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Female urinary incontinence: impact on sexual life and psychosocial wellbeing in patients and partners, and patient-reported outcome after surgery
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Urinary incontinence (UI) and urgency are common conditions and can have a profound influence on many aspects of life. Approximately one in four women has UI and one in ten has daily symptoms. Knowledge is lacking, however, on the impact of UI and urgency on the lives of affected women and their partners and on the situation of women with urinary leakage one year postoperatively.

Aims: To study the consequences of female UI and urgency for patients and their partners on quality of life (QoL), the partner relationship, and their sexual lives. Also to evaluate the success rates of three operation methods: tension-free vaginal tape (TVT), tension-free vaginal tape-obturator (TVT-O), and transobturator tape (TOT) for stress urinary incontinence (SUI), with a particular focus on women who still have urinary leakage one year after surgery.

Methods: Women seeking healthcare for UI and/or urgency and their partners were invited to answer questionnaires. The women completed disease-specific questionnaires and both the women (n = 206) and their partners (n = 109) answered questions about their psychosocial situation, partner relationship, and sexual life. Patient-reported outcomes one year after surgery with TVT, TVT-O, or TOT (n = 3334) were derived from the Swedish National Quality Register for Gynaecological Surgery.

Results: Most of the women reported that their urinary problems negatively affected their physical activities, and almost half reported negative consequences for their social life. Women aged 25–49 years were less satisfied with their psychological health, sexual life, and leisure than women aged 50–74 years. One third of both the women and their partners (all the partners were men) experienced a negative impact on their relationship, and sexual life was negatively affected in almost half of the women and one in five of their men. Coital incontinence was reported in one third of the women. Most of their men did not consider this a problem, but the majority of the affected women did.

Satisfaction with outcome of the operation did not differ between TVT, TVT-O, and TOT, but TVT showed a higher success rate for SUI than TOT did. Higher age, higher body mass index, a diagnosis of mixed urinary incontinence, and a history of urinary leakage in combination with urgency each constitute a risk for a lower operation success rate. After one year, 29% of the women still had some form of UI, but half of these were satisfied with the outcome and most reported fewer negative impacts on family, social, working, and sexual life than before the operation.

Conclusions: Female UI and/or urgency impaired QoL, particularly in young women, and had negative effects on partner relationships and on some partners’ lives. Sexual life was also affected, more often in women with UI and/or urgency than in their partners. At one-year follow-up after surgery, about one third of the women still had some form of UI, but the negative impact on their lives was reduced. A challenge for health care professionals is to initiate a dialogue with women with urinary symptoms about sexual function and what surgery can realistically be expected to accomplish.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2012. , 57 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1488
Keyword [en]
female, partner relationship, patient-reported outcomes, overactive bladder, sexual life, social impact, suburethral slings, quality of life, urgency, urinary incontinence
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:umu:diva-55006ISBN: 978-91-7459-393-8 (print)OAI: oai:DiVA.org:umu-55006DiVA: diva2:525143
Public defence
2012-06-01, Bergasalen, Södra entrén, by 27, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-05-11 Created: 2012-05-07 Last updated: 2012-05-11Bibliographically approved
List of papers
1. The impact of female urinary incontinence and urgency on quality of life and partner relationship
Open this publication in new window or tab >>The impact of female urinary incontinence and urgency on quality of life and partner relationship
2009 (English)In: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 28, no 8, 976-981 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: To examine the impact of female urinary incontinence, urgency and frequency on quality of life, and partner relationship in women (18-74 years) and their partners, and make comparisons with the corresponding age groups in a Swedish population-based study.

METHODS: Women with urinary incontinence, urgency and frequency (n = 206) completed specific questionnaires concerning medical history and the Bristol Female Lower Urinary Tract Symptoms questionnaire. Women who had a stable relationship (n = 170) also answered a questionnaire regarding psychosocial situation, partner relationship and sexual life, and were asked to give a similar questionnaire to their partner. Totally, 109 partners participated.

RESULTS: The vast majority of the women considered that their urinary problems affected their physical activities negatively and almost half reported negative consequences for social life and joint activities. One third of both women and men experienced a negative impact on their relationship and about every fifth felt it had a harmful influence on physical proximity, intimacy, affection, and warmth. Compared to the older women, the younger were less satisfied with their psychological health, sexual life, leisure and financial situation, and compared to the younger men, the young women were less content with their somatic health. Overall, women with urinary problems and their partners were less satisfied with their somatic health than the corresponding age groups in the national population-based study.

CONCLUSIONS: Female urinary incontinence, urgency and frequency significantly impair the quality of life in both younger and older women, and also have negative effects on the partner relationship and the partner's life.

Keyword
frequency;partner relationship;quality of life;urgency;urinary incontinence
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-36783 (URN)10.1002/nau.20709 (DOI)19229955 (PubMedID)
Available from: 2010-10-11 Created: 2010-10-11 Last updated: 2017-12-12Bibliographically approved
2. How do urinary incontinence and urgency affect women's sexual life?
Open this publication in new window or tab >>How do urinary incontinence and urgency affect women's sexual life?
2011 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 6, 621-628 p.Article in journal (Refereed) Published
Abstract [en]

Objectives. To investigate the impact of urinary incontinence (UI) and urgency on women's sexual life and the prevalence of urinary leakage during sexual activity. A further aim was to explore factors affecting sexual desire and satisfaction with sexual life.

