Clinical Consult

Each month, questions with a common theme will be selected and answered comprehensively by one of our Steering Committee members. Previously answered questions will be archived each month for your reference. If you wish to submit a question, click here.

This Month's Question:

Stress urinary incontinence (SUI) can negatively affect a woman’s life. What are the effects of SUI on sexual activity?

Response by Carolyn M. Sampselle, PhD, RNC, posted 09/15/2005:

A diagnosis of SUI is provisionally based on a patient-reported history involving complaints of urine leakage upon a physical exertion, such as sneezing, laughing, or coughing.¹ Half of all cases of female urinary incontinence are attributable solely to SUI; whereas, an additional quarter involve an element of stress incontinence in conjunction with other types of urinary incontinence.² Although prevalence data for SUI are believed to be significantly underreported because of the social stigma associated with the condition, prevalence has been estimated to be 20% to 50%, with a demonstrated increase with aging.^2,3

Urinary leakage has been reported to occur during sexual activity in 11% to 60% of women with SUI, with the range of results reflecting small sample sizes and differences in methodology and population.³ Urinary leakage due to SUI was reported to be more likely to occur during penetration than during orgasm (which is more often associated with urge incontinence).³ The psychological effects include immediate embarrassment, a loss of interest in future sexual activity, and a feeling of loss of femininity.³

Women suffering from SUI cite a number of reasons for their decreased interest in sexual activity: loss of spontaneity, having to launder or dispose of wet pads, needing to sleep separately from their partner, feeling unattractive, and concerns about odor. A partner’s response may compound a woman’s negative feelings.³

During routine health screenings and examinations, the primary care specialist must say to a patient with SUI: "It is not unusual for women with SUI to find they have urine leakage during sexual activity. Do you have any such difficulties in your sex life?" This question is key because of the psychosocial consequences of SUI and sexual dysfunction and the availability of safe and effective treatments.³

Pelvic floor exercises improve symptoms of both SUI and sexual dysfunction.³ Bo et al⁴ reported that after a routine pelvic floor exercise regimen, urinary leakage during intercourse was reduced by nearly 50% versus less than 10% in the nonpelvic exercise group.

Surgery for SUI is not without risk and is typically recommended only when other more conservative options have failed or are not feasible.⁵ A significant percentage of postsurgical SUI patients have been reported to develop postoperative voiding dysfunction (23%), new-onset detrusor overactivity (10%),³ or urinary tract injury (2.6% to 9%).^3,6 Although several studies have reported improved sexual function in SUI patients after surgery, some women experience less sexual enjoyment because of dyspareunia.³

Currently, no FDA-approved pharmacotherapies for SUI exist. However, an investigational serotonin and norepinephrine reuptake inhibitor has been shown in clinical trials to reduce the frequency of SUI episodes in women and ultimately could lead to a novel pharmacotherapy for SUI.⁷

In summary, SUI is rather prevalent in women and can have an association with sexual dysfunction. Primary care specialists can serve their female patients well through careful, caring inquiry to identify candidates for therapies to improve their overall psychological outlook and quality of life regarding both of these potentially coexisting conditions.

References

1. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167-178.
   
   
2. Hunskaar S, Arnold EP, Burgio K, Diokno AC, Herzog AR, Mallet VT. Epidemiology and natural history of urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11:301-319.
   
   
3. Barber MD, Dowsett SA, Mullen KJ, Viktrup L. The impact of stress urinary incontinence on sexual activity in women. Cleve Clin J Med. 2005;72:225-232.
   
   
4. Bo K, Talseth T, Vinsnes A. Randomized controlled trial on the effect of pelvic floor muscle training on quality of life and sexual problems in genuine stress incontinent women. Acta Obstet Gynecol Scand. 2000;79:598-603.
   
   
5. Leach GE, Dmochowski RR, Appell RA, et al. Female Stress Urinary Incontinence Clinical Guidelines Panel summary report on surgical management of female stress urinary incontinence. The American Urological Association. J Urol. 1997;158:875-880.
   
   
6. Tulikangas PK, Weber AM, Larive AB, Walters MD. Intraoperative cystoscopy in conjunction with anti-incontinence surgery. Obstet Gynecol. 2000;95:794-796.
   
   
7. Dmochowski RR, Miklos JR, Norton PA, Zinner NR, Yalcin I, Bump RC; Duloxetine Urinary Incontinence Study Group. Duloxetine versus placebo for the treatment of North American women with stress urinary incontinence. J Urol. 2003;170:1259-1263.