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

INTRODUCTION AND HYPOTHESIS: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.