Body mass index, urinary incontinence, and female sexual dysfunction: how they affect female postmenopausal health

The aim of this study was to evaluate the relationship between body mass index (BMI) and female sexual dysfunction (FSD) among perimenopausal and postmenopausal women with urinary incontinence (UI).

From 2005 to 2008, we enrolled 208 consecutive women affected by UI; all underwent a comprehensive history including two validated questionnaires, physical examination, and urodynamic evaluation. Based on BMI, participants were grouped into normal weight, overweight, and obese.

A total of 158 participants completed both questionnaires (76% response rate); 41 (26%) were normal weight, 73 (46%) were overweight, and 44 (28%) were obese. The increasing Urogenital Distress Inventory score had a direct correlation with age (P < 0.01), year of menopause onset (P < 0.05), and BMI (P < 0.01). FSD was diagnosed in 97 women (61%): 31 (32%) with hypoactive sexual desire, 20 (21%) with sexual arousal disorder, 7 (7%) with orgasmic deficiency, and 39 (40%) with sexual pain disorder. BMI greater than 30 kg/m was independently associated with an increased risk of FSD (odds ratio [OR], 2.02) and UI (OR, 2.03). With adjustment for BMI, the OR for FSD was 1.22 for overweight women and 1.56 for obese women, with respect to healthy participants. The total Female Sexual Function Index score correlated with BMI (r = -0.82, P = 0.0001); in particular, arousal (r = -0.82), orgasm (r = -0.72), lubrication (r = -0.61), and satisfaction (r = -0.63, all P < 0.001) showed an inverse correlation with BMI, whereas desire and pain did not.

Increased BMI early in menopause represents a risk both for UI and for sexual dysfunction. Weight control has an essential role in postmenopause and should be considered early in perimenopause to safeguard female quality of life as well as to prevent or improve UI and female sexual dysfunction symptoms.