1
|
Zhang M, Zhou Y, Yao S, Zhao Y, Batool SS, Huang J, Jiang L, Yan D, Yan W, Yu Z. Effect of stress urinary incontinence on vaginal microbial communities. BMC Microbiol 2024; 24:112. [PMID: 38575862 PMCID: PMC10993610 DOI: 10.1186/s12866-024-03237-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/26/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Postpartum women often experience stress urinary incontinence (SUI) and vaginal microbial dysbiosis, which seriously affect women's physical and mental health. Understanding the relationship between SUI and vaginal microbiota composition may help to prevent vaginal diseases, but research on the potential association between these conditions is limited. RESULTS This study employed 16S rRNA gene sequencing to explore the association between SUI and vaginal dysbiosis. In terms of the vaginal microbiota, both species richness and evenness were significantly higher in the SUI group. Additionally, the results of NMDS and species composition indicated that there were differences in the composition of the vaginal microbiota between the two groups. Specifically, compared to postpartum women without SUI (Non-SUI), the relative abundance of bacteria associated with bacterial dysbiosis, such as Streptococcus, Prevotella, Dialister, and Veillonella, showed an increase, while the relative abundance of Lactobacillus decreased in SUI patients. Furthermore, the vaginal microbial co-occurrence network of SUI patients displayed higher connectivity, complexity, and clustering. CONCLUSION The study highlights the role of Lactobacillus in maintaining vaginal microbial homeostasis. It found a correlation between SUI and vaginal microbiota, indicating an increased risk of vaginal dysbiosis. The findings could enhance our understanding of the relationship between SUI and vaginal dysbiosis in postpartum women, providing valuable insights for preventing bacterial vaginal diseases and improving women's health.
Collapse
Affiliation(s)
- Man Zhang
- Human Microbiome and Health Group, Department of Microbiology, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Yanhua Zhou
- Department of Rehabilitation Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Siqi Yao
- Human Microbiome and Health Group, Department of Microbiology, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Yiming Zhao
- Human Microbiome and Health Group, Department of Microbiology, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Syeda Sundas Batool
- Human Microbiome and Health Group, Department of Microbiology, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Jing Huang
- Department of Parasitology, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Li Jiang
- Department of Rehabilitation Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Dayu Yan
- Department of Gynecology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Wenguang Yan
- Department of Rehabilitation Medicine, The Third Xiangya Hospital, Central South University, Changsha, China.
| | - Zheng Yu
- Human Microbiome and Health Group, Department of Microbiology, School of Basic Medical Science, Central South University, Changsha, Hunan, China.
| |
Collapse
|
2
|
Ntakwinja M, Werth A, Borazjani A, Iglesia C, Williams KJ, Mukwege D. Pelvic floor symptoms among premenopausal women with pelvic organ prolapse in the Democratic Republic of the Congo. Int Urogynecol J 2024; 35:103-108. [PMID: 37897521 DOI: 10.1007/s00192-023-05670-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/26/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Most of the literature on pelvic organ prolapse (POP) has been generated from postmenopausal patients in high-income countries. In the Democratic Republic of the Congo (DRC), a significant proportion of patients who present for surgical management of POP are premenopausal. Little is known about the impact of POP on pelvic floor symptoms in this population. The objective was to describe pelvic floor symptoms and sexual function among premenopausal patients presenting for POP surgery in DRC. METHODS We performed a prospective cohort study of symptomatic premenopausal patients undergoing fertility-sparing POP surgery at a large referral hospital in the DRC. Pelvic floor symptoms were evaluated with the Pelvic Floor Distress Inventory Questionnaire and sexual function with the Pelvic organ prolapse/urinary Incontinence Sexual Questionnaire. Data are presented as means with standard deviations or counts with percentages. RESULTS A total of 107 patients were recruited between April 2019 and December 2021. All had either stage III (95.3%) or stage IV (4.7%) prolapse. Ages were 34.2 ± 6.7 years; 78.5% were married. A majority of patients experienced low abdominal pain (82.2%), heaviness or dullness (95.3%), and bulging or protrusion of the prolapse (92.5%). Almost two-thirds of patients reported no longer being sexually active, and 80% stated that they were not sexually active because of POP. Of the 37 sexually active patients (34.6%), nearly all reported significant sexual impairment because of the prolapse, with only 4 reporting no sexual impairment. CONCLUSIONS This study represents one of the largest prospective series of patients with premenopausal POP. Our results highlight the severity of pelvic floor symptoms and the negative effects on sexual function among this patient population with POP.
Collapse
Affiliation(s)
- Mukanire Ntakwinja
- Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
- Evangelical University in Africa, Bukavu, Democratic Republic of the Congo
| | - Adrienne Werth
- Global Innovations for Reproductive Health & Life, Chicago, IL, USA.
- Hartford Healthcare, Hartford, CT, USA.
| | - Ali Borazjani
- Global Innovations for Reproductive Health & Life, Chicago, IL, USA
- Department of Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cheryl Iglesia
- Departments of Obstetrics & Gynecology and Urology, MedStar Heath, Georgetown University School of Medicine, Washington, DC, USA
| | | | - Denis Mukwege
- Panzi General Referral Hospital, Bukavu, Democratic Republic of the Congo
- Evangelical University in Africa, Bukavu, Democratic Republic of the Congo
| |
Collapse
|
3
|
Chene G, Cerruto E, Moret S, Nohuz E. Long-Term Results after Bilateral Sacrospinous Colposuspension: A Prospective Study. J Clin Med 2023; 12:4691. [PMID: 37510805 PMCID: PMC10380842 DOI: 10.3390/jcm12144691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
The loss of apical support is usually present in patients with pelvic organ prolapse. An effective correction for the vaginal apex may be an essential part of a durable repair for these women. Apical suspension of the sacrospinous ligament is likely one of the best treatments by the vaginal route. We proposed the evaluation of the functional and anatomical long-term results of an ultralight and macroporous sling. In this prospective study, bilateral sacrospinous colposuspension was performed in 32 patients with a specific mesh. Functional assessment with several validated quality of life questionnaires and pelvic examination was performed at 1, 6, 12, and 24 months after surgery. Pelvic examination using the POP-Q classification showed a very good efficacy of the BSC mesh with only three prolapse recurrences at 24 months after surgery. All the following QoL scores were significantly improved by two years: PFIQ-7 (p < 0.0001), PFDI-20 (p < 0.0001), and SF-12 (p < 0.0001). No improvement was achieved by the PISQ12 questionnaire. This vaginal minimally invasive procedure is effective, quick, reproducible, and easy. It may be a relevant option for a vaginal vault or cervical or uterine prolapse.
Collapse
Affiliation(s)
- Gautier Chene
- Department of Gynecology, Hôpital Femme Mère Enfant (HFME), 59 Boulevard Pinel, University Hospital of Lyon, 69500 Bron, France
- EMR 3738 CICLY, University Claude Bernard of Lyon 1, 69000 Lyon, France
| | - Emanuele Cerruto
- Department of Gynecology, Hôpital Femme Mère Enfant (HFME), 59 Boulevard Pinel, University Hospital of Lyon, 69500 Bron, France
| | - Stephanie Moret
- Department of Gynecology, Hôpital Femme Mère Enfant (HFME), 59 Boulevard Pinel, University Hospital of Lyon, 69500 Bron, France
| | - Erdogan Nohuz
- Department of Gynecology, Hôpital Femme Mère Enfant (HFME), 59 Boulevard Pinel, University Hospital of Lyon, 69500 Bron, France
| |
Collapse
|
4
|
Chene G, Cerruto E, Moret S, Nohuz E. Mid-Term Results of a New Transobturator Cystocele Repair by Vaginal Patch Plastron without Mesh. J Clin Med 2023; 12:4582. [PMID: 37510696 PMCID: PMC10380496 DOI: 10.3390/jcm12144582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/19/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Cystoceles are the most common prolapses. Limitation of the use of synthetic mesh has led to the comeback of native tissue repair procedures. We have developed a new transobturator technique with native tissue based on a mix of a vaginal plastron technique and the transobturator procedure. We present the functional and anatomical mid-term results. In this retrospective study, the vaginal plastron technique and the transobturator procedure were performed in 32 patients. Functional assessment with several validated quality-of-life questionnaires (SF-12, PFIQ-7, PFDI-20, PISQ12) and anatomical evaluation with pelvic examination were performed at 1, 6, and 12 months after surgery. The anatomical success rate was 94.4% at 12 months. There was one Clavien-Dindo grade 2 postoperative complication (one urinary tract infection). All of the quality-of-life scores were statistically significantly improved at one year follow-up. The transobturator technique combined with the vaginal plastron seems to be a promising, effective, innovative, and relevant technique for the repair of high-stage cystoceles.
Collapse
Affiliation(s)
- Gautier Chene
- Department of Gynecology, Hôpital Femme Mère Enfant (HFME), University hospital of Lyon, 59 Boulevard Pinel, 69500 Bron, France
- EMR 3738 CICLY, Claude Bernard Lyon 1 University, 69000 Lyon, France
| | - Emanuele Cerruto
- Department of Gynecology, Hôpital Femme Mère Enfant (HFME), University hospital of Lyon, 59 Boulevard Pinel, 69500 Bron, France
| | - Stephanie Moret
- Department of Gynecology, Hôpital Femme Mère Enfant (HFME), University hospital of Lyon, 59 Boulevard Pinel, 69500 Bron, France
| | - Erdogan Nohuz
- Department of Gynecology, Hôpital Femme Mère Enfant (HFME), University hospital of Lyon, 59 Boulevard Pinel, 69500 Bron, France
| |
Collapse
|
5
|
Tian Z, Wang X, Fu L, Du Z, Sun Z. Impact of female stress urinary incontinence and related treatments on the sexual function of male partners: a systematic review and meta-analysis. J Sex Med 2023:7192113. [PMID: 37291077 DOI: 10.1093/jsxmed/qdad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/18/2023] [Accepted: 05/01/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND No conclusions have been reached on whether female stress urinary incontinence (SUI) and related treatments affect male partners' sexual function. AIM To assess the effects of female SUI and related treatments on male partners' sexual function. METHODS A comprehensive search of the PubMed, Embase, Web of Science, Cochrane, and Scopus databases was performed up to September 6, 2022. Studies were included that investigated the effect of female SUI and related treatments on male partners' sexual function. OUTCOME Male partners' sexual function. RESULTS Of the 2294 citations identified, 18 studies with 1350 participants were included. Two studies assessed the effect of female SUI without treatment on male partners' sexual function, finding that partners had more erectile dysfunction, more sexual dissatisfaction, and less sexual frequency than partners of women without urinary incontinence. Seven studies directly assessed the effect of female SUI treatments on male partners' sexual function by surveying the male partners. Among these, 4 assessed transobturator suburethral tape (TOT) surgery; 1 assessed TOT and tension-free vaginal tape obturator surgery; and the remaining 2 assessed pulsed magnetic stimulation and laser treatment. Among the 4 TOT studies, 3 used the International Index of Erectile Function (IIEF). TOT surgery significantly improved the total IIEF score (mean difference [MD] = 9.74, P < .00001), along with erectile function (MD = 1.49, P < .00001), orgasmic function (MD = 0.35, P = .001), sexual desire (MD = 2.08, P < .00001), intercourse satisfaction (MD = 2.36, P < .00001), and overall satisfaction (MD = 3.46, P < .00001). However, the improvements in IIEF items may be of unclear clinical significance, as 4 points in the erectile function domain of the IIEF are typically defined as the minimal clinically important difference. In addition, 9 studies indirectly assessed the effect of female SUI surgery on male partners' sexual function by surveying patients with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. The results demonstrated no significant differences in erectile function (MD = 0.08, P = .40) or premature ejaculation (MD = 0.07, P = .54). CLINICAL IMPLICATIONS The effects of female SUI and related treatments on male partners' sexual function were summarized for the first time, providing a reference for future clinical practice and scientific research. STRENGTHS AND LIMITATIONS A limited number of studies that used various scales met the standardized eligibility criteria. CONCLUSION Female SUI may affect male partners' sexual function, and female patients' anti-incontinence surgery does not appear to have a clinically significant improvement on the sexual function of their partners.
