-12 had an adequate and high internal consistency (Cronbach's alpha 0.806) as well as high test-retest reliability (Pearson correlation coefficient r = 0.807; P < 0.001). Factor analysis results revealed strong construct validity. The mean scores of PISQ-12 were significantly better in the control group compared with the women with UI and/or POP. Sexual function was negatively affected by UI and/or POP as assessed with SF-36 and I-QoL questionnaires.

CONCLUSIONS

This study showed that the Serbian version of the PISQ-12 is a reliable, consistent, valid and condition-specific instrument to assess sexual function in women with UI and/or POP.

Quality of Sexual Life after Native Tissue versus Polypropylene Mesh Augmented Pelvic Floor Reconstructive Surgery

There are still controversies around reconstructive surgeries used in POP treatment. The aim of this study was to compare the QoSL after VNTR vs. TVM surgery due to POP via the use of PISQ-12 and FSFI questionnaires. The study included a group of 121 sexually active patients qualified for reconstructive surgery due to symptomatic POP, and 50 control. The average results of PISQ-12 before and after surgery were compared using the t-test. The significance of the mean differences in demographic groups was measured using the t-test for independent samples and one-way ANOVA. The results in the demographic groups were compared using the Mann–Whitney U test and the Kruskal–Wallis test. Fifty-eight women had VNTR, while 63 had TVM. Results of PISQ-12 revealed significant improvement in the sexual life after reconstructive surgery (27.24 vs. 32.43; p < 0.001, t = 8.48) both after VNTR and TVM. There were no significant differences in the assessment of the QoSL according to PISQ-12 and FSFI results between both analyzed groups of patients (PISQ-12: VNTR vs. TVM; t-test p = 0.19 and FSFI: VNTR vs. TVM; Mann–Whitney U test p = 0.54). VNTR is the treatment of choice in the case of uncomplicated primary POP.

A systematic review of English language patient-reported outcome measures for use in urogynaecology and female pelvic medicine

INTRODUCTION

Patient-reported outcome measures (PROMs) are widely used in clinical practice and research in urogynaecology. There is no consensus on which PROMs should be used. No unifying document identifies all available PROMs and compares the psychometric properties of these.

METHODS

Systematic review of the literature following PRISMA guidelines. Studies where women had been administered an English-language PROM which assessed pelvic-floor symptomatology and psychometric properties had been reported were included.

RESULTS

85 PROMs assessing pelvic-floor symptoms in a urogynaecology population were identified. 43 PROMs assessed lower urinary tract symptoms in 95 studies, four PROMS assessed vaginal symptoms in seven studies, 20 PROMs assessed bowel symptoms in 27 studies and three PROMs assessed sexual symptoms in seven studies. 15 PROMs assessed two or more of these symptom areas in 60 studies. PROMs with the with the best available psychometric evidence within these five areas were (urinary symptoms) the Incontinence Quality-of-Life questionnaire (I-QOL aka ICIQ-UIqol) and International Consultation on Incontinence Questionnaire (ICIQ-UI-SF), (bowel symptoms) the Accidental Bowel Leakage Evaluation (ABLE) questionnaire and the International Consultation on Incontinence Bowel questionnaire (ICIQ-B), (vaginal symptoms) the Pelvic Organ Prolapse Symptom Score (POPSS), (sexual symptoms) the Pelvic organ prolapse- urinary Incontinence Sexual function Questionnaire- IUGA revised (PISQ-IR) and (comprehensive PROMs) the Australian Pelvic Floor Questionnaire and the Electronic Personal Assessment Questionnaire-Pelvic-Floor (ePAQ-PF).

CONCLUSIONS

Multiple PROMs with robust psychometric properties are available. Some widely used PROMs have weak evidence. Formal recommendations on which English-language PROMs to use within clinical practice and research in urogynaecology are required.

