Swati Jha

A new measure of sexual function in women with pelvic floor disorders (PFD): the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR)

Introduction and hypothesisThe objective of this study was to create a valid, reliable, and responsive sexual function measure in women with pelvic floor disorders (PFDs) for both sexually active (SA) and inactive (NSA) women.MethodsExpert review identified concept gaps and generated items evaluated with cognitive interviews. Women underwent Pelvic Organ Prolapse Quantification (POPQ) exams and completed the Incontinence Severity Index (ISI), a prolapse question from the Epidemiology of Prolapse and Incontinence Questionnaire (ISI scores), the Pelvic Floor Distress Inventory-20 (PFDI-20), and the Female Sexual Function Index (FSFI). Principle components and orthogonal varimax rotation and principle factor analysis with oblique rotation identified item grouping. Cronbach’s alpha measured internal consistency. Factor correlations evaluated criterion validation. Change scores compared to change scores in other measures evaluated responsiveness among women who underwent surgery.ResultsA total of 589 women gave baseline data, 200 returned surveys after treatment, and 147 provided test-retest data. For SA women, 3 subscales each in 2 domains (21 items) and for NSA women 2 subscales in each of 2 domains (12 items) emerged with robust psychometric properties. Cronbach’s alpha ranged from .63 to .91. For SA women, correlations were in the anticipated direction with PFDI-20, ISI, and FSFI scores, POPQ, and EPIQ question #35 (all p < .05). PFDI-20, ISI, and FSFI subscale change scores correlated with Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire International Urogynecological Association-revised (PISQ-IR) factor change scores and with mean change scores in women who underwent surgery (all p < .05). For NSA women, PISQ-IR scores correlated with PFDI-20, ISI scores, and with EPIQ question #35 (all p < .05). No items demonstrated differences between test and retest (all p ≥ .05), indicating stability over time.ConclusionsThe PISQ-IR is a valid, reliable, and responsive measure of sexual function.

Impact of Incontinence Surgery on Sexual Function: A Systematic Review and Meta‐Analysis

INTRODUCTION Urinary incontinence has an adverse impact on sexual function. The reports on sexual function following the treatment of urinary incontinence are confusing. AIM To investigate the impact of surgery for stress incontinence on coital incontinence and overall sexual function. METHODS Cochrane Incontinence Group Specialized Register of Controlled Trials, The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched for trials of incontinence surgery assessing sexual function and coital incontinence before and after surgery. Observational studies and randomized controlled trials investigating the impact of surgical correction of stress urinary incontinence on sexual function were included. Surgical interventions included tension-free vaginal tape (TVT), Tension Free Vaginal Tape-Obturator (TVT-O), transobturator tape (TOT), Burch, and autologous fascial sling (AFS). Studies that included patients undergoing concurrent prolapse surgery were excluded from the analysis. Data extraction and analysis was performed independently by two authors. Coital incontinence was analyzed separately and odds ratios (ORs) with 95% confidence intervals (CI ) calculated. The data were analyzed in Review Manager 5 software. MAIN OUTCOME MEASURE Changes in sexual function and coital incontinence following surgery for urinary incontinence. RESULTS Twenty-one articles were identified, which assessed sexual function and/or coital incontinence following continence surgery in the absence of prolapse. Results suggest evidence for a significant reduction in coital incontinence post surgery (OR 0.11; 95% CI 0.07, 0.17). CONCLUSIONS Coital incontinence is significantly reduced following continence surgery. There were several methodological problems with the quality of the primary research particularly related to heterogeneity of studies, use of different outcome measures, and the absence of well-designed randomized controlled trials.

