Sexual activity and function in women with and without pelvic floor disorders.

INTRODUCTION AND HYPOTHESIS: We describe differences in sexual activity and function in women with and without pelvic floor disorders (PFDs). METHODS: Heterosexual women ≥40 years of age who presented to either urogynecology or general gynecology clinics at 11 clinical sites were recruited. Women were asked if they were sexually active with a male partner. Validated questionnaires and Pelvic Organ Prolapse Quantification (POP-Q) examinations assessed urinary incontinence (UI), fecal incontinence (FI), and/or pelvic organ prolapse (POP). Sexual activity and function was measured by the Female Sexual Function Index (FSFI). Student's t test was used to assess continuous variables; categorical variables were assessed with Fisher's exact test and logistic regression. Univariate and multivariate analyses were used to assess the impact of pelvic floor disorders (PFDs) on FSFI total and domain scores. RESULTS: Five hundred and five women met eligibility requirements and gave consent for participation. Women with and without PFDs did not differ in race, body mass index (BMI), comorbid medical conditions, or hormone use. Women with PFDs were slightly older than women without PFDs (55.6 + 10.8 vs. 51.6 + 8.3 years, P <0.001); all analyses were controlled for age. Women with PFDs were as likely to be sexually active as women without PFDs (61.6 vs. 75.5 %, P = 0.09). There was no difference in total FSFI scores between cohorts (23.2 + 8.5 vs. 24.4 + 9.2, P = 0.23) or FSFI domain scores (all P = NS). CONCLUSION: Rates of sexual activity and function are not different between women with and without PFDs.

Does vaginal size impact sexual activity and function?

INTRODUCTION AND HYPOTHESIS: This study seeks to determine if total vaginal length (TVL) or genital hiatus (GH) impact sexual activity and function. METHODS: Heterosexual women >or= 40 years were recruited from urogynecology and gynecology offices. TVL and GH were assessed using the Pelvic Organ Prolapse Quantification exam. Women completed the Female Sexual Function Index (FSFI) and were dichotomized into either normal function (FSFI total > 26) or sexual dysfunction (FSFI

Impact of sacral colpopexy on in vivo vaginal biomechanical properties.

OBJECTIVE: The purpose of this study was to determine if sacral colpopexy has an impact on in vivo vaginal biomechanical properties. STUDY DESIGN: Thirty-five participants who underwent sacral colpopexy were enrolled in this prospective clinical trial. In vivo vaginal biomechanical properties, including elasticity, viscoelasticity, and vaginal stiffness index, as well as symptom severity questionnaires (pelvic floor distress inventory-short form) and Pelvic Organ Prolapse Quantification (POP-Q) examination, were performed preoperatively and 6 weeks postoperatively. RESULTS: Thirty-two participants completed the study. Six weeks after sacral colpopexy participants demonstrated a decrease in prolapse related symptoms (POPDI-6 score, 39.8 vs 9.0, P < .00001) and 97% demonstrated anatomical cure of their prolapse. At 6 weeks follow-up participants demonstrated an increase in elasticity (2.26 vs 3.43, P < .00001), viscoelasticity (1.55 vs 4.08, P < .000001), and vaginal stiffness index (108.65 vs 164.50, P < .01). CONCLUSION: These findings suggest that sacral colpopexy increases in vivo vaginal biomechanical properties, as well as decreasing anatomical and symptom-related severity of pelvic organ prolapse.

Correlation between vaginal stiffness index and pelvic floor disorder quality-of-life scales.

The objective of this study was to determine if vaginal stiffness index, an in vivo vaginal biomechanical property, is correlated with pelvic floor disorder symptom distress, impact on quality of life, or sexual function as measured by disease-specific quality-of-life scales. Forty-eight women completed validated quality-of-life scales (pelvic floor distress inventory-short form, pelvic floor impact questionnaire, and pelvic organ prolapse/urinary incontinence sexual questionnaire) and underwent in vivo vaginal biomechanical testing. After bivariate relationships between vaginal stiffness index and demographic, obstetric, and gynecologic variables were explored, multiple linear regression controlling for pelvic organ prolapse quantitative (POP-Q) stage of prolapse was performed. The vaginal stiffness index was inversely correlated with pelvic organ prolapse distress severity (POPDI-6) after controlling for POP-Q stage of prolapse (p = 0.011, r = 0.67, r (2) = 0.450, beta = -2.3). These findings provide initial evidence for the construct validity of in vivo vaginal biomechanical testing for pelvic organ prolapse evaluation because an increasing vaginal stiffness index is correlated with decreasing symptomatic and anatomic severity of disease.

Systemic and vaginal biomechanical properties of women with normal vaginal support and pelvic organ prolapse.

OBJECTIVE: The objective of the study was to compare the biomechanical properties of vaginal and systemic skin in women with and without pelvic organ prolapse. STUDY DESIGN: In this cross-sectional study, 25 women with pelvic organ prolapse and 23 age-matched women with normal pelvic support were recruited from an office setting. A Cutometer MPA 580 and DermaLab skin probe were used to measure systemic biomechanical parameters and a 1.5 mm offset DermaLab skin probe was used for vaginal biomechanical measurements. RESULTS: There were no significant differences in the baseline demographic, obstetrical, or gynecologic information between the 2 groups. There were no significant differences in the systemic biomechanical parameters between the 2 groups. Women with pelvic organ prolapse had significantly more extensible vaginal skin than women with normal pelvic support (initial stiffness index 7.3 vs 10.9 kpa, final stiffness index 5.9 vs 10.7 kpa; all P values less than .01). Furthermore, vaginal extensibility was related to pelvic organ prolapse quantification stage in a linear fashion. CONCLUSION: Our findings suggest that local, rather than systemic, alterations in biomechanical skin properties are associated with pelvic organ prolapse.

The overactive bladder and quality of life.

Overactive bladder (OAB) affects 16.6% of the U.S. population, or 33 million adults, in some form. Despite the prevalence of OAB, almost 60% of those affected seek no medical assistance for the condition either because of embarrassment or the misconception that it represents an inevitable function of aging. A recent surge of interest on the subject has uncovered the dramatic effect that OAB can have on social interactions, sleep, depression, sexual health, and overall health-related quality of life (HRQoL). The introduction of validated, condition-specific QOL questionnaires has enhanced our ability to measure these subjective dimensions of OAB, and to assess their response to therapeutic interventions.