Sexual function after urinary incontinence surgery

Urinary incontinence (UI) affects between 42 and 71% of women. Sexual dysfunction is prevalent in the general population, but in women with UI, the prevalence is greater (42-56%). This review assesses the effects of urinary continence surgery on the sexual function of women with UI. Stress UI is surgically mostly managed via Burch colposuspension or a mid-urethral sling. These operations are as effective as each other with regards to maintaining or improving in sexual function. One of the main risks of these operations are that urgency UI (UUI) may be exacerbated or arise de novo and this has been shown to decrease sexual function. Severe refractory UUI requires complex surgery, such as percutaneous sacral nerve stimulation (SNS) then augmentation cystoplasty or urinary diversion. SNS may improve sexual function by direct action on the pudendal nerve as well as improving incontinence. Urinary diversion and augmentation cystoplasty are procedures of last resort in women who are refractory to all other UUI treatments. The majority of women report no change or improvement in sexual function as the urinary diversion negates the requirement for incontinence pads and indwelling catheters. Deteriorated sexual function has also been described in up to 37.5%. Thirty percent of women undergoing urinary diversion would have liked more 'sexological' counselling.

The majority of women enjoy maintained or improved sexual function after surgical treatment of UI. It is important to ensure women have appropriate pre-operative assessment and counselling so they may be advised of the risks of failed surgery including deteriorated sexual function.