The UK national prolapse survey: 5 years on

Introduction and hypothesisTo assess trends in the surgical management of pelvic organ prolapse (POP) amongst UK practitioners and changes in practice since a previous similar survey.MethodsAn online questionnaire survey (Typeform Pro) was emailed to British Society of Urogynaecology (BSUG) members. They included urogynaecologists working in tertiary centres, gynaecologists with a designated special interest in urogynaecology and general gynaecologists. The questionnaire included case scenarios encompassing contentious issues in the surgical management of POP and was a revised version of the questionnaire used in the previous surveys. The revised questionnaire included additional questions relating to the use of vaginal mesh and laparoscopic urogynaecology procedures.ResultsOf 516 BSUG members emailed, 212 provided completed responses.. For anterior vaginal wall prolapse the procedure of choice was anterior colporrhaphy (92% of respondents). For uterovaginal prolapse the procedure of choice was still vaginal hysterectomy and repair (75%). For posterior vaginal wall prolapse the procedure of choice was posterior colporrhaphy with midline fascial plication (97%). For vault prolapse the procedure of choice was sacrocolpopexy (54%) followed by vaginal wall repair and sacrospinous fixation (41%). The laparoscopic route was preferred for sacrocolpopexy (62% versus 38% for the open procedure). For primary prolapse, vaginal mesh was used by only 1% of respondents in the anterior compartment and by 3% in the posterior compartment.ConclusionBasic trends in the use of native tissue prolapse surgery remain unchanged. There has been a significant decrease in the use of vaginal mesh for both primary and recurrent prolapse, with increasing use of laparoscopic procedures for prolapse.

Female sexual dysfunction

In recent years female sexual dysfunction (FSD) is increasingly being recognised. It has a detrimental effect on a womans quality of life and includes a range of disorders, and therefore adequate screening and diagnosis of patients are necessary before appropriate treatment can be commenced. As the etiology of FSD is often multi-factorial, arising from a multitude of organic pathologies in addition to having an underlying psychological basis, the treatment is often multidisciplinary. An understanding of the etiopathogenesis is therefore imperative to management. In the past 20 years major changes have occurred in our understanding, conceptualization and treatment of sexual dysfunction. In this article we look at the prevalence, classification, etiology and management of FSD.

Incontinence during intercourse: myths unravelled

Introduction and hypothesisThis study aimed to establish the prevalence of urinary leakage during intercourse, the extent to which urinary leakage impacts on sex life and the correlation between different urodynamic diagnosis and coital leakage.MethodsFour hundred eighty women attending between 1 January 2006 and December 2010 with urinary incontinence and subsequently undergoing urodynamic assessment were included. Data were collected as part of routine clinical care using the electronic Pelvic floor Assessment Questionnaire and correlated with urodynamic findings.ResultsSixty percent of women with urinary incontinence reported leakage during intercourse. Overall quality of life in women with urinary incontinence was strongly correlated to the impact of urinary symptoms on sex life. Parameters of sexual function were no different in women with different urodynamic diagnosis.ConclusionWorsening urinary incontinence has a deleterious effect on sexual function. Urodynamic diagnosis does not correlate with the nature of underlying sexual problems, orgasm or penetration incontinence.

Electronic pelvic floor symptoms assessment: tests of data quality of ePAQ-PF

The objective of the study was to test the data quality, scaling assumptions and scoring algorithms underlying the electronic personal assessment questionnaire—pelvic floor (ePAQ-PF). A cross-sectional survey of 599 women with pelvic floor disorders was carried out. Tests of data quality included secondary factor analysis, internal reliability, descriptive statistics, levels of missing data, floor and ceiling effects, item-to-total correlation scores, item discriminant and convergent validity. Secondary factor analysis verified the domain structure of ePAQ-PF. All 19 domains were internally reliable with Cronbach’s α scores ranging from 0.71 to 0.93. Missing response rates ranged from 0.2% to 1.3%, and all items were found to be most highly correlated with their own corrected scale. Results confirmed the factor structure, data quality and scoring and scaling assumptions of ePAQ-PF, thereby verifying its suitability for measuring symptoms, bother and quality of life in women with pelvic floor disorders.

Prevalence of incontinence in women with benign joint hypermobility syndrome

The objective of this study was to determine whether the prevalence of urinary and anal incontinence in women with benign joint hypermobility syndrome (BJHS) was more than in a control group without this condition. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the Manchester Health Questionnaire were sent to 30 patients with benign joint hypermobility syndrome and 30 healthy women without this condition and results were compared. It was found out that the prevalence of urinary incontinence in the study group we surveyed was 18/30 and in the control group was 9/30 (60 vs 30%; p=0.037). Twenty-three percent (7/30) of the women with BJHS had a problem with anal incontinence but none of the controls had problems with anal incontinence (23 vs 0%; p=0.01). Therefore, the prevalence of both urinary and anal incontinence appears to be significantly higher in women with BJHS when compared to women without this condition.

