Factors Linked to Sexual Function Assessment in Urinary Incontinence Care

Female sexual dysfunction affects up to half of midlife females and is strongly associated with urinary incontinence. Medical visits for urinary incontinence represent critical opportunities to identify and address sexual health concerns; however, the frequency and determinants of sexual function assessment in this high-risk population remain understudied.

The objective of this study was to identify how often sexual function is documented during initial encounters for midlife females with urinary incontinence and factors associated with assessment.

We performed a retrospective electronic health record review of 1,580 initial outpatient encounters for females aged 40-70 years presenting with complaints of urinary incontinence in urogynecology, gynecology, or urology clinics. Sexual function assessment was coded based on the Female Sexual Function Index domains or general sexual functioning statements. Multivariable logistic regression examined associations between patient and health care professional/visit characteristics and documented assessment. Sensitivity analyses assessed the influence of high-volume health care professionals.

Sexual function assessment was documented in 53.1% of encounters. In adjusted analyses, male health care professional sex was associated with significantly lower odds of assessment. Increasing patient age and unmarried status were also independently associated with reduced odds of documentation. Visit location, health care professional specialty, and licensure were significant in the primary model, although specialty and licensure effects were influenced by high-volume health care professionals. Race, ethnicity, and insurance status were not significantly associated with assessment.

Approximately half of midlife females presenting with urinary incontinence did not have documented sexual function assessment, despite known associations of female sexual dysfunction in this population. Assessment patterns varied by health care professional and patient characteristics, suggesting potential disparities in sexual function screening. Standardized approaches to sexual function assessment during urinary incontinence visits may increase female sexual dysfunction detection and improve comprehensive, equitable care.