Factors associated with sexual activity for women with pelvic floor dysfunction - a cross-sectional study / Fatores associados à atividade sexual de mulheres com distúrbios do assoalho pélvico - um estudo transversal

Abstract Objective To examine women with pelvic floor dysfunction (PFDs) and identify factors associated with sexual activity (SA) status that impacts quality of life (QoL). Methods We conducted a cross-sectional study that includedwomen> 18 years old who presented with at least one PFD symptom (urinary incontinence [UI] and/or pelvic organ prolapse [POP]), in outpatient clinics specializing in urogynecology and PFD in Fortaleza, state of Ceará, Brazil, using a service evaluation form and QoL questionnaires. Results The analysis of 659 women with PFD included 286 SA (43.4%) women and 373 non-sexually active (NSA) (56.6%) women, with a mean age of 54.7 (±12) years old. The results revealed that age (odds ratio [OR]= 1.07, 95% confidence interval [CI] 1.03-1.12) and post-menopausal status (OR= 2.28, 95% CI 1.08-4.8) were negatively associated with SA. Being married (OR= 0.43, 95% CI 0.21-0.88) was associated with SA. Pelvic organ prolapse (OR= 1.16, 95% CI 0.81-1.68) and UI (OR= 0.17, 95% CI 0.08-0.36) did not prevent SA. SF-36 Health Survey results indicated that only the domain functional capacity was significantly worse in NSA women (p= 0.012). Two King's Health Questionnaire domains in NSA women, impact of UI (p= 0.005) and personal relationships (p< 0.001), were significantly associated factors. Data from the Prolapse Quality-of-life Questionnaire indicated that NSA women exhibited compromised QoL. Conclusion Postmenopausal status and age negatively affected SA. Being married facilitated SA. Presence of POP and UI did not affect SA. However, NSAwomen with POP exhibited compromised QoL.

Resumo Objetivo Examinar mulheres com disfunções do assoalho pélvico (DAP) e identificar fatores associados ao status de atividade sexual (AS) e impacto na qualidade de vida (QV). Métodos Realizamos um estudo transversal, no qual participaram mulheres > 18 anos, que apresentaram pelo menos um sintoma de DAP (incontinência urinária [UI] e/ou prolapso de órgão pélvico [POP]), em ambulatórios especializados em uroginecologia e DAP emFortaleza, CE, Brasil, utilizando um formulário de avaliação de serviço e questionários de QV. Resultados A análise de 659 mulheres comDAP incluiu 286 mulheres sexualmente ativas (SA) (43,4%) e 373 mulheres não sexualmente ativas (NSA) (56,6%), com idade média de 54,7 (±12) anos. Os resultados revelaram que idade (odds ratio [OR]= 1,07; intervalo de confiança [IC] 95%: 1,03-1,12) e status pós-menopausa (OR= 2,28; IC 95% 1,08-4,8) foram negativamente associados à atividade sexual. O casamento (OR= 0,43; IC 95% 0,21-0,88) foi associado à AS. Por outro lado, POP (OR= 1,16; IC 95% 0,81-1,68) e IU (OR= 0,17; IC 95% 0,08-0,36) não impediram a AS. Os resultados do SF-36 Health Survey indicaram que apenas a capacidade funcional do domínio (p = 0,012) foi significativamente pior em mulheres NSA. Dois domínios King's Health Questionnaire (KHQ, na sigla em inglês) em mulheres NSA, impacto da IU (p = 0,005) e relacionamento pessoal (p< 0,001), foram fatores significativamente associados. Os dados do Prolapse Qualityof- life Questionnaire (P-QoL, na sigla em inglês) indicaram que as mulheres NSA apresentavam QV comprometida. Conclusão O status pós-menopausa e a idade afetaram negativamente a AS, enquanto o casamento facilitou a AS. A presença de POP e IU não afetou a AS. No entanto, as mulheres NSA com POP apresentaram QV comprometida.