Sexual function specific questionnaires as a useful tool in management of urogynecological patients - Review

Urinary incontinence, fecal incontinence and pelvic organ prolapse are one of the most prevalent gynaecological conditions and constitute a huge global problem affecting approximately 20% of women, increasing with age. Pelvic floor disorders can have negative influence on women's quality of life, decreasing social, psychological, occupational, physical and sexual well-being. Pelvic organ prolapse results in anatomical changes to the urogenital tract and it is perceived to be one of the main factor influencing sexual function. Because treatment of pelvic organ prolapse and complications related to it may cause discomfort, the most important outcome of the therapy, including anatomical restoration, is relief in symptoms and improvement in quality of life. Psychometrical instruments for measuring health-related quality of life are essential during evaluation of women with pelvic floor disorders. Assessing severity of pelvic organ prolapse, its' impact on quality of life, therapy planning and the inclusion of sexuality questionnaires as an outcome measure in urogynecological patients allows to analyze impact of surgical treatment on women's sexual life. For this purpose, condition - specific instruments were developed and published. The aim of this study is to present particular questionnaires and their proper practical application in clinical practice, especially before surgical treatment and follow-up. Furthermore, those questionnaires are essential in order to describe patients' expectations during tailored clinical management.

Validation of the Polish version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire

INTRODUCTION AND HYPOTHESIS

The aim of the study was to develop a Polish version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) to evaluate sexual function in patients with stress urinary incontinence (SUI) and pelvic organ prolapse (POP) versus a control group.

METHODS

Before the validation study, a pilot study of the Polish version of the PISQ was performed in 22 women with pelvic floor dysfunctions. The respondents completed the questionnaire at recruitment and 2 weeks later. Test-retest reliability and internal consistency were determined. The validation study was performed in 249 sexually active women (123 with urodynamic SUI and POP; 126 healthy controls). The study group reported urinary incontinence (UI) at the urogynecological ambulatory clinic, where they underwent urogynecological and urodynamic examinations. All participants completed the questionnaire. PISQ results from both groups were compared and correlated with those of the King's Health Questionnaire (KHQ) and patient age.

RESULTS

Test-retest reliability was good according to Pearson's correlation coefficient (r = 0.89, p < 0.001). PISQ had high internal consistency (Cronbach's α = 0.878). The total PISQ score was significantly lower in the study group compared with the controls (83.6 ± 14.9 vs 95.7 ± 10.3, p < 0.001), as were scores for individual domains: Behavioral/Emotive, Physical, Partner-Related (33.9 ± 10.2 vs 39.8 ± 7.8, 31.7 ± 6.9 vs 37.1 ± 2.8, and 18.0 ± 3.1 vs 19.4 ± 2.6 respectively; p < 0.001), confirming the lower quality of sexual function in women with SUI and POP. A correlation between PISQ and KHQ scores and patient age was confirmed.

CONCLUSIONS

The Polish version of the PISQ is a reliable tool for evaluating sexual function in women with POP and UI.

Sexual function in older women with pelvic floor symptoms: a cross-sectional study in general practice

BACKGROUND

Pelvic floor symptoms are common and are negatively associated with sexual function which, in turn, is an important aspect of quality of life. The majority of older women with pelvic floor symptoms are treated in general practice but evidence from studies in general practice on the sexual functioning of these women is scarce.

AIM

This study examined predictors of sexual inactivity in older women with pelvic floor symptoms in general practice and of sexual functioning in those women who are sexually active.

DESIGN AND SETTING

Cross-sectional study in women (aged ≥55 years) from 20 general practices who screened positive on a pelvic floor symptom questionnaire.

METHOD

Logistic and linear regression analyses were used to determine predictors of sexual inactivity and sexual functioning (PISQ-12) by assessing their association with patient characteristics, symptoms (PFDI-20) and degree of prolapse (POP-Q).

RESULTS

A total of 639 women were included (sexually active n = 393, sexually inactive n = 246). Predictors of sexual inactivity were increasing age (odds ratio [OR] = 1.13; 95% confidence interval [CI] = 1.10 to 1.17) and lower education (OR = 2.31; 95% CI = 1.50 to 3.54; Nagelkerke R(2) = 0.208). In sexually active women, sexual functioning was associated with pelvic floor symptom distress (P<0.001) and pelvic floor surgery (P = 0.018; R(2) = 0.138).