The PISQ-IR: considerations in scale scoring and development

IntroductionThis paper provides a detailed discussion of the psychometric analysis and scoring of a revised measure of sexual function in women with pelvic floor disorders (PFD): the Pelvic Organ Prolapse Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR).MethodsStandard tools for evaluating item distributions, relationships, and psychometric properties were used to identify sub-scales and determine how the sub-scales should be scored. The evaluation of items included a nonresponse analysis, the nature of missingness, and imputation methods. The minimum number of items required to be answered and three different scoring methods were evaluated: simple summation, mean calculation, and transformed summation.ResultsItem nonresponse levels are low in women who are sexually active and the psychometric properties of the scales are robust. Moderate levels of item nonresponse are present for women who are not sexually active, which presents some concerns relative to the robustness of the scales. Single imputation for missing items is not advisable and multiple imputation methods, while plausible, are not recommended owing to the complexity of their application in clinical research. The sub-scales can be scored using either mean calculation or transformed summation. Calculation of a summary score is not recommended.ConclusionThe PISQ-IR demonstrates strong psychometric properties in women who are sexually active and acceptable properties in those who are not sexually active. To score the PISQ-IR sub-scales, half of the items must be answered, imputation is not recommended, and either mean calculation or transformed sum methods are recommended. A summary score should not be calculated.

Factors influencing outcome following the tension-free vaginal tape (TVT).

OBJECTIVES To evaluate factors influencing the outcome with tension-free vaginal tape (TVT). STUDY DESIGN A prospective questionnaire survey of 100 women undergoing TVT between January 2006 and May 2007 for urodynamic stress incontinence. All women were assessed pre-operatively and 3 months post-operatively using a validated electronic pelvic floor symptoms assessment questionnaire (ePAQ). Using linear regression, the influence of age, severity of stress incontinence and pre-existing lower urinary tract symptoms (LUTS) were assessed on symptomatic improvement of stress urinary incontinence and on quality of life (QoL). RESULTS Women with more severe symptoms preoperatively had a significantly greater improvement in stress incontinence symptoms (p<0.001) and quality of life (p=0.016). Age and pre-existing LUTS were not associated with adverse outcomes with surgery in terms of improvement in stress incontinence or quality of life. CONCLUSIONS Women with more severe stress urinary incontinence may expect greater improvement, both in their stress incontinence and their health-related quality of life (HRQoL) following a TVT. Age and coexisting lower urinary tract symptoms do not impact significantly on TVT outcomes in terms of the reduction in stress incontinence or improvement in HRQoL.

OASI: a preventable injury?

OBJECTIVE The aim of this study was to determine risk factors for obstetric anal sphincter injury and whether any of them were modifiable. STUDY DESIGN This was a retrospective review of 2572 women (cases=1286; controls=1286) that took place over a 10 year period at a University teaching hospital. Maternal (Age, Parity, BMI and ethnicity), Obstetric (gestational age, assistance during delivery, episiotomy) and fetal (weight) risk factors were analyzed using logistic regression model presented as odds ratio (OR) with 95% confidence intervals (CI). Both univariate and multivariate analyses were conducted with outcome variables comparing cases and controls. Cases without instrumental deliveries were also compared to controls to exclude for the effect of assisted delivery. RESULTS This study shows that in addition to instrumental delivery, primiparity (OR 9.8; CI 7.8-12.3), episiotomy (OR 8.6; CI 6.4-11.6), gestational age over 41 weeks (OR 1.5; CI 1.2-1.9), fetal weight over 4 kg (OR 3.2; CI 2.3-4.4) and Asian ethnicity (OR 1.9; CI 1.4-2.7) were all strongly associated with OASI. A raised BMI over 30 appeared to have a protective effect (OR 0.4; CI 0.2-0.5). CONCLUSIONS Most risk factors related to OASI are non-modifiable however gestational age and episiotomy are modifiable risk factors.