Sexual function in women with bothersome lower urinary tract symptoms: findings from the symptoms of lower urinary tract dysfunction research network (LURN) cohort study

Abstract

Background: Bothersome lower urinary tract symptoms (LUTS) can negatively affect the quality of life in women, including sexual function.

Aim: The primary aim of the study was to explore the association between LUTS severity and sexual functioning among women with LUTS.

Methods: Female participants enrolled in the Symptoms of the first Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN-I) observational cohort study with a frequency rating of at least "sometimes" and a bother rating of at least "somewhat" on at least one LUTS Tool question. LUTS and sexual function were quantified by patient questionnaires at baseline, 3 months, and 12 months after study enrollment. LUTS were assessed via the LUTS Tool, while sexual function was assessed using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, International Urogynecological Association-Revised (PISQ-IR). Longitudinal analyses were restricted to females with completed baseline and 12-month (or 3-month, if missing) questionnaires. Associations between baseline sexual function, clinical characteristics, and LUTS were analyzed using linear regression.

Outcomes: The primary outcomes were bothersome LUTS, defined by the LUTS Tool, and sexual function, defined by the PISQ-IR.

Results: Female participants (n = 528) were identified. At baseline, 245 participants were not sexually active (NSA), while 283 were sexually active (SA). Baseline characteristics of the cohort are described in Table 1; compared with NSA, SA was younger (49 vs 63 years) and more likely to be married/civil union (67% vs 43%). Less severe LUTS (10 points lower) was associated with higher (better) PISQ-IR summary and subscale scores (condition-specific, condition-impact, global quality, and arousal/orgasm subscales) for SA participants. For NSA participants, less severe LUTS was associated with higher condition-specific and condition-impact subscale scores. A subset of participants (n = 406) had follow-up data at 12 months. Longitudinally, LUTS Tool scores improved on average from baseline to 12 months by seven points, while PISQ-IR scores generally remained stable.

Clinical implications: As LUTS improves, overall sexual function in SA and NSA women remains stable.

Strengths and limitations: Strengths of the study include the use of a validated sexual function questionnaire, PISQ-IR, which captures sexual function in women who are not SA. Limitations of the study include the fact that participants presented to tertiary academic centers for care, which may limit the study's generalizability.

Conclusion: In a large cohort of women with prospectively collected data on LUTS and sexual function, sexual function largely remained stable over time even as LUTS bother improved.

Keywords: female sexual function; lower urinary tract symptoms; urinary incontinence.