CONCLUSION

In older women with pelvic floor symptoms, increasing age and lower educational level are predictors of sexual inactivity. Many of these older women are sexually active and pelvic floor symptom distress is negatively associated with sexual functioning. These results may encourage GPs to ask about sexual problems in women with pelvic floor symptoms.

Questionnaires in the assessment of sexual function in women with urinary incontinence and pelvic organ prolapse

CONTEXT

Integrating sexual health in clinical practice is important. In women with pelvic floor disorders, the evaluation of the anatomical defects, lower urinary tract function and the anorectal function often receives more attention than the sexual function.

METHODS

Review of Medline using defined search terms to identify articles related to sexual health assessment in urogynecology and manual analyses was performed. Only articles published in English or Spanish were included.

RESULTS

Only 50% of women attending urogynecological clinics are sexually active. Of those, 60% present with some sort of sexual sexual dysfunction (FSD). Questionnaires and sexuality scales would facilitate discussion of sexual matters between the Health Care professionals and the women, and may increase the likelihood of FSD being diagnosed. The Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ) and the PISQ-IR (IUGA-Revised) are the only female sexual function specific questionnaires currently validated and developed specifically to assess sexual function in women with urinary incontinence and/or pelvic organ prolapse. Furthermore, the PISQ-IR also allows evaluation of the outcomes of women who are not sexually active when requiring urogynecologic care. PISQ-IR is also designed for international validation. In order to use the PISQ-IR in Spain, a proper interpretation and validation of the questionnaire is needed.

CONCLUSIONS

The evaluation of sexual function through specific questionnaires facilitates the identification of the sexual dysfunctions associated to the pelvic floor disorders. The inclusion of sexuality questionnaires as an outcome measure allows to analyze the impact in the sexual life of women treated for an urogynecological problem.

A new measure of sexual function in women with pelvic floor disorders (PFD): the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR)

INTRODUCTION AND HYPOTHESIS

The objective of this study was to create a valid, reliable, and responsive sexual function measure in women with pelvic floor disorders (PFDs) for both sexually active (SA) and inactive (NSA) women.

METHODS

Expert review identified concept gaps and generated items evaluated with cognitive interviews. Women underwent Pelvic Organ Prolapse Quantification (POPQ) exams and completed the Incontinence Severity Index (ISI), a prolapse question from the Epidemiology of Prolapse and Incontinence Questionnaire (ISI scores), the Pelvic Floor Distress Inventory-20 (PFDI-20), and the Female Sexual Function Index (FSFI). Principle components and orthogonal varimax rotation and principle factor analysis with oblique rotation identified item grouping. Cronbach's alpha measured internal consistency. Factor correlations evaluated criterion validation. Change scores compared to change scores in other measures evaluated responsiveness among women who underwent surgery.

RESULTS

A total of 589 women gave baseline data, 200 returned surveys after treatment, and 147 provided test-retest data. For SA women, 3 subscales each in 2 domains (21 items) and for NSA women 2 subscales in each of 2 domains (12 items) emerged with robust psychometric properties. Cronbach's alpha ranged from .63 to .91. For SA women, correlations were in the anticipated direction with PFDI-20, ISI, and FSFI scores, POPQ, and EPIQ question #35 (all p < .05). PFDI-20, ISI, and FSFI subscale change scores correlated with Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire International Urogynecological Association-revised (PISQ-IR) factor change scores and with mean change scores in women who underwent surgery (all p < .05). For NSA women, PISQ-IR scores correlated with PFDI-20, ISI scores, and with EPIQ question #35 (all p < .05). No items demonstrated differences between test and retest (all p ≥ .05), indicating stability over time.

CONCLUSIONS

The PISQ-IR is a valid, reliable, and responsive measure of sexual function.

Pelvic floor dysfunction: women's sexual concerns unraveled

INTRODUCTION

Sexual function of women suffering from pelvic organ prolapse (POP) and/or urinary incontinence (UI) is adversely affected. However, our current understanding of the exact relationship between female sexual dysfunction and POP and/or UI is incomplete. A qualitative study can improve our understanding by describing what women themselves perceive as the real problem.

