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