Female sexual dysfunction and lower urinary tract symptoms associated with vulvovaginal atrophy symptoms: Results of the GENJA study

Association between lower urinary tract symptoms and female sexual function: results from the GENitourinary syndrome of menopause in JApanese women (GENJA) study

BACKGROUND

Female sexual dysfunction (FSD) is highly prevalent in women with lower urinary tract symptoms (LUTS); however, few studies have assessed the association between specific LUTS and FSD.

AIM

To identify which specific LUTS are associated with which domains of female sexual function in Japanese women.

METHODS

Data from 1337 sexually active women aged 40-79 years who participated in the GENitourinary syndrome of menopause in JApanese women (GENJA) study were analyzed. All participants answered web-based questionnaires including the Core Lower Urinary Tract Symptom Score, Female Sexual Function Index (FSFI), and Vulvovaginal Symptoms Questionnaire. We used multivariable regression to assess the association between LUTS and FSFI domain scores, adjusted for age, menstrual status, hormone therapy, hypertension, dyslipidemia, diabetes mellitus, and depression.

OUTCOMES

FSFI domain and total scores associated with LUTS.

RESULTS

The mean age of participants was 54.0 ± 10.7 years. Women with LUTS were more likely to have lower total FSFI scores than those without, except for increased daytime urinary frequency. The multivariate analysis revealed that nocturia was associated with lower orgasm scores (coefficient: -0.23; 95% confidence interval [CI]: -0.45 to -0.01; P = .044), urgency with lower pain scores (coefficient: -0.62; CI: -1.09 to -0.14; P = .011), stress urinary incontinence (coefficient: -0.51; CI: -0.90 to -0.12; P = .011), and vaginal bulge/lump sensations (coefficient: -0.42; CI: -0.81 to -0.04; P = .031) with lower satisfaction scores.

CLINICAL IMPLICATIONS

This study highlights the need to include routine assessments of sexual function in women with LUTS.

STRENGTHS AND LIMITATIONS

This is the first study to comprehensively examine the association between specific LUTS and FSFI domain scores using validated questionnaires in a nationwide epidemiological survey among sexually active Japanese women. Limitations include non-random participant selection and reliance on self-reported data, which represent subjective symptoms.

CONCLUSION

LUTS, including nocturia, urgency, stress urinary incontinence, as well as vaginal bulge/lump sensations, were associated with FSD regardless of age, menstrual status, lifestyle-related diseases, or depression.

Sexual health and wellbeing and the menopause: An EMAS clinical guide

INTRODUCTION

Sexual health and wellbeing are significant aspects of quality of life. However, taking a sexual history is often avoided in medical practice, leaving a void in management and awareness. As the menopause can have a major impact on sexual health, it is imperative that healthcare providers are appropriately trained in sexual health and wellbeing and the aligned disciplines in order to achieve optimal care.

AIM

To provide an evidence-based clinical guide for the assessment and management of sexual problems at the menopause and beyond.

MATERIALS AND METHODS

Review of the literature and consensus of expert opinion.

RESULTS AND CONCLUSION

The assessment of sexual problems includes history taking, examination and laboratory investigation (if indicated), and occasionally the use of specific validated questionnaires. Management of sexual problems requires a multidimensional approach using biopsychosocial measures. Medical management and psychosexual counselling include pharmacological and non-pharmacological interventions, and sex therapy and psychoeducation. Furthermore, perimenopausal women should be advised about the need for contraception if they wish to avoid pregnancy. Also, sexually transmitted diseases can be acquired at any age. To conclude, taking a sexual history should be incorporated into medical practice and healthcare providers should be appropriately trained to assess and manage sexual problems at the menopause and beyond.

Prevalence and impact on daily life of lower urinary tract symptoms in Japan: Results of the 2023 Japan Community Health Survey (JaCS 2023)

OBJECTIVES

A large-scale nationwide epidemiological survey of lower urinary tract symptoms (LUTS) was conducted via the Internet in 2023 to clarify the current prevalence of LUTS and evaluate its impact on daily life in Japan.

METHODS

The survey was conducted among individuals aged 20-99 years old who had anonymously registered with a Japanese online research company. The survey consisted of 48 questions related to LUTS and daily life.

RESULTS

A total of 6210 participants (3088 females and 3122 males), who were selected by probability sampling based on the composition of the Japanese population (age range: 20-99), were recruited. The overall prevalence of LUTS was 77.9% among the subjects aged ≥20 and 82.5% among those aged ≥40. The prevalence of LUTS differed between the sexes and trends toward significant increases in prevalence with age were seen for almost all LUTS. Furthermore, the prevalence of overactive bladder (OAB) was 11.9% among the subjects aged ≥20 and 13.8% among those aged ≥40. This study also showed that LUTS negatively affected daily life. However, the percentage of subjects who visited a physician to receive treatment for LUTS was low, including for participants with a history of treatment for LUTS, although this increased with age.

CONCLUSION

The prevalence of LUTS, including OAB, increased with age and negatively affected daily life. However, since the percentage of patients who visit a physician to receive treatment for LUTS remains low, further educational activities regarding LUTS are necessary.