Design. A semi-structured questionnaire study.

Setting and Sample. Sexually active women (n=147) aged 18-74years with UI and urgency were recruited from four outpatient clinics.

Methods. The women completed questionnaires concerning medical history, psychosocial situation, partner relationship, sexual life, and answered the Bristol Female Lower Urinary Tract Symptoms questionnaire. All underwent clinical evaluation.

Main outcome measures. Prevalence of urinary leakage during sexual activity, factors affecting sexual desire and sexual satisfaction.

Results. The vast majority considered sexuality to be important in their lives. One-third of the women had urinary leakage during sexual activity. Half reported that sexual life was more or less spoiled due to their UI or urgency, they were worried about having urinary leakage during intercourse and almost two-thirds worried about odor and felt unattractive. The women's dissatisfaction with sexual life was strongly correlated to unsatisfying psychological health, orgasmic disability and worry about urinary leakage during intercourse. Insufficient vaginal lubrication, unsatisfying psychological health, and their partners' ill health were significantly correlated to decreased sexual desire.

Conclusion. UI and urgency have a negative impact on women's sexual life. Thus, a dialogue about sexual function in women with urinary symptoms should become an integral component in clinical management.

Place, publisher, year, edition, pages
Wiley, 2011
Keyword
Female, sexual life, urgency, urinary incontinence
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:umu:diva-42135 (URN)10.1111/j.1600-0412.2011.01120.x (DOI)21371000 (PubMedID)
Available from: 2011-04-06 Created: 2011-04-06 Last updated: 2017-12-11Bibliographically approved
3. Impact of female urinary incontinence and urgency on women's and their partners' sexual life
Open this publication in new window or tab >>Impact of female urinary incontinence and urgency on women's and their partners' sexual life
2011 (English)In: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 30, no 7, 1276-1280 p.Article in journal (Refereed) Published
Abstract [en]

Aims: To assess the impact of female urinary incontinence (UI) and urgency on women's and their partners' sexual life in sexually active couples and to elucidate the concordance of answers within couples.

Methods: Women aged 18-74 years with UI and/or urgency (n = 206) were consecutively recruited from four outpatient clinics. Those with a partner (n = 170) completed a questionnaire regarding relationship and sexual life and gave a similar questionnaire to him. The present paper focuses on 99 couples with an active sexual life.

Results: Twenty-two percent of the men and 43% of the women stated that the female urinary symptoms impaired their sexual life. Forty-nine percent of the women expressed worries about having urinary leakage during sexual activity, but most of their men, 94%, did not. Twenty-three percent of the men and 39% of the women responded that the woman leaked urine during sexual activity. The majority, 84%, of women considered this a problem, but 65% of their partners did not. Except for this disparity, the rest of the answers were significant concordant within the couples.

Conclusions: Female UI and urgency negatively affected sexual life in almost half of the women and in every fifth partner. A need for information and advice concerning sexual issues due to the woman's urinary disorder was found in one fifth of the couples. The majority of women with urinary leakage during sexual activities considered this as a problem, but most of their partners did not. Overall, the concordance of the answers within the couples was high.

Place, publisher, year, edition, pages
Wiley, 2011
Keyword
female, male partner, sexual life, urgency, urinary incontinence
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-42136 (URN)10.1002/nau.21039 (DOI)21351129 (PubMedID)
Note
Article first published online: 23 FEB 2011Available from: 2011-04-06 Created: 2011-04-06 Last updated: 2017-12-11Bibliographically approved
4. Female urinary incontinence: patient-reported outcomes 1 year after midurethral sling operations
Open this publication in new window or tab >>Female urinary incontinence: patient-reported outcomes 1 year after midurethral sling operations
Show others...
2012 (English)In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 23, no 10, 1353-1359 p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION AND HYPOTHESIS: Although midurethral slings have become standard surgical methods to treat stress urinary incontinence (SUI), little is known about women who still have urinary incontinence (UI) after surgery. This study assesses and compares the patient-reported outcome 12 months after tension-free vaginal tape (TVT), tension-free vaginal tape-obturator (TVT-O), and transobturator tape (TOT), with a special focus on women who still have urinary leakage postoperatively.

METHODS: This study analyzed preoperative and 12-month postoperative data from 3,334 women registered in the Swedish National Quality Register for Gynecological Surgery.

RESULTS: Among the women operated with TVT (n = 2,059), TVT-O (n = 797), and TOT (n = 478), 67 %, 62 %, and 61 %, respectively, were very satisfied with the result at the 1-year follow-up. There was a significantly higher chance of becoming continent after TVT compared with TOT. In total, 977 women (29 %) still had some form of urinary leakage postoperatively. Among the postoperatively incontinent women who expressed a negative impact of UI on family, social, work, and sexual life preoperatively, considerably fewer reported a negative impact in all domains after surgery. Of those in the postoperatively incontinent group who had coital incontinence preoperatively, 63 % reported a cure of coital incontinence.

CONCLUSIONS: The proportion of women very satisfied with the result of the operation did not differ between the three groups. TVT had a higher SUI cure rate than did TOT. Despite urinary leakage 1-year postoperatively, half of the women were satisfied with the result of the operation.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-55004 (URN)10.1007/s00192-012-1752-9 (DOI)22527550 (PubMedID)
Available from: 2012-05-07 Created: 2012-05-07 Last updated: 2017-12-07Bibliographically approved

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