Commented Abstracts

The short-term effect of surgical treatment for stress urinary incontinence using sub urethral support techniques on sexual function.

Pinto AC, Baracat F, Montellato ND,
Mitre AI, Lucon AM, Srougi M.
Int Braz J Urol. 2007 Nov-Dec;33(6):822-8.


OBJECTIVES: To evaluate the impact of surgical treatment of stress urinary incontinence on the sexual function of women and to identify whether such treatment can improve their sexual function and overall quality of life.
MATERIALS AND METHODS: 64 heterosexual women with such indication were studied using the Female Sexual Function Index (FSFI) questionnaire, modified by introducing one question to evaluate the impact of urine loss. This was applied preoperatively and six months after surgery.
RESULT: Among these 64 patients, 60.94% had regular sexual activity, while 39.06% did not. Among sexually active patients, 59% had urine loss during sexual intercourse and, of these, 87% had urine losses in half or more of sexual relations. There were no statistically significant differences in assessments of desire, arousal, lubrication, orgasm, satisfaction and pain, or in totaling the scores, between the preoperative period and six months after surgical treatment. However, the scores for urine losses during sexual intercourse were significantly better after the operation.
CONCLUSIONS: Analysis of the results allowed the following conclusions to be reached: Urine lost during sexual activity was frequent among patients with stress urinary incontinence. Suburethral support surgery did not jeopardize sexual activity. Patients cured of stress urinary incontinence did not present improvement in sexual function


Editor’s comment


Studies of female sexual function are still scarce in the medical literature. Given the high prevalence of UI and the natural embarrassment associated with urine loss, it is justifiable to guess that repairing the problem would have a significant impact on sexual life. The complaint of urine loss during sexual activity is indeed frequent and may be related to orgasm (generally by inhibited detrusor contraction) or, more frequently, to stress over intercourse. It may also occur only in specific sexual positions and be affected by the presence of cystocele. Particularly in young women, it causes affective withdrawal, decreases arousal and sex frequency, and jeopardizes conjugal relationships. Thus, improved sexual function after surgery would be expected. On the other hand, vaginal incisions and the placement of either synthetic or biological material on the vaginal anterior wall could lead to sexual dysfunction accompanied by pain and decreased local sensitivity as a large number of nerve terminals are found in this anatomical site. Some authors have reported the improvement of some parameters associated with sex life1, whereas others2, in agreement with Pinto and collaborators, did not observe the theoretic positive or negative effects of this intervention on the sex life of women with urine loss during sexual intercourse. Further studies including a larger number of cases and stratifying patients by age and urine loss frequency and severity can help to determine the real impact of UI and surgery on female sexual function.


Aparecido Donizeti Agostinho