Impact of Incontinence Surgery on Sexual Function: A Systematic Review and Meta-Analysis

Abstract

Introduction Urinary incontinence has an adverse impact on sexual function. The reports on sexual function following the treatment of urinary incontinence are confusing. Aim To investigate the impact of surgery for stress incontinence on coital incontinence and overall sexual function. Methods Cochrane Incontinence Group Specialized Register of Controlled Trials, The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched for trials of incontinence surgery assessing sexual function and coital incontinence before and after surgery. Observational studies and randomized controlled trials investigating the impact of surgical correction of stress urinary incontinence on sexual function were included. Surgical interventions included tension-free vaginal tape (TVT), Tension Free Vaginal Tape-Obturator (TVT-O), transobturator tape (TOT), Burch, and autologous fascial sling (AFS). Studies that included patients undergoing concurrent prolapse surgery were excluded from the analysis. Data extraction and analysis was performed independently by two authors. Coital incontinence was analyzed separately and odds ratios (ORs) with 95% confidence intervals (CI) calculated. The data were analyzed in Review Manager 5 software. Main Outcome Measure Changes in sexual function and coital incontinence following surgery for urinary incontinence. Results Twenty-one articles were identified, which assessed sexual function and/or coital incontinence following continence surgery in the absence of prolapse. Results suggest evidence for a significant reduction in coital incontinence post surgery (OR 0.11; 95% CI 0.07, 0.17). Conclusions Coital incontinence is significantly reduced following continence surgery. There were several methodological problems with the quality of the primary research particularly related to heterogeneity of studies, use of different outcome measures, and the absence of well-designed randomized controlled trials.

Effects of Transobturator Midurethral Sling Surgery on Sexual Functions: One-Year Follow-Up

“…The authors suggested that TOT had positive effect on female sexual functions by reducing urinary leakage and pain during or after sexual activity. In a systematic review evaluating 21 articles assess- ing sexual functions and/or coital incontinence following continence surgery in the absence of prolapse in 1,271 women, there was significant reduction in coital incontinence postoperatively [2]. Similar results were observed in other studies [4,8,18,30].…”

“…The mean age of menopause was 46.7 ± 5.2 (31-53); the mean number of years since menopause was 7.5 ± 5.6 (0. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. The mean number of deliveries were 2.9 ± 1.4 (0-9).…”

“…Studies have shown that women with urinary in-continence report less frequent sexual intercourse and fear of incontinence might be a restricting factor for sexual activity. Sexual function is an important aspect of well-being and some women undergoing surgery for stress incontinence do so in the hope that it will improve their sexual function [2]. Bekker et al [4] suggested that autonomic innervation of the clitoris and the vaginal wall may be affected during retropubic and transobturator midurethral sling surgeries, which may have an adverse effect on clitoris functions, vaginal lubrications, and therefore on sexual functions.…”

“…Stress urinary incontinence (SUI) is defined as the complaint of involuntary loss of urine on effort or physical exertion or on sneezing or coughing [1] and affects up to 25% of women [2]. SUI has an adverse effect on social, occupational, domestic, psychological, and physical and sexual well-being [3].…”

Sexual function in women with pelvic floor disorders

“…Studies have shown that surgery to address stress urinary incontinence (SUI) has a positive impact on sexual function, particularly with resolution of coital incontinence. 7,8 In a systematic review of 18 studies addressing sexual function post-SUI surgery, 32% of patients reported an improvement, 55% reported no change and a small but still substantial 13% of patients reported worsening of sexual function. Improvements in sexual health following treatment for SUI are due to a reduction in coital incontinence; it has not been shown that surgery has any impact on other aspects of sexual function such as desire, arousal or orgasm.…”