Collapse
Affiliation(s)
- Zhao Tian
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Xiuqi Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Linru Fu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Zhe Du
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| | - Zhijing Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing 100730, China
| |
Collapse
|
6
|
Dieter AA, Halder GE, Pennycuff JF, Singh R, El-Nashar SA, Lipetskaia L, Orejuela FJ, Jeppson PC, Sleemi A, Raman SV, Balk EM, Rogers RG, Antosh DD. Patient-Reported Outcome Measures for Use in Women With Pelvic Organ Prolapse: A Systematic Review. Obstet Gynecol 2023; 141:1098-1114. [PMID: 37073897 PMCID: PMC10524573 DOI: 10.1097/aog.0000000000005212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/23/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To describe the psychometric properties of existing patient-reported outcome measures for women with prolapse using the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) framework. Additional objectives were to describe the patient-reported outcome scoring method or interpretation, methods of administration, and to compile a list of the non-English languages in which the patient-reported outcomes are reportedly validated. DATA SOURCES PubMed and EMBASE was searched through September 2021. Study characteristics, patient-reported outcome details, and psychometric testing data were extracted. Methodologic quality was assessed with COSMIN guidelines. METHODS OF STUDY SELECTION Studies reporting the validation of a patient-reported outcome in women with prolapse (or women with pelvic floor disorders that included a prolapse assessment) and reporting psychometric testing data on English-language patient-reported outcome for at least one measurement property per COSMIN and the U.S. Department of Health and Human Services definitions were included, as well as studies reporting the translation of an existing patient-reported outcome into another language, a new method of patient-reported outcome administration, or a scoring interpretation. Studies reporting only pretreatment and posttreatment scores, only content or face validity, or only findings for nonprolapse domains of the patient-reported outcome were excluded. TABULATION, INTEGRATION, AND RESULTS Fifty-four studies covering 32 patient-reported outcomes were included; 106 studies assessing translation into a non-English language were excluded from the formal review. The number of validation studies per patient-reported outcome (one version of one questionnaire) ranged from 1 to 11. Reliability was the most reported measurement property, and most measurement properties received an average rating of sufficient. The condition-specific patient-reported outcomes had on average more studies and reported data across more measurement properties compared with adapted and generic patient-reported outcomes. CONCLUSION Although measurement property data vary on patient-reported outcomes for women with prolapse, most data were of good quality. Overall, condition-specific patient-reported outcomes had more studies and reported data across more measurement properties. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021278796.
Collapse
|
7
|
Impact of laparoscopic sacrocolpopexy (LSC) on sexual function in women with advanced stages of pelvic organ prolapse (POP): A five-year prospective study. Eur J Obstet Gynecol Reprod Biol 2023; 284:12-15. [PMID: 36907055 DOI: 10.1016/j.ejogrb.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE To compare patients undergoing laparoscopic sacrocolpopexy (LSC) for pelvic organ prolapse (POP), in terms of sexual function and surgical anatomical outcomes more than 5-years follow up period. STUDY DESIGN This is a cohort study of prospectively collected data that includes all women who underwent LSC between July 2005 and December 2021 at a tertiary care center. A total of 228 women were enrolled in this study. Patients completed a validated quality of life questionnaires and were evaluated using the POP-Q, the PFDI-20, PFIQ-7 and the PISQ-12 scores. Patients were divided preoperatively if they are sexually active or not and postoperatively according to the sexual improvement after POP surgery. RESULTS There was a statistically significant improvement in the PFDI, PFIQ and POPQ score. There was no significant improvement in the PISQ-12 score with more than 5 years follow-up. 76.1 % of patients who were not sexually active preoperatively resumed their sexual activity after the surgery. CONCLUSION The anatomical correction of a pelvic organ prolapse and pelvic floor disorders by laparoscopic sacrocolpopexy allowed a significant proportion (over ¾) of the women to resume sexual activity whom had not previously been sexually active. However, PISQ 12 scores did not alter significantly in those who were sexually active prior to surgery. Sexual function is a very complex issue affected by multitude of factors among which prolapse seems to be less important.
Collapse
|
8
|
Zakhour S, Sardinha A, Levitan M, Berger W, Nardi AE. Instruments for assessing sexual dysfunction in Arabic: A systematic literature review. Transcult Psychiatry 2022; 59:819-830. [PMID: 35818838 DOI: 10.1177/13634615221105120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Sexual health is relevant throughout a person's life; however, studying human sexuality is complex and requires particular care when working with individuals from different cultural and social backgrounds. Much of the research addressing this subject has been conducted in Western countries, and that in non-Western countries is generally based on small sample sizes. The biopsychosocial nature of sexuality and its dysfunctions should be taken into consideration given that it is indispensable when conducting and assessing sexual studies in different countries and cultures. Therefore, culturally sensitive studies that consider cultural contexts and determinants as well as social markers are needed. The topic of sexuality in Arab culture is still enigmatic. This enigma has impacted the advancement of sexual science and limited researchers, health care practitioners, and patients. Thus, the aim of this systematic literature review was to find and assemble all scales and questionnaires regarding human sexual health that have been translated into Arabic and validated in order to promote a critical analysis of the methods used in each instrument and to inform readers and researchers of the limits and potential of each scale. Electronic databases were systematically searched, and eight instruments were selected for inclusion: the Arabic Index of Premature Ejaculation (AIPE), the Sexual Health Inventory for Men (SHIM), the Arabic Female Sexual Function Index (ArFSFI), the Female Genital Self-Image Scale (AVFGSIS), the Arabic Arizona Sexual Experiences Scale (ASEX), the Egyptian Pelvic Organ Prolapse/Incontinence Sexual Questionnaire (PISQ-IR), the Saudi Arabian Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire in Arabic (PSIQ-IR), and the Arabic Female Sexual Distress Scale (FSDS). All included instruments showed good validity and reliability for the target population. Future studies are needed to develop culturally sensitive instruments.
Collapse
Affiliation(s)
- Stephanie Zakhour
- Institute of Psychiatry (IPUB), Department of Psychiatry & Legal Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | | | | | | |
Collapse
|
9
|
Cichowski S, Grzybowska ME, Halder GE, Jansen S, Gold D, Espuña M, Jha S, Al-Badr A, Abdelrahman A, Rogers RG. International Urogynecology Consultation: Patient Reported Outcome Measures (PROs) use in the evaluation of patients with pelvic organ prolapse. Int Urogynecol J 2022; 33:2603-2631. [PMID: 35980442 DOI: 10.1007/s00192-022-05315-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Patient-reported outcome measure instruments include patient-reported outcomes (PROs) and patient-reported goals (PRGs), which allow practitioners to measure symptoms and determine outcomes of treatment that matter to patients. METHODS This is a structured review completed by the International Urogynecology Consultation (IUC), sponsored by the International Urogynecological Association (IUGA). The aim of this working group was to evaluate and synthesize the existing evidence for PROs and PRGs in the initial clinical work-up/evaluation and research arena for patients with pelvic organ prolapse (POP). RESULTS The initial search generated 3589 non-duplicated studies. After abstract review by 4 authors, 211 full texts were assessed for eligibility by 2 writing group members, and 199 studies were reviewed in detail. Any disagreements on abstract or full-text articles were resolved by a third reviewer or during video meetings as a group. The list of POP PROs and information on PRGs was developed from these articles. Tables were generated to describe the validation of each PRO and to provide currently available, validated translations. CONCLUSIONS All patients presenting for POP should be evaluated for vaginal, bladder, bowel and sexual symptoms including their goals for symptom treatment. This screening can be facilitated by a validated PRO; however, most PROs provide more information than needed to provide clinical care and were designed for research purposes.
Collapse
Affiliation(s)
| | - Magdalena Emilia Grzybowska
- Department of Gynecology, Gynecological Oncology and Gynecological Endocrinology Medical University of Gdansk, Gdansk, Poland
| | | | | | - Daniela Gold
- Department of Gynecology, Medical University Graz, Graz, Austria
| | | | - Swati Jha
- Sheffield Teaching Hospitals NHS trust, Sheffield, UK
| | | | | | | |
Collapse
|
10
|
Rotstein E, von Rosen P, Karlström S, Knutsson JE, Rose N, Forslin E, Palmgren PJ, Tegerstedt G, Engberg H. Development and initial validation of a Swedish inventory to screen for symptoms of deficient perineum in women after vaginal childbirth: 'Karolinska Symptoms After Perineal Tear Inventory'. BMC Pregnancy Childbirth 2022; 22:638. [PMID: 35964017 PMCID: PMC9375344 DOI: 10.1186/s12884-022-04964-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Perineal tears are common after vaginal birth and may result in pelvic floor symptoms. However, there is no validated questionnaire that addresses long-term symptoms in women with a deficient perineum after vaginal birth. Thus, the objective of this study was to develop and psychometrically evaluate a clinical screening inventory that estimates subjective symptoms in women with a deficient perineum more than one year after vaginal delivery. Material and methods The development and psychometric evaluation employed both qualitative and quantitative methods. Qualitative strategies involved content validity and Think Aloud protocol for generation of items. The psychometric evaluation employed principal component analysis to reduce the number of items. The inventory was completed by women with persistent symptoms after perineal tears (N = 170). Results were compared to those of primiparous women giving birth by caesarean section (N = 54) and nulliparous women (N = 338). Results A preliminary 41-item inventory was developed, and the psychometric evaluation resulted in a final 11-item inventory. Women with confirmed deficient perineum after perineal trauma scored significantly higher on the symptoms inventory than women in control groups. A cut-off value of ≥ 8 could distinguish patients from controls with high sensitivity (100%) and specificity (87–91%). Conclusions The Karolinska Symptoms After Perineal Tear Inventory, is a psychometrically valid 11-item patient-reported outcome measure for symptoms of deficient perineum more than one year after vaginal birth. More research is needed to validate the inventory in various patient populations as well as its use in pelvic floor interventions. The inventory has the potential to improve patient counseling and care in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04964-w.