AIM

To gain a more in-depth understanding of the impact of POP and/or UI on the different categories of female sexual dysfunction by way of a qualitative study.

METHODS

Qualitative semistructured interviews were conducted in 37 women scheduled for pelvic floor surgery, and one was excluded from analysis due to incomplete recordings.

MAIN OUTCOME MEASURES

The impact of POP and/or UI on female sexual function.

RESULTS

Only 17% of women were completely positive about their sex life. Both POP and UI had a negative effect on body image. Women with POP had a negative image of their vagina, which caused them to be insecure about their partner's sexual experience, while women with UI were embarrassed about their incontinence and pad use, and feared smelling of urine. Worries about the presence of POP during sexual activity, discomfort from POP, and reduced genital sensations were the most important reasons for decreased desire, arousal, and difficulty reaching an orgasm in women with POP. Fear of incontinence during intercourse affected desire, arousal, and orgasm and could be a cause for dyspareunia in women with UI. Desire was divided into two main elements: "drive" and "motivation." Although "drive," i.e., spontaneous sexual interest, was not commonly affected by POP and/or UI, a decrease in "motivation" or the willingness to engage in sexual activity was the most common sexual dysfunction mentioned.

CONCLUSIONS

Body image plays a key role in the sexual functioning of women with POP and/or UI with the biggest impact on women's "motivation."

The effects of translating the Multidimensional Sexuality Questionnaire from English to Mandarin: a test of reliability and validity

BACKGROUND

In China, sexuality studies using validated psychosexual instruments are limited, with no valid Mandarin language version of a sexuality inventory with psychometric properties available for use. Thus, the Mandarin version of the Multidimensional Sexuality Questionnaire (M-MSQ), comprising four subscales, originating from the Multidimensional Sexuality Questionnaire, was tested for its psychometric properties.

METHODS

A convenience sampling technique was employed to recruit 200 oil workers (100 males and 100 females) in northern China. Originally, 158 participants (84 males and 74 females) completed the questionnaire; these accounted for 79% of the total study sample. From this group, a subsample of 50 participants (25 males and 25 females) was randomly selected to investigate the test-retest reliability. Of these, the responses of 33 participants (18 males and 15 females) were valid. The analysis on reliability was based on Cronbach's α, Pearson's correlation coefficient (r) and the intraclass correlation coefficient, also including evaluation on criterion validity and discriminatory validity.

RESULTS

The M-MSQ was found to be homogeneous in factor structure, comparing well with the original questionnaire. Both the discriminatory validity and the criterion-related validity were satisfactory in the total sample and gender groups, in addition, the overall reliability of the M-MSQ was sound in internal consistency with Cronbach's α=0.900-0.931. The results of the test-retest showed that the stability of the M-MSQ achieved a positive statistically significant standard assessed by Pearson's coefficient and the intraclass correlation coefficient.

CONCLUSION

The M-MSQ is reliable in these four subscales, and may be used as a measure of sexual esteem, sexual conscious, sexual motivation and sexual satisfaction in Mandarin speakers.

Impact of overactive bladder and lower urinary tract symptoms on sexual health in Japanese women

INTRODUCTION AND HYPOTHESIS

This study aims to assess whether lower urinary tract symptoms (LUTS) affect sexual function in Japanese females.

METHODS

A multi-component questionnaire was mailed to 576 female hospital workers. It contained the Female Sexual Function Index (FSFI) and a self-administered questionnaire pertaining to LUTS.

RESULTS

Of the 276 responses (overall response rate, 47.9%), 146 questionnaires were evaluable. LUTS had been experienced by 72 (49.3%) of the respondents, 17 (11.6%) had urge urinary incontinence, and 35 (24.0%) had stress urinary incontinence (SUI). The mean overall FSFI score was 22.4 ± 9.0. The mean FSFI score was not significantly different between women with LUTS and women without LUTS (23.2 ± 9.3 and 21.6 ± 8.8, respectively; P = 0.057). However, the mean FSFI score of women with SUI was significantly lower than that of women without it (P = 0.04). No other symptoms showed significant differences in FSFI scores.

CONCLUSIONS

Our results suggest that sexual dysfunction is related to SUI.