Incontinência dupla: fatores associados e impacto sobre a qualidade de vida em mulheres atendidas em serviço de referência / Double incontinence: associated factors and impact on the quality of life of women attended at a health referral service

OBJETIVO: Avaliar, em uma população feminina com incontinência urinária, a prevalência de incontinência dupla, seus fatores associados e seu impacto sobre a qualidade de vida. MÉTIDO: Estudo transversal em mulheres com incontinência urinária ou dupla (incontinência urinária e fecal) atendidas em um hospital terciário do Sistema Único de Saúde. Foram colhidas informações sociodemográficas e clínicas, e a qualidade de vida foi avaliada por meio de questionários validados. A associação entre as variáveis e os tipos de disfunção (incontinência urinária e dupla) e com a pior percepção geral de saúde foi determinada pelos testes de Mann-Whitney, qui-quadrado e Fisher. RESULTADOS: A amostra do estudo foi composta por 227 mulheres, das quais 120 (52,9%) eram idosas. A prevalência de incontinência dupla foi de 14,1%, e os fatores a ela associados foram maior número de comorbidades (p-valor=0,04), polifarmácia (p-valor=0,04) e presença de retocele (p-valor=0,02). Mostraram associação com pior percepção geral de saúde o IMC (quanto maior, pior; p-valor=0,02) e maior número de comorbidades (p-valor=0,05), mas não a incontinência dupla (p-valor=0,36). CONCLUSÃO: A prevalência de incontinência dupla foi diferente da encontrada em estudos realizados em cenários semelhantes. A população estudada apresenta baixos escores de percepção geral de saúde, mas a incontinência dupla não esteve associada a tais escores. A presença de múltiplas comorbidades está associada tanto à presença de incontinência dupla quanto à pior percepção geral de saúde. AU

Objective: To evaluate the prevalence, associated factors, and impact on quality of life of double incontinence in a group of women with urinary incontinence. METHOD: A cross-sectional study was performed, including female patients with urinary or double incontinence (urinary and fecal incontinence) treated at a tertiary hospital from the public healthcare system. Information about sociodemographic and clinical characteristics was collected, and quality of life was assessed using validated questionnaires. The Mann-Whitney, Chi-square, and Fisher tests were used to evaluate the association between the variables and the types of dysfunction (urinary or double incontinence) and a worse general health perception. RESULTS: Of 227 incontinent women included in the study, 120 (52,9%) were older individuals. The prevalence of double incontinence was 14.1% (32 patients). Double incontinence was associated with a higher number of comorbidities (p-value=0.04), polypharmacy (p-value=0.04), and rectocele (p-valor=0.02). Higher BMI (p-value=0.02) and number of comorbidities (p-value=0.05), but not double incontinence (p-value=0.36), were associated with low general health perception scores. CONCLUSION: the prevalence of double incontinence was different from other studies conducted in similar scenarios. The group of women included in the study presented low general health perception scores, but this was not associated with the presence of double incontinence. A higher number of comorbidities was associated with both double incontinence and a lower general health perception. AU

Correlates of Pelvic Floor Disorders in Women Fifty years and Over Attending Out-patient Gynaecology and Urology Clinics at a Tertiary Hospital in Kingston and St Andrew, Jamaica / Correlatos de los Trastornos del Suelo Pélvico en Mujeres de Cincuenta años o más que Asisten a las Clínicas Externas de Ginecología y Urología en un Hospital Terciario in Kingston y Saint Andrew, Jamaica

ABSTRACT Objective: To identify correlates of pelvic floor disorders in a clinic-based sample of women fifty years and older. Method: Two hundred and sixty-three randomly selected gynaecology and urology clinic attendees fifty years and older provided information on health, reproductive history, sociodemographics and pelvic floor disorders. Associations between having at least one pelvic floor disorder and the other variables were explored using bivariate and multivariate analyses. Results: Approximately, 52% of women had at least one pelvic floor disorder and each additional vaginal delivery increased these odds by 14%, controlling for important health and sociodemographic variables. Conclusion: Pelvic floor disorders can negatively affect quality of life in older age. Given the increased likelihood of their occurrence with each vaginal delivery, reproductive and post-reproductive health services should prioritise female pelvic medicine, pelvic floor strengthening and physical therapy to improve women's genitourinary health.