Collapse
Affiliation(s)
- Emilia Rotstein
- Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. .,Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.
| | - Philip von Rosen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Sofie Karlström
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Jona Elings Knutsson
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Nina Rose
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ellinore Forslin
- Department of Obstetrics and Gynecology, Hospital of Västmanland Västerås, Västerås, Sweden
| | - Per J Palmgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Tegerstedt
- Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Hedvig Engberg
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
11
|
Leanza V, Di Stefano A, Paladino EC, Rivoli L, Distefano REC, Palumbo M. Stasis ulcer and hydronephrosis after severe genital prolapse: a case report. J Med Case Rep 2022; 16:173. [PMID: 35477487 PMCID: PMC9047285 DOI: 10.1186/s13256-022-03405-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction and importance The most common complication of pelvic organ prolapse is stress urinary incontinence, whereas hydronephrosis or stasis ulcers are quite rare and typical of severe stages. The best treatment for this unusual presentation is still controversial. Here we present our approach. Case presentation Here we present the case of a 70-year-old White/Caucasian woman who presented to our hospital with genital procidentia lasting for 10 years that was associated with both hydronephrosis and stasis ulcers. Clinical findings and investigations The Pelvic Organ Prolapse Quantitation system was used to assess the severity of the prolapse, being evaluated as stage IV with the apical compartment leading. A thorough search of the literature was conducted to find any similar cases and evaluate the best evidence treatment. Interventions and outcomes A no-mesh procedure comprising vaginal hysterectomy, axial apex suspension, and anterior and posterior repair with ulcerated skin removal resulted in complete resolution of both mechanical and functional symptoms. At 3- and 6-month follow-up visits, a satisfying vaginal profile without hydronephrosis was seen. The Pelvic Organ Prolapse Quantitation at 6 months follow-up was as follows: Aa -3, Ba -3, C -7; gh 2, pb 3, tvt 9; Ap -3, Bp -3. Relevance and impact Pelvic organ prolapse involves many organs and causes further complications, leading seldom to renal insufficiency and stasis ulcers. A temporary solution to the obstruction can be achieved by utilizing a pessary, but this device cannot be applied when a stasis ulcer has been previously established. The use of mesh for pelvic floor repair is controversial, but a previous vaginal ulcer may represent a contraindication. A complete evaluation and a challenging surgery may allow the recovery of complicated and severe pelvic organ prolapse. Native tissue pelvic repair gives no erosion postsurgical risk, which is the typical complication of the prosthesis.
Collapse
Affiliation(s)
- Vito Leanza
- Ist. Patologia Ostetrica e Ginecologica, Department of General Surgery and Medical Surgical Specialities, University of Catania, Via Santa Sofia 78, 95100, Catania, Italy
| | - Alessandra Di Stefano
- Ist. Patologia Ostetrica e Ginecologica, Department of General Surgery and Medical Surgical Specialities, University of Catania, Via Santa Sofia 78, 95100, Catania, Italy
| | - Erika Carlotta Paladino
- Ist. Patologia Ostetrica e Ginecologica, Department of General Surgery and Medical Surgical Specialities, University of Catania, Via Santa Sofia 78, 95100, Catania, Italy
| | - Luca Rivoli
- Ist. Patologia Ostetrica e Ginecologica, Department of General Surgery and Medical Surgical Specialities, University of Catania, Via Santa Sofia 78, 95100, Catania, Italy
| | - Rosario Emanuele Carlo Distefano
- Ist. Patologia Ostetrica e Ginecologica, Department of General Surgery and Medical Surgical Specialities, University of Catania, Via Santa Sofia 78, 95100, Catania, Italy.
| | - Marco Palumbo
- Ist. Patologia Ostetrica e Ginecologica, Department of General Surgery and Medical Surgical Specialities, University of Catania, Via Santa Sofia 78, 95100, Catania, Italy
| |
Collapse
|
12
|
Heřmánková B, Špiritović M, Šmucrová H, Oreská S, Štorkánová H, Komarc M, Pavelka K, Šenolt L, Vencovský J, Bečvář R, Tomčík M. Female Sexual Dysfunction and Pelvic Floor Muscle Function Associated with Systemic Sclerosis: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:612. [PMID: 35010872 PMCID: PMC8744868 DOI: 10.3390/ijerph19010612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 02/04/2023]
Abstract
Only a few studies have addressed sexual health in patients with systemic sclerosis (SSc). This study aimed to compare female sexual function and pelvic floor muscle function in SSc patients with healthy controls (HC) matched by age, and to identify the potential implications of clinical features on sexual function. Our cohort included 90 women with SSc and 90 HC aged 18-70 years that completed six well-established and validated questionnaires assessing sexual function (Brief Index of Sexual Function for Women, Female Sexual Function Index, Sexual Quality of Life Questionnaire-Female, Sexual Function Questionnaire) and pelvic floor function (Pelvic Floor Impact Questionnaire-Short Form 7 and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire Short Form). Results from women with SSc and HC were contrasted and correlated with relevant clinical features. The prevalence of female sexual dysfunction was 73% in SSc patients (vs. 31% in HC). Women with SSc reported significantly worse pelvic floor function and sexual function than HC. Impaired sexual function was correlated with higher disease activity, the presence of dyspnea and interstitial lung disease, increased systemic inflammation, reduced physical activity, functional disability, more severe depression, more pronounced fatigue, and impaired quality of life. We demonstrate that sexual dysfunction is highly prevalent among women with SSc. This aspect of the disease deserves more attention both in clinical care and at the level of international research collaboration.
Collapse
Affiliation(s)
- Barbora Heřmánková
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic
| | - Maja Špiritović
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic
| | - Hana Šmucrová
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
| | - Sabína Oreská
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
| | - Hana Štorkánová
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic;
| | - Karel Pavelka
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
| | - Ladislav Šenolt
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
| | - Radim Bečvář
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
| | - Michal Tomčík
- Institute of Rheumatology, 128 00 Prague, Czech Republic; (B.H.); (M.Š.); (H.Š.); (S.O.); (H.Š.); (K.P.); (L.Š.); (J.V.); (R.B.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 121 08 Prague, Czech Republic
| |
Collapse
|
13
|
Robinson D, Prodigalidad LT, Chan S, Serati M, Lozo S, Lowder J, Ghetti C, Hullfish K, Hagen S, Dumoulin C. International Urogynaecology Consultation chapter 1 committee 4: patients' perception of disease burden of pelvic organ prolapse. Int Urogynecol J 2022; 33:189-210. [PMID: 34977951 DOI: 10.1007/s00192-021-04997-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/15/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This manuscript from Chapter 1 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) reports on the patients' perception of disease burden associated with pelvic organ prolapse. MATERIALS AND METHODS An international group containing a team of eight urogynaecologists, a physiotherapist and a statistician performed a search of the literature using pre-specified search terms in PubMed and Embase (January 2000 to August 2020). The division of sections within this report includes: (1) perception of POP and the relationship with body image and poor health; (2) a vaginal bulge as it impacts health and wellbeing in women; (3) the impact of POP on sexual life; (4) body image and pelvic floor disorders; (5) POP and mood; (6) appropriate use of treatment goals to better meet patients' expected benefits; (7) using health-related quality of life questionnaires to quantify patients' perception of POP; (8) The financial burden of POP to patients and society. Abstracts were reviewed and publications were eliminated if not relevant or did not include populations with POP or were not relevant to the subject areas as noted by the authors. The manuscripts were next reviewed for suitability using the Specialist Unit for Review Evidence (SURE) checklists for cohort, cross-sectional and case-control epidemiologic studies. RESULTS The original individual literature searches yielded 2312 references of which 190 were used in the final manuscript. The following perceptions were identified: (1) women were found to have varying perceptions of POP including shame and embarrassment. Some regard POP as consequence of aging and consider there is no effective therapy. (2) POP is perceived as a vaginal bulge and affects lifestyle and emotional wellbeing. The main driver for treatment is absence of bulge sensation. (3) POP is known to affect frequency of sexual intercourse but has less impact on satisfaction. (4) Prolapse-specific body image and genital self-image are important components of a women's emotional, physical and sexual wellbeing. (5) POP is commonly associated with depression and anxiety symptoms which impact HRQoL although are not correlated with objective anatomical findings. (6) Patient-centered treatment goals are useful in facilitating communication, shared decision-making and expectations before and after reconstructive surgery. (7) Disease-specific HRQoL questionnaires are important tools to assess bother and outcome following surgery, and there are now several tools with Level 1 evidence and a Grade A recommendation. (8) The cost of POP to the individual and to society is considerable in terms of productivity. In general, conservative measures tend to be more cost-effective than surgical intervention. CONCLUSIONS Patients' perception of POP varies in different patients and has a far-reaching impact on their overall state of health and wellbeing. However, recognizing that it is a combination of body image and overall health (which affects mental health) allows clinicians to better tailor expectations for treatment to individual patients. There are HRQoL tools that can be used to quantify these impacts in clinical care and research. The costs to the individual patient (which affects their perception of POP) is an area that is poorly understood and needs more research.
Collapse
Affiliation(s)
- Dudley Robinson
- Department of Urogynaecology, Kings College Hospital, London, UK.
| | - Lisa T Prodigalidad
- Division of Urogynaecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynaecology, University of the Philippines - College of Medicine, Philippine General Hospital, Manila, Philippines
| | - Symphorosa Chan
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | | | - Svjetlana Lozo
- Female Pelvic Medicine and Reconstructive Surgery, Columbia University Medical Centre, New York, NY, USA
| | - Jerry Lowder
- Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynaecology, Washington University, St Louis, MO, USA
| | - Chiara Ghetti
- Female Pelvic Medicine and Reconstructive Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Kathie Hullfish
- Departments of Obstetrics/Gynaecology and Urology, Division Female Pelvic Medicine and Reconstructive Surgery, UVA Health System, Charlottesville, VA, USA
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professionals Research Unit, Glasgow Caledonian University, Glasgow, Scotland
| | - Chantal Dumoulin
- Canadian Research Chair in Urogynaecological Health and Aging, University of Montreal, Montreal, Canada
| |
Collapse
|
14
|
Heřmánková B, Špiritović M, Oreská S, Štorkánová H, Komarc M, Klein M, Mann H, Pavelka K, Šenolt L, Vencovský J, Tomčík M. Sexual function in patients with idiopathic inflammatory myopathies: a cross-sectional study. Rheumatology (Oxford) 2021; 60:5060-5072. [PMID: 33956947 PMCID: PMC8566285 DOI: 10.1093/rheumatology/keab397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/27/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To date, there is almost no information concerning the sexual health of patients with idiopathic inflammatory myopathies (IIM). This cross-sectional study aimed to compare sexual function in patients with IIM to age-/sex-matched healthy controls (HC) and determine the potential impact of clinical features on sexual function. METHODS In total, 122 women (61 with IIM, 61 age-matched HC) and 22 men (11 with IIM, 11 age-matched HC) aged 18-80 years completed gender-specific selection of 7 well-established and validated questionnaires assessing sexual health and function (Female Sexual Function Index, Brief Index of Sexual Function for Women, Sexual Function Questionnaire, Sexual Quality of Life Questionnaire-Female, International Index of Erectile Function, Male Sexual Health Questionnaire, Sexual Quality of Life Questionnaire-Male). Results were compared between patients and HC and correlated with selected disease-related features. RESULTS The prevalence of sexual dysfunction in IIM was 59% in women (vs 40% in HC), and 64% (vs 9% in HC) in men. Men and women with IIM reported significantly impaired sexual function compared with sex-/age-matched HC. Decreased sexual function was associated with muscle weakness, disability, physical inactivity, fatigue, depression and decreased quality of life. CONCLUSIONS Our results suggest that sexual dysfunction is common among IIM patients and more attention should be paid to this aspect of the disease.
