Female sexual dysfunction: are urogynecologists ready for it?

Roos, Anne‐Marie; Thakar, Ranee; Sultan, Abdul H.; Scheer, Inka

doi:10.1007/s00192-008-0735-3

Cited by 35 publications

(35 citation statements)

References 17 publications

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“…Our study further substantiates the importance of asking women about sexual problems when they present with urinary incontinence as it is a very common symptom, but unless asked, women will not divulge voluntarily this information [11]. Our study also dispels the belief traditionally held in relation to coital incontinence and found that urodynamic diagnosis is not linked to underlying sexual problems, orgasm or penetration incontinence.…”

Section: Discussionsupporting

confidence: 82%

Incontinence during intercourse: myths unravelled

2012

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Section: Discussionsupporting

confidence: 82%

Incontinence during intercourse: myths unravelled

2012

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“…A number of previous surveys of similar national and international professional groups have been published, with response rates between 21% and 67%. 48,[96][97][98] None of these studies employed incentives to take part, and indeed none used reminder letters or e-mails. 95,99 Clearly the level of interest or excitement generated by the topic in potential respondents is of importance in encouraging responses.…”

Section: Clinicians' Viewsmentioning

confidence: 99%

INVESTIGATE-I (INVasive Evaluation before Surgical Treatment of Incontinence Gives Added Therapeutic Effect?): a mixed-methods study to assess the feasibility of a future randomised controlled trial of invasive urodynamic testing prior to surgery for stress urinary incontinence in women

Hilton

Armstrong

Brennand

et al. 2015

Health Technology Assessment

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BackgroundThe position of invasive urodynamic testing in the diagnostic pathway for urinary incontinence (UI) is unclear. Systematic reviews have called for further trials evaluating clinical utility, although a preliminary feasibility study was considered appropriate.ObjectivesTo inform the decision whether or not to proceed to a definitive randomised trial of invasive urodynamic testing compared with clinical assessment with non-invasive tests, prior to surgery in women with stress UI (SUI) or stress predominant mixed UI (MUI).DesignA mixed-methods study comprising a pragmatic multicentre randomised pilot trial; economic evaluation; survey of clinicians’ views about invasive urodynamic testing; qualitative interviews with clinicians and trial participants.SettingUrogynaecology, female urology and general gynaecology units in Newcastle, Leicester, Swansea, Sheffield, Northumberland, Gateshead and South Tees.ParticipantsTrial recruits were women with SUI or stress predominant MUI who were considering surgery after unsuccessful conservative treatment. Relevant clinicians completed two online surveys. Subsets of survey respondents and trial participants took part in separate qualitative interview studies.InterventionsPilot trial participants were randomised to undergo clinical assessment with non-invasive tests (control arm); or assessment as controls, plus invasive urodynamic testing (intervention arm).Main outcome measuresConfirmation that units can identify and recruit eligible women; acceptability of investigation strategies and data collection tools; acquisition of outcome data to determine the sample size for a definitive trial. The proposed primary outcome for the definitive trial was International Consultation on Incontinence Modular Questionnaire (ICIQ) Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) (total score) 6 months after surgery or the start of non-surgical treatment; secondary outcomes included: ICIQ-FLUTS (subscales); ICIQ Urinary Incontinence Short Form; ICIQ Lower Urinary Tract Symptoms Quality of Life; Urogenital Distress Inventory; EuroQol-5D; costs, quality-adjusted life-years (QALYs) and incremental cost per QALY, Short Form 12; 3-day bladder diary.ResultsOf 284 eligible women, 222 (78%) were recruited; 165/219 (75%) returned questionnaires at baseline and 125/200 (63%) who were sent questionnaires at follow-up. There were few missing data items in returned questionnaires, with individual outcome scales calculable for 81%–94%. Most women underwent surgery; management plans were changed in 19 (19%) participants following invasive urodynamic testing. Participant Costs Questionnaires were returned by 53% 6 months after treatment; complete data to undertake cost–utility analysis were available in 27% (intervention) and 47% (control). While insufficient to recommend changes in practice, the results suggest further research would be valuable. All clinicians responding to the survey had access to invasive urodynamic testing, and most saw it as essential prior to surgery in women with SUI with or without other symptoms; nevertheless, 70% considered the research question underlying INVESTIGATE important and most were willing to randomise patients in a definitive trial. Participants interviewed were positive about the trial and associated documentation; the desire of some women to avoid invasive urodynamic testing contrasted with opinions expressed by clinicians through both survey and interview responses.ConclusionsAll elements of a definitive trial and economic evaluation were rehearsed; several areas for protocol modification were identified. Such a trial would require to 400–900 participants, depending on the difference in primary outcome sought.Future workA definitive trial of invasive urodynamic testing versus clinical assessment prior to surgery for SUI or stress predominant MUI should be undertaken.Trial registrationCurrent Controlled Trials ISRCTN71327395.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Lack of time, ignorance of therapeutic options to treat sexual dysfunctions and the belief that sexuality is not an important issue among these women due to their advanced mean age, are the reasons referred to by professionals in order to justify why they do not systematically ask about sexual life when taking the urogynecological history. 12,13 The sexual lives of the women attended to in clinical practice in urogynecology can be grouped into a first group with pelvic Table 1 Major studies examining the activity and sexual function in women with pelvic floor disease.…”

Section: Resultsmentioning

confidence: 99%