Continuing Medical Education: Urogenital Complaints and Female Sexual Dysfunction (Part 1) (CME)

ABSTRACT Introduction Sexual dysfunction and dyspareunia are common complaints in women with urological disorders. Aim To provide a comprehensive review of sexual dysfunction related to common hypersensitive/hyperactive urogenital disorders including interstitial cystitis/painful bladder syndrome (IC/PBS), overactive bladder (OAB) with and without incontinence, and high-tone pelvic floor muscle dysfunction and the appropriate treatment strategies. Methods A medical literature search using several related terms including sexual dysfunction, dyspareunia, IC/PBS, OAB, urinary incontinence pelvic floor dysfunction, and levator ani muscle spasm. Main Outcome Measures Review of the medical literature to identify relation between sexual dysfunction and common urological disorders in women and to describe appropriate treatment strategies to improve the women's quality of life. Results A thorough review of sexual dysfunction in urological disorders and their related treatments modalities including: behavioral, pharmacological, and nonpharmacological therapies. Conclusions Sexual dysfunction is a common, underestimated, and untreated complaint in women with urologic disorders. Identifying sexual complaints and treating the underlying etiologies can result in significant improvement in a woman's quality of life. This process requires a focused, multidisciplinary approach tailored to meet the needs of women with urogenital complaints. Wehbe SA, Whitmore K, and Kellogg-Spadt S. Urogenital complaints and female sexual dysfunction (part 1).

[1]  D. Tincello,et al.  Interstitial cystitis in the UK: results of a questionnaire survey of members of the Interstitial Cystitis Support Group. , 2005, European journal of obstetrics, gynecology, and reproductive biology.

[2]  David G. Simons,et al.  Myofascial Pain and Dysfunction : The Trigger Point Manual , 1992 .

[3]  S. Xie,et al.  Nonbladder related symptoms in patients with interstitial cystitis. , 2001, The Journal of urology.

[4]  James A Koziol,et al.  Increased prevalence of interstitial cystitis: previously unrecognized urologic and gynecologic cases identified using a new symptom questionnaire and intravesical potassium sensitivity. , 2002, Urology.

[5]  C. Butrick Interstitial Cystitis and Chronic Pelvic Pain: New Insights in Neuropathology, Diagnosis, and Treatment , 2003, Clinical obstetrics and gynecology.

[6]  G. Ghoniem,et al.  Levator ani trigger point injections: An underutilized treatment for chronic pelvic pain , 2007, Neurourology and urodynamics.

[7]  E. Laumann,et al.  Sexual dysfunction in the United States: prevalence and predictors. , 1999, JAMA.

[8]  J. Teichman,et al.  Interstitial cystitis and female sexual dysfunction. , 2007, Urology.

[9]  A. Wein,et al.  Summary of the National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases Workshop on Interstitial Cystitis, National Institutes of Health, Bethesda, Maryland, August 28-29, 1987. , 1988, The Journal of urology.

[10]  S. Chuai,et al.  Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. , 2009, The Journal of urology.

[11]  K. Whitmore Self-care regimens for patients with interstitial cystitis. , 1994, The Urologic clinics of North America.

[12]  G. Cundiff,et al.  Sexual function among women with urinary incontinence and pelvic organ prolapse. , 2004, American journal of obstetrics and gynecology.

[13]  P. Hanno,et al.  Interstitial cystitis: unexplained associations with other chronic disease and pain syndromes. , 1998, Urology.

[14]  A. Cihan,et al.  Sexual function in women with urinary incontinence , 2005, International Journal of Impotence Research.

[15]  D. Webster,et al.  Use and effectiveness of sexual self-care strategies for interstitial cystitis. , 1995, Urologic Nursing.

[16]  J. Abbott,et al.  Botulinum Toxin Type A for Chronic Pain and Pelvic Floor Spasm in Women: A Randomized Controlled Trial , 2006, Obstetrics and gynecology.

[17]  R. Kotarinos,et al.  Rehabilitation of the short pelvic floor. II: Treatment of the patient with the short pelvic floor , 2003, International Urogynecology Journal.

[18]  J. Abbott,et al.  Pilot study of botulinum toxin type A in the treatment of chronic pelvic pain associated with spasm of the levator ani muscles , 2004, The Australian & New Zealand journal of obstetrics & gynaecology.