Collapse
Affiliation(s)
- Barbora Heřmánková
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Maja Špiritović
- Department of Physiotherapy, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
- Institute of Rheumatology, Prague, Czech Republic
| | - Sabína Oreská
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Štorkánová
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Komarc
- Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Martin Klein
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Heřman Mann
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karel Pavelka
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ladislav Šenolt
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Vencovský
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Michal Tomčík
- Institute of Rheumatology, Prague, Czech Republic
- Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| |
Collapse
|
15
|
Antosh DD, Megahed NN. Sexual Function After Pelvic Reconstructive Surgery. Obstet Gynecol Clin North Am 2021; 48:639-651. [PMID: 34416942 DOI: 10.1016/j.ogc.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Improvement in sexual function is an important goal for many women undergoing surgery for pelvic organ prolapse, and patient counseling regarding changes in sexual function and activity is necessary prior to pelvic reconstructive surgery. Based on validated questionnaires, sexual function either remains unchanged or improves after pelvic reconstructive surgery for prolapse, while dyspareunia prevalence is reduced. De novo dyspareunia ranges from 0% to 9% after various types of prolapse surgery, with the exception of posterior repair.
Collapse
Affiliation(s)
- Danielle D Antosh
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, 6550 Fannin Street, Suite 2221, Houston, TX 77030, USA.
| | - Nadia N Megahed
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, 6550 Fannin Street, Suite 2221, Houston, TX 77030, USA
| |
Collapse
|
16
|
Gray TG, Vickers H, Krishnaswamy P, Jha S. A systematic review of English language patient-reported outcome measures for use in urogynaecology and female pelvic medicine. Int Urogynecol J 2021; 32:2033-2092. [PMID: 34037815 DOI: 10.1007/s00192-021-04810-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/17/2021] [Indexed: 12/17/2022]
Abstract
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.
Collapse
Affiliation(s)
- Thomas G Gray
- Department of Urogynaecology and Pelvic Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, c/o Secretary, Room 27.3.024, Level Three, West Block, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
| | - Holly Vickers
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Priyanka Krishnaswamy
- Department of Urogynaecology, Queen Elizabeth University Hospital, G51 4TF, Glasgow, UK
| | - Swati Jha
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| |
Collapse
|
17
|
Hwang UJ, Lee MS, Jung SH, Ahn SH, Kwon OY. Relationship Between Sexual Function and Pelvic Floor and Hip Muscle Strength in Women With Stress Urinary Incontinence. Sex Med 2021; 9:100325. [PMID: 33662705 PMCID: PMC8072144 DOI: 10.1016/j.esxm.2021.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION The pelvic floor muscle (PFM) could affect female sexual functions. The hip muscles are morphologically and functionally linked to PFM and are important elements of female sexual attraction. AIM To determine the relationship between female sexual function and hip muscle strength and PFM functions in women with stress urinary incontinence (SUI). METHODS A total of 42 women with SUI were recruited in this study. Female sexual function was measured using the pelvic organ prolapse urinary incontinence sexual function questionnaire (PISQ). PFM functions were measured using a perineometer. Hip muscle strength was measured using a Smart KEMA tension sensor. The relationship between female sexual function and PFM function and hip muscle strength was assessed using Pearson correlation coefficients and multiple regression analyses with forward selection. MAIN OUTCOME MEASURES PISQ score, PFM functions (strength and endurance), and strength of hip extensor, abductor, and adductor were the main outcome measures. RESULTS For the behavioral/emotive domain in the PISQ, hip extensor strength (r = 0.452), PFM strength (r = 0.441), PFM endurance (r = 0.362), and hip adductor strength (r = 0.324) were significantly correlated and hip extensor strength emerged in multiple regression. For the physical domain in the PISQ, hip abductor strength (r = 0.417), PFM endurance (r = 0.356), hip adductor strength (r = 0.332), and PFM strength (r = 0.322) were significantly correlated and hip abductor strength entered in multiple regression. For partner-related domain in the PISQ, hip adductor (r = 0.386) and abductor strength (r = 0.314) were significantly correlated and hip adductor strength appeared in multiple regression. For the PISQ total score, hip extensor strength (r = 0.484), PFM endurance (r = 0.470), hip adductor strength (r = 0.424), hip abductor strength (r = 0.393), and PFM strength (r = 0.387) were significantly correlated and hip extensor strength and PFM endurance emerged in multiple regression. CONCLUSION The female sexual function could be related to not only PFM functions but also hip muscle strength in women with SUI. Hwang UJ, Lee MS, Jung SH, Ahn SH, Kwon OY. Relationship Between Sexual Function and Pelvic Floor and Hip Muscle Strength in Women With Stress Urinary Incontinence. Sex Med 2021;9:100325.
Collapse
Affiliation(s)
- U J Hwang
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea
| | - M S Lee
- Sophie-Marceau Women's Clinic, Daegu, South Korea
| | - S H Jung
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea
| | - S H Ahn
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, South Korea
| | - O Y Kwon
- Department of Physical Therapy, College of Health Science, Laboratory of Kinetic Ergocise Based on Movement Analysis, Yonsei University, Wonju, South Korea.
| |
Collapse
|
18
|
Heavy Load Carrying and Symptoms of Pelvic Organ Prolapse among Women in Tanzania and Nepal: An Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031279. [PMID: 33572663 PMCID: PMC7908160 DOI: 10.3390/ijerph18031279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
Heavy load carrying of water, firewood, and sand/stones is a ubiquitous activity for women living in developing countries. Although the intra-abdominal pressure associated with heavy load carrying is hypothesized to increase the risk of pelvic organ prolapse (POP) among women, relevant epidemiologic data are lacking. We conducted a comparative study involving two exploratory cross-sectional studies among convenience samples of women carrying heavy loads, with different characteristics: (1) as part of their activities for daily living, in Shinyanga region, Tanzania; and (2) working as sand miners in Pokhara, Nepal. Women were categorized has having “low” or “high” load-carrying exposures based on the measured weights of the loads being carried at the time of the survey, as well as on self-reported duration and frequency of load carrying. A summary score for lower abdominal discomfort suggestive of POP was generated using questions from the Pelvic Organ Prolapse Distress Inventory (POPDI-6). Women with higher load carrying exposures had on average higher discomfort scores in both Tanzania (adjusted prevalence difference (PDa) = 3.7; 95% CI: −3.8–11.3; p = 0.33) and Nepal (PDa = 9.3; 95% CI: −4.9–23.6; p = 0.18). We identified trends suggestive of an association between increasing heavy load carrying exposures and symptoms of lower abdominal discomfort. Our findings underscore the need for larger epidemiologic studies of the potential adverse reproductive health effects of heavy load carrying activities on women in developing countries.
Collapse
|
19
|
[Validation of a new self-questionnaire to assess sexuality in patients operated on for urinary incontinence or genital prolapse (Pelvi-Perineal Surgery Sexuality Questionnaire - PPSSQ)]. Prog Urol 2021; 31:671-682. [PMID: 33446471 DOI: 10.1016/j.purol.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/13/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The main objective of this study was to validate a new questionnaire evaluating sexual health, in a population of sexually active women or not, who have surgery for stress urinary incontinence or pelvic organ prolapse with or without mesh reinforcement. MATERIAL AND METHODS After the development of a first version of the questionnaire by members from the main French societies involved in the study of women's sexuality, a linguistic validation of the content of the questionnaire was carried out through semi-structured interviews. Then, a psychometric validation was carried out in a prospective multicenter cohort study. The questionnaire was evaluated in terms of acceptability, quality, dimensionality, internal consistency, temporal stability, sensitivity to changes and construction validity. RESULTS Linguistic validation was carried out in 25 patients. Psychometric validation was carried out in 297 women (291 with available data) operated on for urinary incontinence by midurethral sling (n=79) or for pelvic organ prolapse by the vaginal route with mesh (n=105), without mesh (n=22) or by laparoscopic sacrocolpopexy (n=85) between January 18, 2013 and January 18, 2016. Within the 288/291 women who had filed the question No. 1 allowing to know their sexual "status", 159 (55%) women were sexually active and 129 (45%) women were not sexually active before surgery. Within the 288 women, 165 had completed the questionnaire preoperatively and at 12 months and 111 had completed the questionnaire at 12 months and 12 months+1 week. The questionnaire was well accepted by the women and of good quality. All the questions were kept, but a change in the order and numbering of the questions had to be made. Two clinically relevant dimensions were identified in this analysis: a "sexual health" dimension comprising 5 questions and a "discomfort and pain" dimension comprising 3 questions. The overall questionnaire and both dimensions had good reliability and moderate to excellent temporal stability. A statistically significant association was demonstrated between question 15 and the improvement reported by PGI-I and the anatomical success rate on POP-Q classification. A strong correlation was found between the "sexual health" score and the total FSFI score. CONCLUSION The Pelvi-Perineal Surgery Sexuality Questionnaire (PPSSQ) is a 13-question self-questionnaire validated in a population of sexually active women or not, operated on for stress urinary incontinence or pelvic organ prolapse by laparoscopy or vaginal surgery, with or without mesh. LEVEL OF EVIDENCE 4.
Collapse
|
20
|
French validation of the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-IUGA revised (PISQ-IR). Int Urogynecol J 2021; 32:3183-3198. [PMID: 33399902 DOI: 10.1007/s00192-020-04625-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to clinically validate the French-translated PISQ-IR in a French-speaking population of women with pelvic floor disorders. METHODS We aimed to recruit 300 women to account for potential attrition secondary to failure to respond or loss to follow-up. Women were enrolled as part of an RCT and from a separate specific study. Both studies included surgically managed patients. Data were collected at recruitment, visit 1 (V1), V2 (9-12 months postoperatively) and V3 (V2 + 5-15 days). Participants also completed a PFDI 20, ICI-Q and FSFI and were assessed by POP-Q. RESULTS A total of 297 women were recruited between 18 January 2013 and 18 January 2016. Data were available for 291, 148 and 110 participants at V1, V2 and V3, respectively. The non-response rate for the NSA items varied from 5% to 30%, while for SA women, the non-response rate for the items varied from 0% to 15%. The tool was deemed reliable for five domains of the summary score. We also identified that several sections demonstrated acceptable to good temporal stability. A statistically significant score change was identified in different domains in the participants categorized as improved on either PGI-I or POP-Q. We also identified moderate to strong correlations between PISQ-IR and FSFI. CONCLUSIONS The French translated PISQ-IR has several strengths in support of its validity. Our findings confirm the validity of the summary scores in addition to the item-based initial scoring system.
Collapse
|
21
|
Pelvic Floor Sensations After the First Vaginal Delivery: A Qualitative Study. Female Pelvic Med Reconstr Surg 2021; 27:e234-e246. [PMID: 31145228 DOI: 10.1097/spv.0000000000000742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Current validated instruments to screen for pelvic organ prolapse and its sequelae address bulge symptoms, bowel and bladder changes, and sexual intimacy. However, sensitivity is lower in younger women, and there is no instrument specifically designed to screen in postpartum, primiparous women for early changes, that is, changes that may be noticed before the symptom of a bulge or signs of pelvic organ prolapse occur. Our goal was to elucidate early sensations of pelvic floor support changes in primiparous women after their first vaginal delivery. These could be the focus of future studies differentiating such sensations from a normal postpartum, aiding identification of women for further follow-up. METHODS Using comparative focused ethnographic methods, we purposefully sampled and interviewed 17 multiparous women diagnosed with pelvic organ prolapse and 60 primiparous women, half Euro-American and half Mexican American, English or Spanish speaking. Audiotapes were transcribed and then translated. Using inductive coding and matrix analysis, we used constant comparison across transcript data and clustered coded data into body systems-level matrices to arrive at categories of early changes. RESULTS We identified early changes by ethnic group in pelvic area sensations and bowel, bladder, and sexual function, including sensations not mentioned in extant questionnaires. CONCLUSIONS Early changes may be distressing but difficult for women to introduce in a clinical conversation. Querying these changes may enhance patient-provider communication. Future research is needed to validate these items in questionnaires designed to identify women with persistent early changes that may lead to subsequent objective pelvic organ prolapse.
