Contributing Factors for Sexual Inactivity and Sexual Dysfunction in Women with Pelvic Floor Disorders

Factors contributing to sexual inactivity and dysfunction in women with pelvic floor dysfunction (PFD) remain unclear. We hypothesized that sexuality may be affected by different biopsychosocial factors.

A cross-sectional study was conducted in women with PFD attending a tertiary urogynecology unit. Sexual activity and function were assessed using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-IR) validated in Spanish. Demographic and clinical data were collected through validated questionnaires (International Consultation on Incontinence Questionnaire, Bladder Control Self-Assessment Questionnaire, Pelvic Floor Distress Inventory-20 (to be homogeneous with the previous ones)), POP Quantification stage, and the modified Oxford scale.

Among 1169 women (mean age 60.2 ± 13.5 years; 71.3% menopausal), 88.1% reported urinary incontinence, 54.4% anal incontinence (AI), and 40.6% symptomatic pelvic organ prolapse (POP). The sexually inactive rate was 40.4% (472 out of 1169), mainly because of a lack of interest (353 out of 472), and 24.1% (114 out of 472) because of PFD. Based on the PISQ-IR cutoff, the sexual dysfunction rate was 24.4% (170 out of 697) among sexually active participants. Multivariate analysis identified biological factors contributing to sexual inactivity (older age, hypertension, and symptomatic POP; all p ≤ 0.05) and sexual dysfunction (dyspareunia, symptomatic POP, and AI symptoms; all p ≤ 0.05). Notably, two biological factors contribute to a lower risk of sexual dysfunction: a higher Oxford score (p = 0.029) and older age (p = 0.002). Psychological factors such as mental health problems were associated with sexual dysfunction (p = 0.015), whereas the social factor of having a partner was strongly associated with being sexually active (p < 0.001).

Multiple biopsychosocial factors influence sexual activity and function in women with PFD. Approximately 2 out of 5 women were sexually inactive and a quarter were at risk of sexual dysfunction. The PISQ-IR helps health care professionals to identify women whose sexual activity or function is affected by pelvic floor symptoms.