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Development and validity of a questionnaire for coital urinary incontinence: clinical and urodynamic analysis

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Abstract

Introduction and hypothesis

To develop and validate a questionnaire (coital incontinence questionnaire-CIQ) for CI and perform clinical and urodynamic analysis of patients with CI.

Methods

A total of 414 female patients with urinary incontinence undergoing urodynamics were included in this study. All patients were evaluated with a detailed history, questionnaires, physical examination, relevant laboratory tests and urodynamics. Content, construct and convergent validity of the questionnaire were evaluated. Patients were divided into groups: with CI (group 1) and without CI (group 2).

Results

Overall test-retest reliability coefficients of CIQ were high (r = 0.968, p = 0.01), and the internal consistency was excellent (Cronbach’s alpha, 0.964). The test-retest scores did not show a statistically significant difference (p = 0.158). Approximately 34% of these women had CI. Body mass index (BMI), parity, daily incontinence episodes, daily pad counts and 1-h pad test results were higher in group 1 than group 2 (p < 0.05). Multivariate analysis revealed that a daily incontinence episode, BMI, maximum cystometric capacity and PdetQmax were statistically significant factors associated with CI. Urinary incontinence types were different between groups (p < 0.0001). Incontinence with both penetration and orgasm was the most common form of CI (54.4%), and CI severity differed significantly among the forms of CI (p = 0.007). CI negatively interferes with patients’ sexual life, their relationship with their partner and quality of life in most patients.

Conclusions

The CIQ is a reliable, valid and useful tool for assessment of all aspects of CI in women. CI seems to be related to the severity of urinary incontinence. Further studies are needed to clarify this subject.

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Acknowledgements

We thank Dr. Sena Tokay for language editing of the manuscript and Ms. Nuriye Durmaz for data collection.

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Authors and Affiliations

  1. Clinics of Urology, University of Health Sciences Dr. Lütfi Kirdar Training and Research Hospital, Kartal, Istanbul, Turkey

    Fatih Tarhan

  2. Department of Public Health, Marmara University School of Medicine, Istanbul, Turkey

    Pınar Ay

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  1. Fatih Tarhan
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  2. Pınar Ay
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Correspondence to Fatih Tarhan.

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Appendix I: Coital incontinence questionnaire

Appendix I: Coital incontinence questionnaire

The questions below are specifically about with your urine leakage during sexual activity. When answering the following questions, please consider the symptoms you have experienced within the last 3 months only. Your answers will be completely confidential. There is no “right” or “wrong” answer. Please choose the answer that best corresponds to your situation. Be sure to answer all the questions.

In answering these questions, the following definitions apply:

Sexual intercourse is defined as the action or process of inserting the penis into the vagina.

Thank you very much for answering this questionnaire.

1. How much urine do you usually leak during sexual intercourse? (Please circle the number of your answer.)

None, 0

A small amount, 1

A moderate amount, 2

A large amount, 3

2. How often do you experience urinary leakage during sexual intercourse? (Please circle the number of your answer.)

Never, 0

Less than half of the time, 1

About half of the time, 2

More than half of the time, 3

All the time, 4

3. How much does your urine leakage during sexual intercourse interfere with your sexual life? (Please circle the number of your answer.)

Not at all, 0

Slightly, 1

Moderately, 2

Extremely, 3

4. How much does your urine leakage during sexual intercourse distress your relationship with your partner? (Please circle the number of your answer.)

Not at all, 0

Slightly distressed, 1

Moderately distressed, 2

Very distressed, 3

5. If you were to spend the rest of your life with your symptoms, how would you feel about that? (Please circle the number of your answer.)

Pleased, 0

Mixed feelings, 1

Unhappy, 2

6. How much do you experience the feelings such as fear, disgust, hesitation, shame or guilt because of your urine leakage during sexual intercourse? (Please circle the number of your answer.)

Not at all, 0

Slightly, 1

Moderately, 2

Extremely, 3

7. Which of the following statements describes your condition best? Please choose all the answers that apply to you.

a. I never have any urine leakage during sexual intercourse. No, 0. Yes, 1

b. I have urine leakage during intromission of my partner’s penis into my vagina. No, 0. Yes, 1.

c. I have urine leakage when I have orgasm during sexual intercourse. No, 0. Yes, 1.

d. I have urine leakage when I masturbate. No, 0. Yes, 1

e. I have urine leakage during arousal/foreplay. No, 0. Yes, 1

8. Is your urinary incontinence during sexual intercourse related to the position of sexual intercourse?

a. I never have any urine leakage during sexual intercourse. No, 0. Yes, 1

b. I have urine leakage in all positions. No, 0. Yes, 1.

c. I have urine leakage when my partner lies on top. No, 0. Yes, 1.

d. I have urine leakage when I lie on top. No, 0. Yes, 1.

e. I have urine leakage when my partner lies behind my back. No, 0. Yes, 1.

f. I have urine leakage in other positions. No, 0. Yes, 1.

9. Are you taking any measures to avoid urine leakage during sexual intercourse?

a. I never have any urine leakage during sexual intercourse. No, 0. Yes, 1.

b. I have urine leakage during sexual intercourse, but I do not take any precautions. No, 0. Yes, 1.

c. I urinate before sexual intercourse. No, 0. Yes, 1.

d. I squeeze my bottom during sexual intercourse. No, 0. Yes, 1.

e. I avoid sexual intercourse. No, 0. Yes, 1.

Note: No linguistic validation was performed to obtain the English version of the CIQ presented in this publication. As such, the version cannot be considered as a validated tool and therefore cannot be used for English-speaking people.

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Tarhan, F., Ay, P. Development and validity of a questionnaire for coital urinary incontinence: clinical and urodynamic analysis. Int Urogynecol J 30, 2141–2148 (2019). https://doi.org/10.1007/s00192-018-03863-z

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