Collapse
|
22
|
Tomoe H, Sekiguchi Y, Ozaki Y, Ninomiya N, Sato Y, Takahashi S. [LINGUISTIC VALIDATION OF JAPANESE VERSION OF THE VULVOVAGINAL SYMPTOMS QUESTIONNAIRE (VSQ)]. Nihon Hinyokika Gakkai Zasshi 2021; 112:173-178. [PMID: 36261346 DOI: 10.5980/jpnjurol.112.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
(Purpose) To translate the Vulvovaginal Symptoms Questionnaire (VSQ) into Japanese and evaluate the linguistic validation of the translated VSQ. (Methods) The translation and evaluation of the VSQ were performed through 3 steps: forward translation based on 2 urologists and discussed by another 3 urologists; the community review process, which consisted of one-on-one cognitive interviews with 20 patients by professional interviewers; backward translation by a native English speaker, which was discussed with the original author of the VSQ. (Results) The original author of the VSQ generally approved our translation. (Conclusion) The Japanese version of the VSQ was translated in a linguistically valid manner. It is equivalent to the original English questionnaire. It may provide a tool to assess sexual function for Japanese women with genitourinary syndrome of menopause.
Collapse
Affiliation(s)
- Hikaru Tomoe
- Department of Urology and Pelvic Reconstructive Surgery, Tokyo Women's Medical University Medical Center East
| | - Yuki Sekiguchi
- Department of Female Urology, Women's Clinic LUNA Nextstage
| | - Yumi Ozaki
- Department of Urology, Tokai Central Hospital
| | - Noriko Ninomiya
- Department of Female Urology, Women's Clinic LUNA Shinsaibashi
| | | | | |
Collapse
|
23
|
Sexual Activity and Dyspareunia 1 Year After Surgical Repair of Pelvic Organ Prolapse. Obstet Gynecol 2020; 136:492-500. [PMID: 32769645 DOI: 10.1097/aog.0000000000003992] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe sexual activity and risks for dyspareunia after pelvic organ prolapse surgery. METHODS This was a secondary analysis of data from four randomized trials conducted between 2002 and 2018. Standard assessments and validated measures of sexual function were assessed at baseline and at 12 months postoperatively. Anterior apical surgeries were grouped by approach: transvaginal native tissue repairs, transvaginal mesh or graft-augmented repairs, and abdominal sacrocolpopexy. Additional surgeries, which included posterior repair, hysterectomy, and slings, were analyzed. Bivariate analyses and logistic regression models identified risk factors for postoperative dyspareunia. RESULTS Of the 1,337 women enrolled in the trials, 932 had sufficient outcome data to determine dyspareunia status. Of these before surgery, 445 (47.8%) were sexually active without dyspareunia, 89 (9.6%) were sexually active with dyspareunia, 93 (10.0%) were not sexually active owing to fear of dyspareunia, and 305 (32.7%) were not sexually active for other reasons. At 12 months, dyspareunia or fear of dyspareunia was present in 63 of 627 (10.0%); occurred de novo in 17 of 445 (3.8%) and resolved in 136 of 182 (74.7%). Multivariable regression demonstrated baseline dyspareunia as the only factor associated with postoperative dyspareunia (adjusted odds ratio 7.8, 95% CI 4.2-14.4). No other factors, including surgical approach, were significantly associated with postoperative dyspareunia. Too few had de novo dyspareunia to perform modeling. CONCLUSION Dyspareunia is common in one in five women before undergoing prolapse surgery. Surgical repair resolves dyspareunia in three out of four women with low rates of de novo dyspareunia at less than 4%. Preoperative dyspareunia appears to be the only predictor of postoperative dyspareunia. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT00065845, NCT00460434, NCT00597935, and NCT01802281.
Collapse
|
24
|
Falconer C, Altman D, Poutakidis G, Rahkola-Soisalo P, Mikkola T, Morcos E. Long-term outcomes of pelvic organ prolapse repair using a mesh-capturing device when comparing single- versus multicenter use. Arch Gynecol Obstet 2020; 303:135-142. [PMID: 32915305 PMCID: PMC7854402 DOI: 10.1007/s00404-020-05764-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/24/2020] [Indexed: 11/05/2022]
Abstract
Purpose The aim of this study was to compare long-term effects of high-volume surgery at a single-center to multicenter use when using a mesh-capturing device for pelvic organ prolapse (POP) repair. Methods Five years after surgery 101 (88%) at the single center were compared with 164 (81.2%) in the multicenter trial. Outcome measurements included clinical examination, prolapse-specific symptom questionnaires [Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire—short form (PFIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)] and pain estimation by VAS (0–10). Results Optimal apical segment outcome was 95% in the single- compared to 83.3% in the multicenter study (p < 0.001). POP recurrence in the anterior and posterior walls (POP-Q, Ba and Bp ≥ 0) was more common at the multicenter as compared to the single center [(19.8% vs 5.4%) and (26% vs 2.7%), (p < 0.001)]. Reoperations for POP and mesh-related complications were more frequent in the multicenter study [31/202 (15.3%) vs 7/116 (6.1%), p < 0.001]. Total PFDI-20, PFIQ-7 and PISQ-12 scores were comparable between the cohorts. There were no significant differences in overall pain scores in-between the cohorts during follow-up. At the single center, 1/81 patients (1.2%) had VAS 7/10, i.e. severe pain, as compared to 3/131 (2.3%) in the multicenter study (p = 0.277). Conclusions Despite the high objective and subjective long-term effectiveness of the procedure in both regular use, and at a high-volume center, centralizing the use of a standardized capturing-device guided transvaginal mesh for POP repair reduced secondary interventions by more than half.
Collapse
Affiliation(s)
- Christian Falconer
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 171 77, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, 182 88, Stockholm, Sweden
| | - Daniel Altman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Georgios Poutakidis
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 171 77, Stockholm, Sweden.,Department of Obstetrics and Gynecology, Danderyd Hospital, 182 88, Stockholm, Sweden
| | - Päivi Rahkola-Soisalo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tomi Mikkola
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Folkhälsan Research Center, Helsinki, Finland
| | - Edward Morcos
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Obstetrics and Gynecology, Danderyd Hospital, 182 88, Stockholm, Sweden.
| |
Collapse
|
25
|
Ducey A, Donoso C, Ross S, Robert M. From anatomy to patient experience in pelvic floor surgery: Mindlines, evidence, responsibility, and transvaginal mesh. Soc Sci Med 2020; 260:113151. [PMID: 32738706 DOI: 10.1016/j.socscimed.2020.113151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/04/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022]
Abstract
Beginning in the late 1990s, surgeons around the world widely adopted the transvaginal placement of permanent synthetic mesh for the treatment of several common pelvic floor disorders in women. By 2012 it had become the subject of extensive litigation, including one of the biggest mass-tort cases in U.S. history, with litigants reporting debilitating and unexpected complications. Based on qualitative research that includes interviews with surgeons, observations of medical conferences, and analysis of archival materials, we argue the adoption of transvaginal mesh cannot be fully explained without recognizing the role of mindlines, or collective moral-epistemological ways of knowing and acting responsibly. The adoption of mesh was anchored in a mindline focused on repairing anatomy. The harms that resulted from transvaginal mesh necessitated a shift to a focus on patient experience. We analyze the role of evidence-based medicine (EBM) in the re-organization of these surgeons' mindlines, showing that mindlines are not reducible to evidence as defined by EBM and that evidence thus defined facilitated the adoption of transvaginal mesh.
Collapse
Affiliation(s)
- Ariel Ducey
- Department of Sociology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
| | - Claudia Donoso
- Graduate International Relations, St. Mary's University, San Antonio, TX, USA
| | - Sue Ross
- Women's Health Research, Department of Obstetrics and Gynaecology, Royal Alexandra Hospital, University of Alberta, Canada
| | - Magali Robert
- Cumming School of Medicine, Department of Obstetrics and Gynecology, University of Calgary, Canada
| |
Collapse
|
26
|
Writing in the Margins of Sexual Function Questionnaires: A Qualitative Analysis of Data From Women With Pelvic Floor Disorders. J Sex Med 2020; 17:1705-1714. [PMID: 32694067 DOI: 10.1016/j.jsxm.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/05/2020] [Accepted: 06/01/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND The impact of pelvic floor disorders (PFDs) on female sexual function is not well understood, partly due to difficulties in measurement and evaluation. AIM We sought to assess how women with PFDs respond to sexual function questionnaires through an analysis of survey marginalia, or the comments written in the margins of fixed-choice surveys. METHODS 94 women with PFDs completed validated written sexual function questionnaires (Global Study of Sexual Attitudes and Behaviors survey, Female Sexual Function Index, and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, International Urogynecological Association-Revised). Marginalia, or the additions, eliminations, and changes subjects made (by hand) to survey items, were collected. Data were coded and analyzed qualitatively using grounded theory methodology. OUTCOMES Themes and emergent concepts related to the content of survey marginalia were the primary outcomes of this study. RESULTS We observed 177 instances of marginalia across all questionnaires. Qualitative analysis revealed 7 preliminary themes and 2 emergent concepts. Preliminary themes included partner-related topics, loss, problems during intercourse, emotional problems, other medical problems, and survey answer choices failing to capture the spectrum of patient experiences. Emergent concepts revealed highly diverse sexual function in this population and a wide range of factors that influence sexual function. CLINICAL IMPLICATIONS Conducting qualitative studies alongside sexual function questionnaires can allow for a more meaningful assessment of the sexual function of women with various underlying conditions, such as PFDs. STRENGTHS & LIMITATIONS This is the first study of its kind to analyze survey marginalia from sexual function questionnaires among women with PFDs. The limitations of this study include the inherently spontaneous nature of marginalia data. In addition, the ways in which study participants responded to sexual function questionnaires in our study may not be reflective of all potential subjects. CONCLUSION Analysis of survey marginalia from sexual function questionnaires amongst women with PFDs revealed new information regarding patients' histories, concerns, and thoughts. Over half of the women in this study felt the need to expand, explain, or eliminate responses from the questionnaires. Many subjects were no longer sexually active, which accounted for a large majority of participants leaving questions blank or responding with "N/A." Standard sexual evaluation tools may fail to capture the complexity, spectrum, and depth and breadth of patient experiences. Parameshwar PS, Borok J, Jung E, et al. Writing in the Margins of Sexual Function Questionnaires: A Qualitative Analysis of Data From Women With Pelvic Floor Disorders. J Sex Med 2020;17:1705-1714.