[19]  Wise Tn Sexuality in chronic illness. , 1977 .

[20]  A. Graziottin Sexual Pain Disorders: Dyspareunia and Vaginismus , 2008 .

[21]  B. Levy,et al.  Chronic Pelvic Pain: An Integrated Approach , 1998 .

[22]  Georgina L Jones,et al.  The impact of TVT on sexual function , 2009, International Urogynecology Journal.

[23]  K. Fugl-Meyer,et al.  Some sexological characteristics of stress incontinent women. , 1996, Scandinavian journal of urology and nephrology.

[24]  D. Myers Chapter 27 – Interstitial Cystitis and Chronic Pelvic Pain , 2007 .

[25]  D. Dewitt Dyspareunia. Tracing the cause. , 1991, Postgraduate medicine.

[26]  J. Seo,et al.  The effect of overactive bladder syndrome on the sexual quality of life in Korean young and middle aged women , 2005, International Journal of Impotence Research.

[27]  J. Abbott,et al.  The use of botulinum toxin type A (BOTOX®) as treatment for intractable chronic pelvic pain associated with spasm of the levator ani muscles , 2005, BJOG : an international journal of obstetrics and gynaecology.

[28]  J. Travell Myofascial pain and dysfunction , 1983 .

[29]  F. Ling,et al.  Dyspareunia. A special type of chronic pelvic pain. , 1993, Obstetrics and gynecology clinics of North America.

[30]  J. Koziol Epidemiology of interstitial cystitis. , 1994, The Urologic clinics of North America.

[31]  J. Nickel,et al.  Editorial: Interstitial Cystitis—an Elusive Clinical Target? , 2003 .

[32]  H. Mensink,et al.  Is the diet of patients with interstitial cystitis related to their disease? , 1997, European urology.

[33]  A. Diokno,et al.  Sexual function and sexual distress in women with interstitial cystitis: a case-control study. , 2007, Urology.

[34]  K. Whitmore,et al.  Modified Thiele massage as therapeutic intervention for female patients with interstitial cystitis and high-tone pelvic floor dysfunction. , 2004, Urology.

[35]  J. Metts,et al.  Interstitial cystitis: urgency and frequency syndrome. , 2001, American family physician.

[36]  D. Webster Recontextualizing sexuality in chronic illness: women and interstitial cystitis. , 1997, Health care for women international.

[37]  Stanley Zaslau,et al.  Sexual dysfunction in patients with painful bladder syndrome is age related and progressive. , 2008, The Canadian journal of urology.

[38]  Magnus Fall,et al.  The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. , 2003, Urology.

[39]  C. May,et al.  Incontinence and sexuality: findings from a qualitative perspective. , 1999, Journal of advanced nursing.

[40]  L. Heim,et al.  Evaluation and differential diagnosis of dyspareunia. , 2001, American family physician.

[41]  J Curtis Nickel,et al.  Sexual function is a determinant of poor quality of life for women with treatment refractory interstitial cystitis. , 2007, The Journal of urology.

[42]  T. Canavan,et al.  Dyspareunia in women , 2000, Postgraduate medicine.

[43]  M. Pons,et al.  Coital urinary incontinence: impact on quality of life as measured by the King’s Health Questionnaire , 2008, International Urogynecology Journal.

[44]  R. Moldwin Similarities between interstitial cystitis and male chronic pelvic pain syndrome , 2002, Current urology reports.

[45]  P. Abrams,et al.  How widespread are the symptoms of an overactive bladder and how are they managed? A population‐based prevalence study , 2001, BJU international.

[46]  J. Weiss,et al.  Pelvic floor myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. , 2001, The Journal of urology.

[47]  C. Tinelli,et al.  Different clinical presentation of interstitial cystitis syndrome , 2004, International Urogynecology Journal.

[48]  H. Putter,et al.  The place of female sexual dysfunction in the urological practice: results of a Dutch survey. , 2009, The journal of sexual medicine.

[49]  J. Paulson,et al.  Clinical trial: effects of botulinum toxin on levator ani syndrome – a double‐blind, placebo‐controlled study , 2009, Alimentary pharmacology & therapeutics.

