Review article
Impact of pelvic floor disorders and prolapse on female sexual function and response

https://doi.org/10.1016/S0094-0143(02)00056-3Get rights and content

Section snippets

Incidence of pelvic floor disorders and female sexual dysfunction

Disorders of the pelvic floor include incontinence, cystocele, rectocele, enterocele, and vaginal and uterine prolapse. Urinary incontinence affects an estimated 10% to 58% of women [4]. The variation in the prevalence may result from confounding variables in survey collection. Data on the prevalence of genital prolapse are not as clear. However, over 400,000 procedures for this condition occur annually in the United States [4], and likely many more patients are medically managed for these

Pelvic floor disorders and sexual dysfunction

Pelvic floor disorders, a term generally used to describe dysfunction in the continence mechanisms and genital prolapse, can affect sexual function. The pelvic floor consists of all the tissues between the pelvic peritoneum and the perineum, the visceral fascia and pelvic diaphragm, and the urogenital and anal triangles [1] and includes the bony pelvis, connective tissues, muscles, and nerves. These structures provide the support for the pelvic organs and the coordination of voiding,

1998 American Foundation of Urologic Disease (AFUD) consensus panel classifications and definitions of FSD

Masters and Johnson first described the female sexual response in 1966. They proposed four successive phases: excitement, plateau, orgasm, and resolution [29]. In 1974, Kaplan described three phases: desire, arousal, and orgasm [30]. In October 1998, an AFUD Consensus Panel convened that was made up of 19 experts on FSD from five countries. These experts were from the fields of endocrinology, family medicine, gynecology, nursing, pharmacology, physiology, psychiatry, psychology, rehabilitation

Hypoactive sexual desire disorder

Hypoactive sexual desire disorder is the persistent recurring deficiency (or absence) of sexual fantasies/thoughts, or receptivity to sexual activity, which causes personal distress.

Sexual arousal disorder

Sexual arousal disorder is the persistent or recurring inability to attain or maintain sufficient sexual excitement causing personal distress. It may be experienced as a lack of subjective excitement or lack of genital lubrication/swelling or other somatic responses.

Physiologically, women with sexual arousal disorder do not produce adequate vaginal lubrication or engorgement and may complain of decreased genital sensation. Organic causes include aging, menopause, pelvic surgery, medications,

Orgasmic disorder

Orgasmic disorder is the persistent or recurrent difficulty, delay in, or absence of attaining orgasm after sufficient sexual stimulation and arousal, which causes personal distress.

Dyspareunia

Dyspareunia is the recurrent or persistent genital pain associated with sexual intercourse. Although this condition has historically been defined by psychological theories, the current treatment approach favors an integrated pain model. Identification of the initiating factors is essential to reaching a successful diagnosis. Potential etiologies include vaginismus, inadequate lubrication, atrophy, and vulvodynia (vulvar vestibulitis). Less common etiologies are endometriosis, pelvic congestion,

Female sexual anatomy: abnormalities leading to sexual dysfunction

An understanding of the anatomy of the female pelvis is essential to understanding the mechanisms of sexual dysfunction. This region can be separated anatomically into the internal genitalia and external genitalia [17].

Summary

Pelvic floor disorders and FSD are prevalent and challenging problems. These disorders include prolapse of the uterus, cervix, vagina, bladder, and rectum and incontinence. These diseases likely affect women's sexual well-being through physical and emotional effects. Women with pelvic floor disorders often have co-existing urologic and sexual complaints. Patients who present with these urologic problems should be questioned about their sexual function. Surgical treatment in these patients may

First page preview

First page preview
Click to open first page preview

References (44)

  • M.C. Klein et al.

    Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation

    Am J Obstet Gynecol

    (1994)
  • E.J. Gill et al.

    Pathophysiology of pelvic organ prolapse

    Obstet Gynecol Clin North Am

    (1998)
  • C. Wester et al.

    Normal pelvic floor physiology

    Obstet Gynecol Clin North Am

    (1998)
  • V.T. Mallett et al.

    The epidemiology of female pelvic floor dysfunction

    Curr Opin Obstet Gynecol

    (1994)
  • K. Bo et al.

    Randomized controlled trial of the effect of pelvic floor muscle training on quality of life and sexual problems in genuine stress incontinent women

    Acta Obstet Gynecol Scand

    (2000)
  • P. Hilton

    Urinary incontinence during sexual intercourse: a common, but rarely volunteered, symptom

    Br J Obstet Gynecol

    (1988)
  • D. Gordon et al.

    Sexual function in women attending a urogynecology clinic

    Int Urogynecol J Pelvic Floor Dysfunct

    (1999)
  • M.D. Walters et al.

    Psychosexual study of women with detrusor instability

    Obstet Gynecol

    (1990)
  • Berman JR, Raz S. Sexual dysfunction in women with pelvic prolapse [abstract]. In: Program of the female sexual...
  • T. Gungor et al.

    Influence of anterior colporrhaphy with colpoperineoplasty operations for stress incontinence and/or genital descent on sexual life

    J Pak Med Assoc

    (1997)
  • I. Spector et al.

    Incidence and prevalence of the sexual dysfunctions: a critical review of the empirical literature

    Arch Sex Behav

    (1990)
  • E. Laumann et al.

    Sexual dysfunction in the United States: prevalence and predictors

    JAMA

    (1999)
  • Cited by (34)

    • Urogynecology and sexual function research. How are we doing?

      2009, Journal of Sexual Medicine
      Citation Excerpt :

      Female SF was found to be negatively impacted by the presence of lower urinary tract symptom, with urinary incontinence (UI) and detrusor overactivity causing the greatest degree of SD [7]. Several studies reported that 40–50% of patients with UI also report impairment of SF [8–10]. Recent studies demonstrated improvement in SF following treatment for UI [11–13].

    View all citing articles on Scopus
    View full text