Collapse
|
27
|
Effects of surface electrical stimulation during sitting on pelvic floor muscle function and sexual function in women with stress urinary incontinence. Obstet Gynecol Sci 2020; 63:370-378. [PMID: 32489983 PMCID: PMC7231947 DOI: 10.5468/ogs.2020.63.3.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/21/2019] [Accepted: 11/06/2019] [Indexed: 11/08/2022] Open
Abstract
Objective Dysfunction of the pelvic floor muscles (PFM) is associated with sexual dysfunction in women with stress urinary incontinence (SUI). The EasyK7 device was developed to stimulate the PFM by surface electrical stimulation during sitting (SESdS). We investigated the effects of SESdS on PFM function and sexual function in women with SUI. Methods Women with SUI were randomized into the SESdS and control groups. PFM function and sexual function were assessed using a perineometer and the pelvic organ prolapse–urinary incontinence sexual function questionnaire (PISQ), respectively. After 8 weeks, the groups were compared using either analysis of covariance with the baseline values as covariates or the paired Student's t-test. Results The final analysis included 16 subjects from each group. There were significant differences between the SESdS and control groups after the intervention, as well as within the SESdS group between the pre- and post-intervention measurements. The P-values for the differences in PFM measurements between the groups, and between the pre- and post- intervention measurements within the SESdS group, were 0.001 and 0.004 for power, 0.015 and 0.011 for strength, and 0.012 and 0.034 for endurance, respectively. In addition, in the PISQ, there were significant differences between the groups and between the pre- and post-intervention measurements within the SESdS group in the partner-related domain (between groups: P=0.003; within SESdS group: P=0.024) and total score (between groups: P<0.001; within SESdS group: P=0.001). Conclusion SESdS can improve PFM function and sexual function in women with SUI. Trial Registration Clinical Research Information Service Identifier: KCT0003357
Collapse
|
28
|
Hill AM, Shatkin-Margolis A, Smith BC, Pauls RN. Associating genital hiatus size with long-term outcomes after apical suspension. Int Urogynecol J 2019; 31:1537-1544. [DOI: 10.1007/s00192-019-04138-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/23/2019] [Indexed: 11/25/2022]
|
29
|
An update of a former
FIGO
Working Group Report on Management of Posterior Compartment Prolapse. Int J Gynaecol Obstet 2019; 148:135-144. [DOI: 10.1002/ijgo.13006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 09/04/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022]
|
30
|
Walters SJ, Jacques RM, Dos Anjos Henriques-Cadby IB, Candlish J, Totton N, Xian MTS. Sample size estimation for randomised controlled trials with repeated assessment of patient-reported outcomes: what correlation between baseline and follow-up outcomes should we assume? Trials 2019; 20:566. [PMID: 31519202 PMCID: PMC6743178 DOI: 10.1186/s13063-019-3671-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/20/2019] [Indexed: 12/02/2022] Open
Abstract
Background Patient-reported outcome measures (PROMs) are now frequently used in randomised controlled trials (RCTs) as primary endpoints. RCTs are longitudinal, and many have a baseline (PRE) assessment of the outcome and one or more post-randomisation assessments of outcome (POST). With such pre-test post-test RCT designs there are several ways of estimating the sample size and analysing the outcome data: analysis of post-randomisation treatment means (POST); analysis of mean changes from pre- to post-randomisation (CHANGE); analysis of covariance (ANCOVA). Sample size estimation using the CHANGE and ANCOVA methods requires specification of the correlation between the baseline and follow-up measurements. Other parameters in the sample size estimation method being unchanged, an assumed correlation of 0.70 (between baseline and follow-up outcomes) means that we can halve the required sample size at the study design stage if we used an ANCOVA method compared to a comparison of POST treatment means method. So what correlation (between baseline and follow-up outcomes) should be assumed and used in the sample size calculation? The aim of this paper is to estimate the correlations between baseline and follow-up PROMs in RCTs. Methods The Pearson correlation coefficients between the baseline and repeated PROM assessments from 20 RCTs (with 7173 participants at baseline) were calculated and summarised. Results The 20 reviewed RCTs had sample sizes, at baseline, ranging from 49 to 2659 participants. The time points for the post-randomisation follow-up assessments ranged from 7 days to 24 months; 464 correlations, between baseline and follow-up, were estimated; the mean correlation was 0.50 (median 0.51; standard deviation 0.15; range − 0.13 to 0.91). Conclusions There is a general consistency in the correlations between the repeated PROMs, with the majority being in the range of 0.4 to –0.6. The implications are that we can reduce the sample size in an RCT by 25% if we use an ANCOVA model, with a correlation of 0.50, for the design and analysis. There is a decline in correlation amongst more distant pairs of time points.
Collapse
Affiliation(s)
- Stephen J Walters
- School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Richard M Jacques
- School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | | | - Jane Candlish
- School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Nikki Totton
- School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Mica Teo Shu Xian
- School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, UK
| |
Collapse
|
31
|
Pelvic Organ Prolapse Repair Using the Uphold Vaginal Support System: 5-Year Follow-Up. Female Pelvic Med Reconstr Surg 2019; 25:200-205. [DOI: 10.1097/spv.0000000000000530] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
32
|
Dellenmark-Blom M, Sjöström S, Abrahamsson K, Holmdahl G. Health-related quality of life among children, adolescents, and adults with bladder exstrophy-epispadias complex: a systematic review of the literature and recommendations for future research. Qual Life Res 2019; 28:1389-1412. [PMID: 30725391 DOI: 10.1007/s11136-019-02119-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Bladder exstrophy-epispadias complex (BEEC) is a rare spectrum of genitourinary malformations. Children risk long-term urinary and genital dysfunctions. To achieve a comprehensive understanding, this study aimed to review the literature on generic and disease-specific health-related quality of life (HRQOL) in BEEC patients, and methodologies used. METHODS A literature search was conducted in Pubmed/CINAHL/Embase/PsycINFO/Cochrane, from inception to May 2018. A meta-analysis of HRQOL in BEEC patients compared to healthy references was performed. RESULTS Twenty-one articles (published 1994-2018), describing HRQOL of children and adolescents (n = 5) and adults only (n = 5), or integrated age populations (n = 11), were identified (median sample size 24, loss to follow-up 43%, response rate 84%). Overall HRQOL was reduced in BEEC patients compared to healthy references in 4/4 studies. Impaired physical or general health in BEEC patients has been described in 9 articles, diminished mental health in 11, restricted social health in 10, and sexual health/functioning or body perception impairments in 13 articles. Urinary incontinence was the most common factor related to worse HRQOL (12 studies). In six studies, HRQOL was better than healthy norms. In eligible studies (n = 5), the pooled estimate of the effect of BEEC indicated worse HRQOL for children and adults (0 > effect sizes < 0.5). Thirty-six HRQOL assessments were used, none developed and validated for BEEC. CONCLUSIONS HRQOL in BEEC patients may be negatively impacted, particularly considering mental and social HRQOL. Sexual health/functioning or body perception impairments may be present in adolescents and adults. However, HRQOL is heterogeneously assessed and subsequent findings are differently reported. Additional research is warranted and can be improved.
Collapse
Affiliation(s)
- Michaela Dellenmark-Blom
- Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, 416 85, Gothenburg, Sweden. .,Department of Pediatrics, The Queen Silvia Children's Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 416 86, Gothenburg, Sweden.
| | - Sofia Sjöström
- Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, 416 85, Gothenburg, Sweden.,Department of Pediatrics, The Queen Silvia Children's Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 416 86, Gothenburg, Sweden
| | - Kate Abrahamsson
- Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, 416 85, Gothenburg, Sweden.,Department of Pediatrics, The Queen Silvia Children's Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 416 86, Gothenburg, Sweden
| | - Gundela Holmdahl
- Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, 416 85, Gothenburg, Sweden.,Department of Pediatrics, The Queen Silvia Children's Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 416 86, Gothenburg, Sweden
| |
Collapse
|
33
|
|
34
|
Uterosacral Ligament Suspension Versus Robotic Sacrocolpopexy for Treatment of Apical Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 2019; 25:93-98. [DOI: 10.1097/spv.0000000000000704] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Buckingham L, Haggerty A, Graul A, Morgan M, Burger R, Ko E, Andy U, Giuntoli R. Sexual function following hysterectomy for endometrial cancer: A five-year follow up investigation. Gynecol Oncol 2018; 152:139-144. [PMID: 30420200 DOI: 10.1016/j.ygyno.2018.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/12/2018] [Accepted: 10/20/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVES We sought to determine a baseline and five-year follow up sexual function score in women undergoing hysterectomy for endometrial cancer. METHODS A cross-section of endometrial cancer patients receiving care from 2006 to 2010 was identified. Patients were surveyed during academic year 2011 using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ). Respondents were re-surveyed in 2016. The PISQ was also administered at a single time point to a control group of urogynecology patients. Statistical analyses were conducted using STATA software, version 13.1. RESULTS 129 endometrial cancer and 63 matched urogynecology patients responded to an initial survey and sufficiently answered the PISQ. There was no statistical difference in BMI, race, diabetes, or smoking history between groups. In 2011, 62.5% of endometrial cancer patients versus 72.6% of urogynecology patients reported sexual activity (p = 0.166). Median PISQ score for these groups was 33 [IQR 29-38] and 32 [IQR 28-37] respectively (p = 0.472). Twenty-nine (22%) endometrial cancer patients sufficiently answered the initial and 5-year follow up PISQ to be included in follow up analysis. Median PISQ score at five years was not significantly different from baseline: 31 [IQR 27-39] versus 33 [IQR 31-38] (p = 0.299). With multivariable modeling, no demographic or clinical characteristics of endometrial cancer patients were independently associated with sexual function (p = NS). CONCLUSIONS Sexual function for endometrial cancer patients was not significantly different from women treated for benign disease. Sexual function also remained stable for endometrial cancer patients regardless of time from initial treatment. Further prospective studies are needed to better characterize sexual function in endometrial cancer survivors.
Collapse
Affiliation(s)
- Lindsey Buckingham
- University of Pennsylvania Health System, 3400 Civic Center Blvd, Third Floor, West Pavilion, Philadelphia 19104, PA, USA.
| | - Ashley Haggerty
- University of Pennsylvania Health System, 3400 Civic Center Blvd, Third Floor, West Pavilion, Philadelphia 19104, PA, USA
| | - Ashley Graul
- University of Pennsylvania Health System, 3400 Civic Center Blvd, Third Floor, West Pavilion, Philadelphia 19104, PA, USA
| | - Mark Morgan
- University of Pennsylvania Health System, 3400 Civic Center Blvd, Third Floor, West Pavilion, Philadelphia 19104, PA, USA
| | - Robert Burger
- University of Pennsylvania Health System, 3400 Civic Center Blvd, Third Floor, West Pavilion, Philadelphia 19104, PA, USA
| | - Emily Ko
- University of Pennsylvania Health System, 3400 Civic Center Blvd, Third Floor, West Pavilion, Philadelphia 19104, PA, USA
| | - Uduak Andy
- University of Pennsylvania Health System, 3400 Civic Center Blvd, Third Floor, West Pavilion, Philadelphia 19104, PA, USA
| | - Robert Giuntoli
- University of Pennsylvania Health System, 3400 Civic Center Blvd, Third Floor, West Pavilion, Philadelphia 19104, PA, USA
| |
Collapse
|
36
|
Monti M, Schiavi MC, Colagiovanni V, Sciuga V, D'oria O, Cerone G, Scudo M, Zullo MA, Muzii L, Benedetti Panici P. Effectiveness, quality of life and sexual functions in women with anterior compartment prolapse treated by native tissue repair. ACTA ACUST UNITED AC 2018; 71:18-24. [PMID: 30291702 DOI: 10.23736/s0026-4784.18.04305-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Anterior compartment defect is the most common pelvic organ prolapse. It is defined as the descent of the bladder into the anterior vaginal wall. The etiology is multifactorial and the main risk factors are vaginal delivery and conditions associated with increased abdominal strain. Aging is significantly associated with the prevalence and severity of pelvic organ prolapse. Treatment may be conservative or surgical according to symptoms, prolapse degree and not forgetting both patient and doctor preferences. The aim of this work is to identify the most efficient surgical treatment of cystocele and its recurrences. There are two different surgical approaches for the treatment of cystocele: traditional repair and mesh repair. Prosthetic treatment gives higher anatomical success rate but traditional anterior repair has less complication demonstrating a lower risk of reoperation. Surgical treatment in general improves both the quality of life (QoL) and the sexual function. We carried out a research on the impact of the anterior defect before and after native tissue surgery on QoL and sexual function. The efficacy and complications of the treatment were also assessed.