[50]  C. Comiter Sacral neuromodulation for the symptomatic treatment of refractory interstitial cystitis: a prospective study. , 2003, The Journal of urology.

[51]  L. Derogatis,et al.  Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. , 2000, The Journal of urology.

[52]  G. Thiele COCCYGODYNIA AND PAIN IN THE SUPERIOR GLUTEAL REGION: AND DOWN THE BACK OF THE THIGH: CAUSATION BY TONIC SPASM OF THE LEVATOR ANI, COCCYGEUS AND PIRIFORMIS MUSCLES AND RELIEF BY MASSAGE OF THESE MUSCLES , 1937 .

[53]  D. Myers,et al.  Gynecologic manifestations of interstitial cystitis. , 2002, Clinical obstetrics and gynecology.

[54]  Candace S. Brown,et al.  The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. , 2000, Journal of sex & marital therapy.

[55]  K. Coyne,et al.  Overactive bladder and women's sexual health: what is the impact? , 2007, The journal of sexual medicine.

[56]  K. Whitmore,et al.  Role of the female urologist/urogynecologist , 2005 .

[57]  L. Bertolasi,et al.  Botulinum Toxin for the Treatment of Genital Pain Syndromes , 2004, Gynecologic and Obstetric Investigation.

[58]  Brian L. Cohen,et al.  The impact of lower urinary tract symptoms and urinary incontinence on female sexual dysfunction using a validated instrument. , 2008, The journal of sexual medicine.

[59]  Seung-June Oh,et al.  Generic and Disease-Specific Health-Related Quality of Life in Women with Coital Incontinence: A Prospective, Multicenter Study , 2007, Gynecologic and Obstetric Investigation.

[60]  G. Thiele Coccygodynia: Cause and treatment , 1963, Diseases of the colon and rectum.

[61]  R. Evans Treatment approaches for interstitial cystitis: multimodality therapy. , 2002, Reviews in urology.

[62]  M. Rosenberg,et al.  Prevalence of interstitial cystitis in a primary care setting. , 2007, Urology.

[63]  J. Teichman,et al.  How do patients with interstitial cystitis present? , 2001, The Journal of urology.

[64]  J. Dell Chronic pelvic pain of bladder origin: a focus on interstitial cystitis. , 2003, International journal of fertility and women's medicine.

[65]  Z. Matthews,et al.  Dyspareunia and urinary sensory symptoms in India: population-based study. , 2006, The journal of sexual medicine.

[66]  S. Uccella,et al.  Female urinary incontinence during intercourse: a review on an understudied problem for women's sexuality. , 2009, The journal of sexual medicine.

[67]  K. Whitmore,et al.  Pelvic floor muscle re-education treatment of the overactive bladder and painful bladder syndrome. , 2002, Clinical obstetrics and gynecology.

[68]  J. Kusek,et al.  The diagnosis of interstitial cystitis revisited: lessons learned from the National Institutes of Health Interstitial Cystitis Database study. , 1999, The Journal of urology.

[69]  A. Grant,et al.  Conservative management of persistent postnatal urinary and faecal incontinence: randomised controlled trial , 2001, BMJ : British Medical Journal.

[70]  F. Montorsi,et al.  Sexual dysfunction is common in women with lower urinary tract symptoms and urinary incontinence: results of a cross-sectional study. , 2004, European urology.

[71]  L. Dennerstein,et al.  What can prevalence studies tell us about female sexual difficulty and dysfunction? , 2006, The journal of sexual medicine.

[72]  M. Eisemann,et al.  Social adjustment and spouse relationships among women with stress incontinence before and after surgical treatment. , 1996, Social science & medicine.

[73]  Anssi Auvinen,et al.  Prevalence of clinically confirmed interstitial cystitis in women: a population based study in Finland. , 2005, The Journal of urology.

[74]  J. Landis,et al.  Associations among urodynamic findings and symptoms in women enrolled in the Interstitial Cystitis Data Base (ICDB) Study. , 1997, Urology.

[75]  A. Weber,et al.  Sexual function and vaginal anatomy in women before and after surgery for pelvic organ prolapse and urinary incontinence. , 2000, American journal of obstetrics and gynecology.