RESUMEN Objetivo: Identificar los correlatos de los trastornos del suelo pélvico en una muestra clínica de mujeres de 50 años o más. Método: Doscientos sesenta y seis mujeres de cincuenta años o más, que asisten a la clínica de ginecología y urología, fueron seleccionadas aleatoriamente. Dichas pacientes proporcionaron información sobre salud, historial reproductivo, y trastornos sociodemográficos del suelo pélvico. Las asociaciones entre tener al menos un trastorno del suelo pélvico y las otras variables se exploraron mediante análisis bivariantes y multivariantes. Resultados: Aproximadamente 52% de las mujeres tenían al menos un trastorno del suelo pélvico, y cada parto vaginal adicional aumentó estas probabilidades en un 14%, controlando las variables sanitarias y sociodemográficas importantes. Conclusión: Los trastornos del suelo pélvico pueden afectar negativamente la calidad de vida en la edad avanzada. Dada la mayor probabilidad de que ocurran con cada parto vaginal, los servicios de salud reproductiva y pos reproductiva deben priorizar la medicina pélvica femenina, el fortalecimiento del suelo pélvico y la terapia física para mejorar la salud genitourinaria de las mujeres.

Cuestionarios de calidad de vida en las mujeres con disfunciones del suelo pélvico / Quality of life questionnaires for women with pelvic floor dysfunction

Las disfunciones del suelo pélvico tienen un impacto significativo en la calidad de vida de la mujer que la padece. Ella no solo sufrirá de las manifestaciones físicas de algún grado de prolapso, sino de aquellas derivadas de las perturbaciones psíquicas, sexuales, laborales y sociales que estas originan. Los cuestionarios de calidad de vida proporcionan una amplia información sobre la repercusión de los síntomas y signos en la vida de la paciente lo cual permite entender estas condiciones de manera integral. El objetivo de esta revisión fue describir el impacto en la calidad de vida de las mujeres con disfunciones del suelo pélvico y los cuestionarios empleados para evaluarla, sin mediar intervenciones. Se realizó una búsqueda en las bases de datos de Pubmed, SciELO, Hinari, Cochrane y Clinical Key en junio y julio del 2015. Las disfunciones del suelo pélvico generan un impacto negativo en la calidad, que varía según la severidad de los síntomas. Las mujeres presentan limitaciones en la actividad física, actividades cotidianas, el sueño, la sexualidad y suelen estar angustiadas y deprimidas. La medición de la severidad de los síntomas y de los cambios en la calidad de vida en las pacientes con disfunciones del suelo pélvico es parte esencial de la evaluación para el diagnóstico y tratamiento de las mujeres(AU)

Pelvic floor dysfunction has a significant impact on the quality of life of its female sufferers. These women will not only be affected by the physical manifestations of the disease, such as some degree of prolapse, but also by the psychic, sexual, occupational and social disturbances it brings about. Quality of life questionnaires provide broad information about the effect of the signs and symptoms of the condition upon the patient's daily life, permitting a more comprehensive understanding of the condition. The purpose of the present review was to describe the impact of pelvic floor dysfunction upon the quality of life of sufferers, as well as the questionnaires used to evaluate it, without mediating interventions. A search was conducted in the databases Pubmed, SciELO, Hinari, Cochrane and Clinical Key in June and July 2015. Pelvic floor dysfunction has a negative impact on the quality of life, which varies in keeping with the severity of symptoms. Women patients are faced with limitations in their physical activity, their daily life, sleep and sexuality, and tend to be anguished and depressed. Measurement of the severity of symptoms and changes in the quality of life of patients with pelvic floor dysfunction is an essential part of the evaluation for the diagnosis and treatment of the disease(AU)