Collapse
Affiliation(s)
- Marco Monti
- Department of Gynecological, Obstetric and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy -
| | - Michele C Schiavi
- Department of Gynecological, Obstetric and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Vanessa Colagiovanni
- Department of Gynecological, Obstetric and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Valentina Sciuga
- Department of Gynecological, Obstetric and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Ottavia D'oria
- Department of Gynecological, Obstetric and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Gennaro Cerone
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Maria Scudo
- Department of Gynecological, Obstetric and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Marzio A Zullo
- Department of Surgery-Week Surgery, Campus Biomedico University, Rome, Italy
| | - Ludovico Muzii
- Department of Gynecological, Obstetric and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecological, Obstetric and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| |
Collapse
|
37
|
Delay in Seeking Care for Pelvic Floor Disorders Among Caregivers. Female Pelvic Med Reconstr Surg 2018; 26:458-463. [PMID: 30045052 DOI: 10.1097/spv.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In 2015, 44 million adults were informal, unpaid caregivers to an adult or child. Caregiving (CG) is associated with poor self-care, higher depression rates, and decreased quality of life. Our primary objective was to determine if CG is associated with a delay in seeking care for pelvic floor disorders (PFDs). METHODS We performed a cross-sectional survey of new urogynecology patients from September 2015 to January 2016. Subjects completed the Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, Patient Reported Outcomes Measurement Information System-Depression surveys, and a survey of care-seeking practices. Caregiving was defined as considering one's self a primary caregiver and assisting with 2 or more activities and instrumental activities of daily living. Multiple logistic regression identified variables associated with delayed care-seeking for 1 or more year. RESULTS Two hundred fifty-six patients completed the survey, 82 caregivers (32%) and 174 noncaregivers (NCGs). Sixty-seven percent of caregivers cared for a child and 33% for an adult. There was no difference between caregivers and NCGs in PFD symptom duration, Pelvic Floor Distress Inventory, or Patient Reported Outcomes Measurement Information System depression scores. Caregiving had higher mean Pelvic Floor Impact Questionnaire scores (69.6 vs 51.0, P = 0.02). There was no difference in proportion of patients who delayed care for 1 year or more (42% vs 54%, P = 0.08). A higher proportion of caregivers for an adult waited for 1 year or more (75% vs 42% NCG, P = 0.001). On multiple logistic regression, CG for adults only was associated with delaying care for 1 year or more (adjusted odds ratio, 3.73; confidence interval, 1.33-10.44; P = 0.01). CONCLUSIONS One third of patients presenting to a urogynecology practice are caregivers. Caregiving for an adult was associated with a delay in seeking care for PFDs.
Collapse
|
38
|
van Dongen H, van der Vaart H, Kluivers KB, Elzevier H, Roovers JP, Milani AL. Dutch translation and validation of the pelvic organ prolapse/incontinence sexual questionnaire-IUGA revised (PISQ-IR). Int Urogynecol J 2018; 30:107-114. [PMID: 30008079 DOI: 10.1007/s00192-018-3718-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/26/2018] [Indexed: 01/23/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Condition-specific sexual questionnaires are important patient-reported outcome measures. The aim of this study was to translate and validate the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-International Urogynecology Association Revised (PISQ-IR) into Dutch. METHODS The translated PISQ-IR was linguistically validated, followed by psychometrical validation among women presenting with symptoms of pelvic floor dysfunction in urogynecology clinics. For analysis of the criterion validity, the Pelvic Floor Dysfunction Inventory-20 (PFDI-20) and Female Sexual Function Index (FSFI) were used. Descriptive statistics, floor and ceiling effects, internal consistency using Cronbach's alpha coefficient and Pearson's and Spearman's correlations were calculated for all PISQ-IR subscales. RESULTS The PISQ-IR was completed by 220 women, of whom 61 (27.7%) considered themselves not sexually active (NSA) and 159 (72.3%) sexually active (SA). The mean age of participating women was 57 years; 49.5% reported symptoms of pelvic organ prolapse (POP), 66.8% urinary incontinence and 2.3% anal incontinence. The PISQ-IR subscales were analyzed separately for SA and NSA women with Cronbach's alpha coefficient ranging from 0.61 to 0.87. Moderate to high correlations were observed between PISQ-IR subscales and corresponding FSFI subscales and a moderate correlation between urinary distress and the condition impact (CI) subscale among NSA subjects. CONCLUSIONS The Dutch PISQ-IR demonstrated a good internal consistency and criterion validity compared with the FSFI, but criterion validity compared with the PFDI-20 was poor except for urinary distress in NSA women and needs further attention.
Collapse
Affiliation(s)
- Heleen van Dongen
- Department of Obstetrics and Gynecology, Groene Hart Hospital, Bleulandweg 10, 2803 HH, Gouda, The Netherlands.
| | - Huub van der Vaart
- Department of Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kirsten B Kluivers
- Department of Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henk Elzevier
- Department of Urology and Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Paul Roovers
- Department of Gynecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Alfredo L Milani
- Department of Obstetrics and Gynecology, Reinier de Graaf Hospital, Delft, The Netherlands
| |
Collapse
|
39
|
An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction. Int Urogynecol J 2018; 29:647-666. [DOI: 10.1007/s00192-018-3603-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 01/13/2023]
|
40
|
Pérez-Tomás C, Gómez-Pérez L, Romero-Maroto J, Palazón-Bru A, Navarro-Cremades F, Cortés-Castell E. Sexual Quality of Life After Treatment of Stress Urinary Incontinence With Adjustable Tension-free Mesh System in Women Who Were Sexually Active Before Surgery. Urology 2018. [PMID: 29522866 DOI: 10.1016/j.urology.2018.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To assess the sexuality and quality of life of sexually active women with stress or mixed urinary incontinence (SUI or MUI) after surgery with adjustable tension-free suburethral mesh system (transobturator adjustable tape or transvaginal adjustable tape). MATERIALS AND METHODS This intervention study with 2 years of follow-up (visits at 3 months, 1 year, and 2 years) involved 60 women with SUI or MUI who underwent surgery using transobturator adjustable tape or transvaginal adjustable tape during 2008-2014 in a Spanish region. The variables of interest measured pre- and postintervention were the global scores on the following questionnaires: (1) the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire-12; (2) the International Consultation on Incontinence Questionnaire; and (3) the Incontinence Quality of Life Questionnaire. Mixed linear models were constructed to determine the effect of the intervention on the outcome variables. RESULTS A significant improvement (P <.001) was seen over time in all the questionnaires, although between the 1- and 2-year visits there was a slight deterioration in all of them. CONCLUSION The technique provided an improved quality of life and sexuality, which was maintained at all the postoperative visits compared with baseline.
Collapse
Affiliation(s)
- Carla Pérez-Tomás
- Department of Urology, University Hospital of San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Luis Gómez-Pérez
- Department of Urology, University Hospital of San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Jesús Romero-Maroto
- Department of Urology, University Hospital of San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Antonio Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain.
| | - Felipe Navarro-Cremades
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - Ernesto Cortés-Castell
- Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| |
Collapse
|
41
|
A Scoping Study of Psychosocial Factors in Women Diagnosed With and/or Treated for Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 2018; 26:327-348. [PMID: 29509647 DOI: 10.1097/spv.0000000000000578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Pelvic organ prolapse (POP) is prevalent and can impact women's physical and psychosocial health. To develop interventions that support this population, an understanding of the state of research on psychosocial factors related to POP is essential. We conducted a scoping study focused on the psychosocial experience of women with POP. The purpose of this review was to (1) inventory and describe the current state of knowledge of the psychosocial experience of women with POP, (2) identify gaps in knowledge, and (3) identify targets for future research. METHOD Electronic databases PsycINFO, PubMed, EMBASE, and CINAHL were searched through November 1, 2017. RESULTS Of 524 titles reviewed, 103 articles met all inclusion criteria. Articles were grouped by the disease period (ie, prediagnosis, diagnosis/preintervention, intervention, follow-up, and mixed) and psychosocial factors. Most articles (n = 73) focused on women undergoing intervention. Articles focusing on the preintervention period was the next largest category (n = 14). Follow-up after intervention (n = 8) and samples of mixed disease periods (n = 7) were less common. One article focused on women before diagnosis. Articles focused on quality of life (QOL; n = 79), sexual function (n = 51), satisfaction (n = 16), body image (n = 13), psychological distress (n = 4), and knowledge (n = 3). CONCLUSIONS Research on the psychosocial experience of POP has largely focused on changes in QOL and sexual function. Future research should target emotional experience of women with POP; relationships among QOL, psychological distress, body image, and sexual function; and psychosocial factors related to treatment outcomes.
Collapse
|
42
|
Altman D, Geale K, Falconer C, Morcos E. A generic health-related quality of life instrument for assessing pelvic organ prolapse surgery: correlation with condition-specific outcome measures. Int Urogynecol J 2018; 29:1093-1099. [DOI: 10.1007/s00192-018-3587-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/29/2018] [Indexed: 02/06/2023]
|
43
|
Jha S, Walters SJ, Bortolami O, Dixon S, Alshreef A. Impact of pelvic floor muscle training on sexual function of women with urinary incontinence and a comparison of electrical stimulation versus standard treatment (IPSU trial): a randomised controlled trial. Physiotherapy 2018; 104:91-97. [DOI: 10.1016/j.physio.2017.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
|
44
|
Rogers RG, Pauls RN, Thakar R, Morin M, Kuhn A, Petri E, Fatton B, Whitmore K, Kinsberg S, Lee J. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction. Neurourol Urodyn 2018; 37:1220-1240. [PMID: 29441607 DOI: 10.1002/nau.23508] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 12/18/2022]
Abstract
AIMS The terminology in current use for sexual function and dysfunction in women with pelvic floor disorders lacks uniformity, which leads to uncertainty, confusion, and unintended ambiguity. The terminology for the sexual health of women with pelvic floor dysfunction needs to be collated in a clinically-based consensus report. METHODS This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA), and the International Continence Society (ICS), assisted at intervals by many external referees. Internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Importantly, this report is not meant to replace, but rather complement current terminology used in other fields for female sexual health and to clarify terms specific to women with pelvic floor dysfunction. RESULTS A clinically based terminology report for sexual health in women with pelvic floor dysfunction encompassing over 100 separate definitions, has been developed. Key aims have been to make the terminology interpretable by practitioners, trainees, and researchers in female pelvic floor dysfunction. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible. CONCLUSION A consensus-based terminology report for female sexual health in women with pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
Collapse
Affiliation(s)
| | | | - Ranee Thakar
- Croydon University Hospital Croydon, London, United Kingdom
| | | | - Annette Kuhn
- University Teaching Hospital Berne (Inselspital), Bern, Switzerland
| | | | - Brigitte Fatton
- University Hospital Nîmes, Nimes, Languedoc-Roussillon, France
| | | | | | - Joseph Lee
- University of New South Wales, St Vincents Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
45
|
Grossi U, Stevens N, McAlees E, Lacy-Colson J, Brown S, Dixon A, Di Tanna GL, Scott SM, Norton C, Marlin N, Mason J, Knowles CH. Stepped-wedge randomised trial of laparoscopic ventral mesh rectopexy in adults with chronic constipation: study protocol for a randomized controlled trial. Trials 2018; 19:90. [PMID: 29402303 PMCID: PMC5800022 DOI: 10.1186/s13063-018-2456-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 12/30/2017] [Indexed: 02/08/2023] Open
Abstract
Background Laparoscopic ventral mesh rectopexy (LVMR) is an established treatment for external full-thickness rectal prolapse. However, its clinical efficacy in patients with internal prolapse is uncertain due to the lack of high-quality evidence. Methods An individual level, stepped-wedge randomised trial has been designed to allow observer-blinded data comparisons between patients awaiting LVMR with those who have undergone surgery. Adults with symptomatic internal rectal prolapse, unresponsive to prior conservative management, will be eligible to participate. They will be randomised to three arms with different delays before surgery (0, 12 and 24 weeks). Efficacy outcome data will be collected at equally stepped time points (12, 24, 36 and 48 weeks). The primary objective is to determine clinical efficacy of LVMR compared to controls with reduction in the Patient Assessment of Constipation Quality of Life (PAC-QOL) at 24 weeks serving as the primary outcome. Secondary objectives are to determine: (1) the clinical effectiveness of LVMR to 48 weeks to a maximum of 72 weeks; (2) pre-operative determinants of outcome; (3) relevant health economics for LVMR; (4) qualitative evaluation of patient and health professional experience of LVMR and (5) 30-day morbidity and mortality rates. Discussion An individual-level, stepped-wedge, randomised trial serves the purpose of providing an untreated comparison for the active treatment group, while at the same time allowing the waiting-listed participants an opportunity to obtain the intervention at a later date. In keeping with the basic ethical tenets of this design, the average waiting time for LVMR (12 weeks) will be shorter than that for routine services (24 weeks). Trial registration ISRCTN registry, ISRCTN11747152. Registered on 30 September 2015. The trial was prospectively registered (first patient enrolled on 21 March 2016). Electronic supplementary material The online version of this article (10.1186/s13063-018-2456-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ugo Grossi
- National Bowel Research Cente (NBRC) - Digestive Disease, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, 4 Newark Street, London, E1 2AT, UK.
| | - Natasha Stevens
- Pragmatic Clinical Trials Unit, Blizard Institute, Queen Mary, University of London, London, UK
| | - Eleanor McAlees
- National Bowel Research Cente (NBRC) - Digestive Disease, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, 4 Newark Street, London, E1 2AT, UK
| | | | | | | | - Gian Luca Di Tanna
- Pragmatic Clinical Trials Unit, Blizard Institute, Queen Mary, University of London, London, UK
| | - S Mark Scott
- National Bowel Research Cente (NBRC) - Digestive Disease, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, 4 Newark Street, London, E1 2AT, UK
| | | | - Nadine Marlin
- Pragmatic Clinical Trials Unit, Blizard Institute, Queen Mary, University of London, London, UK
| | | | - Charles H Knowles
- National Bowel Research Cente (NBRC) - Digestive Disease, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, 4 Newark Street, London, E1 2AT, UK
| | | |
Collapse
|
46
|
Tyagi V, Perera M, Guerrero K, Hagen S, Pringle S. Prospective observational study of the impact of vaginal surgery (pelvic organ prolapse with or without urinary incontinence) on female sexual function. Int Urogynecol J 2017; 29:837-845. [PMID: 29071360 DOI: 10.1007/s00192-017-3500-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 10/05/2017] [Indexed: 12/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS There is a difference of opinion in the literature as to whether pelvic organ prolapse (POP) is a direct cause of female sexual dysfunction (FSD). Sexual function in women is negatively impacted by the presence of urinary symptoms. Thus, sexual dysfunction (SD) might be improved, unchanged, or worsened by pelvic floor surgery. METHODS In this study, we observed SD and impact of surgical intervention on female sexual function (FSF) using a validated Prolapse/Urinary Incontinence Sexual Questionnaire Short Form (PISQ-12) in women undergoing surgery for POP with or without urinary incontinence. Two hundred women were recruited and followed up at 6 and 12 months postoperatively. RESULTS Sexual function (SF) as measured by the PISQ-12 improved after surgery irrespective of the nature of surgery or the patient's past gynaecology history. Improvement in SF was seen by 6 months (97 patients) postsurgery (P < 0.05), after which (at 12 months; 80 patients) no further change was observed. Improved SF was associated with better patient satisfaction postoperatively. CONCLUSIONS Sexual function improved in women following surgery for POP with or withour urinary incontinence, irrespective of the nature of surgery and the patient's past gynecologic history. Results of this study will assist when counselling women with POP with or without urinary incontinence regarding treatment options.
Collapse
Affiliation(s)
- Veenu Tyagi
- NHS Greater Glasgow and Clyde, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK.
| | - Mahesh Perera
- NHS Greater Glasgow and Clyde, Princes Royal Maternity Hospital, 16 Alexandra Parade, Glasgow, G16 2ER, UK
| | - Karen Guerrero
- NHS Greater Glasgow and Clyde, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Stewart Pringle
- NHS Greater Glasgow and Clyde, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| |
Collapse
|
47
|
Grzybowska ME, Wydra D. Predictors of sexual function in women with stress urinary incontinence. Neurourol Urodyn 2017; 37:861-868. [DOI: 10.1002/nau.23370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 06/24/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Magdalena E. Grzybowska
- Department of Gynecology; Gynecologic Oncology and Gynecologic Endocrinology; Medical University of Gdańsk; Gdańsk Poland
| | - Dariusz Wydra
- Department of Gynecology; Gynecologic Oncology and Gynecologic Endocrinology; Medical University of Gdańsk; Gdańsk Poland
| |
Collapse
|
48
|
Pyke R, Clayton A. What Sexual Behaviors Relate to Decreased Sexual Desire in Women? A Review and Proposal for End Points in Treatment Trials for Hypoactive Sexual Desire Disorder. Sex Med 2017; 5:e73-e83. [PMID: 28041924 PMCID: PMC5440628 DOI: 10.1016/j.esxm.2016.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/09/2016] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Counts of satisfying sexual events (SSEs) per month have been criticized as an end point in treatment trials of women with hypoactive sexual desire disorder (HSDD) but grounding improvement in sexual desire by assessing changes in sexual behavior remains of some importance. METHODS We conducted a literature review to find validated measurements that are specific sexual behavioral correlates of low sexual desire. We compared expert-proposed criteria for dysfunctional desire, expert-developed sets of scale items, and self-rated scales developed before issuance of, or in accordance with, the Food and Drug Administration's guidance on developing patient-reported outcomes. Behavioral measurements of HSDD were isolated from these sets of criteria or scales. MAIN OUTCOME MEASURES We outline a plan to evaluate such behavioral measurements of HSDD with reference to SSEs. RESULTS Eleven rating scales, four expert-originated and seven self-rated scales mainly derived from patient input were identified as well validated and relevant to HSDD. Three recent sets of diagnostic criteria for conditions such as HSDD were compared with the scales. Twenty-four different symptoms were found in the scales. Content found relevant to HSDD during development of the rating scales varied highly among measurements, including the self-rated scales developed in conformity with current recommendations for patient-reported outcome measurements. The only item on all sets was desire for sexual activity. Four other items were in approximately at least half the sets: sexual thoughts or fantasies, frequency of sexual activity, receptivity, and initiations. Sexual thoughts or fantasies were in every expert-derived set but in only three of the seven patient-derived sets. Receptivity was in five of the seven expert-derived sets vs two of the seven patient-derived sets. Frequency of sexual activity was in one of the seven expert-derived sets but in five of the patient-derived sets. Initiation was in approximately half the two sets. All other items were on one to three sets each. We identified three sexual behaviors of validated specificity for female HSDD: frequency of sexual activity, receptivity, and initiations. Six or seven items are relevant and informative. The item on frequency of sexual activity in the Changes in Sexual Functioning-Female scale is the only item that covers frequency of dyadic and solitary sexual activity. An item in the Female Sexual Desire Questionnaire (FSDQ) covers the intuitively relevant topic of frequency of sexual activity motivated by the woman's desire. Three FSDQ items on initiations and two items on receptivity reflect expert opinion on the sexual behaviors of most relevance to HSDD, but the FSDQ has not been validated in women with HSDD. CONCLUSIONS SSEs have been discredited as the primary measurement in clinical trials of women with HSDD, but it would be meaningful to include at least one sexual behavioral symptom specific to HSDD as an end point. Expert-recommended sexual behaviors specifically related to HSDD are irregularly represented in self-rating scales whether developed as in the Food and Drug Administration guidance on patient-reported outcomes or not. Six or seven items on sexual behavior in self-rated scales can be recommended for relevance to women with HSDD in clinical trials. Items on female sexual behavior should be tested in comparison with SSEs in women with HSDD for relevance and for treatment sensitivity, and responder and functional and dysfunctional cutoffs should be determined before incorporation into large-scale clinical trials. Pyke R and Clayton A. What Sexual Behaviors Relate to Decreased Sexual Desire in Women? A Review and Proposal for End Points in Treatment Trials for Hypoactive Sexual Desire Disorder. Sex Med 2017;5:e73-e83.
Collapse
Affiliation(s)
- Robert Pyke
- S1 Biopharma, Inc, Medical, New Fairfield, CT, USA.
| | - Anita Clayton
- Psychiatry and Behavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| |
Collapse
|
49
|
Morcos E, Altman D, Hunde D, Falconer C. Comparison of single- versus multicenter outcomes for pelvic organ prolapse repair using a mesh-capturing device. Int Urogynecol J 2017; 29:91-97. [DOI: 10.1007/s00192-017-3364-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/02/2017] [Indexed: 01/21/2023]
|
50
|
Saiki L, Meize-Grochowski R. Urinary Incontinence and Psychosocial Factors Associated With Intimate Relationship Satisfaction Among Midlife Women. J Obstet Gynecol Neonatal Nurs 2017; 46:555-566. [PMID: 28477970 DOI: 10.1016/j.jogn.2017.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore associations among symptoms of urinary incontinence, severity of symptoms, and measures of psychosocial health that may be assessed during a well-woman screening examination and the possible contribution of these variables to the relationship satisfaction of partnered midlife women living with urinary incontinence. DESIGN Exploratory correlational design using self-report questionnaires. SETTING Community recruitment by posted fliers, advertisements, and social media. PARTICIPANTS Partnered women, ages 45 to 65 years, with urinary incontinence (N = 57). METHODS Self-report measures of severity of incontinence symptoms, relationship satisfaction, self-concept/emotional health (self-esteem, body image, depression, anxiety), and relationship factors (sexual quality of life, incontinence-related communication). Data were analyzed using Spearman rho correlation with an exploration of the contribution of study factors to relationship satisfaction through standard multiple regression. RESULTS The severity of urinary incontinence symptoms had no significant correlation with scores on relationship satisfaction or psychosocial health. Measures of self-concept/emotional health and relationship factors were significantly correlated with each other (rs = .40-.75, p < .01) and with relationship satisfaction (rs = .35-.71, p < .05). Preliminary exploration of the contribution of study factors to relationship satisfaction through exploratory regression analysis showed unique contributions from sexual quality of life (18.7%, p < .001) and depression (8.7%, p = .004). CONCLUSION Midlife women with urinary incontinence, regardless of symptom severity, might benefit from screening for poorer sexual quality of life and mild depression symptoms because these two study factors significantly contributed to poorer intimate relationship satisfaction among this study's participants.
Collapse
|