1. A Prospective Study of the Impact of Bladder Incontinence Surgery on Sexual Satisfaction K. Witzke, DO, Gregory McIntosh, DO, FACOS, Jeffrey Schock, DO, FACOS, and Amy Brode DO Department of Urology, Michigan State University College of Osteopathic Medicine and Mt. Clemens Regional Medical Center K. Witzke, DO, Gregory McIntosh, DO, FACOS, Jeffrey Schock, DO, FACOS, and Amy Brode DO Department of Urology, Michigan State University College of Osteopathic Medicine and Mt. Clemens Regional Medical Center

2. Introduction There is limited research done in the field of women’s sexual health. Women’s sexual dysfunction is age-related, progressive and common affecting up to 50% of women. 1 Women with lower urinary tract symptoms or incontinence have a deteriorating sexual life noted to be as high as 26-47%. 2 1 A. Salonia, European Urology, 45 (2004), 642-648 2 Dalpiaz O, et al, BJU Int. 2008, Mar;101 (6)717-21 There is limited research done in the field of women’s sexual health. Women’s sexual dysfunction is age-related, progressive and common affecting up to 50% of women. 1 Women with lower urinary tract symptoms or incontinence have a deteriorating sexual life noted to be as high as 26-47%. 2 1 A. Salonia, European Urology, 45 (2004), 642-648 2 Dalpiaz O, et al, BJU Int. 2008, Mar;101 (6)717-21

3. Introduction: Recent studies have addressed the overall lack of consideration in the area of sexual health for female patients undergoing pelvic surgery. 3,4 There very few studies which incorporate patient’s partners and their sexual health. 3: Nappi R, et al, Clinical Biologic Pathophysiologiy of Women’s Sexual Dysfunction, J Sex Med 2005; 2:4- 25. 4: Althof SE, et al, Current Perspectives on the clinical assessment and diagnosis of female sexual dysfunction and clinical studies of potential therapies: A statement of concern. J Sex Med 2005; 2,146-53. Recent studies have addressed the overall lack of consideration in the area of sexual health for female patients undergoing pelvic surgery. 3,4 There very few studies which incorporate patient’s partners and their sexual health. 3: Nappi R, et al, Clinical Biologic Pathophysiologiy of Women’s Sexual Dysfunction, J Sex Med 2005; 2:4- 25. 4: Althof SE, et al, Current Perspectives on the clinical assessment and diagnosis of female sexual dysfunction and clinical studies of potential therapies: A statement of concern. J Sex Med 2005; 2,146-53.

4. Purpose It is our goal to survey female patients and their male partners both before and after incontinence surgery. We would like to identify if this surgery altered patients and/or their partners sexual satisfaction.

5. Materials and Methods Prospective pilot study from April 2007-2009 including female surgical patients and their monogamous male partners for one year duration. Surgery included: Cystocele, Rectocele, Periurethral Injections, Sling Procedures, and Interstim insertion. Participants were 18-80 years of age. Four Validated questionnaires were utilized Two for female patients Female Sexual Function Index (FSFI) Sexual Distress Scale (SDS) Two for male partners: International Index of Erectile Function (IIEF) Sexual Distress Scale (SDS) Prospective pilot study from April 2007-2009 including female surgical patients and their monogamous male partners for one year duration. Surgery included: Cystocele, Rectocele, Periurethral Injections, Sling Procedures, and Interstim insertion. Participants were 18-80 years of age. Four Validated questionnaires were utilized Two for female patients Female Sexual Function Index (FSFI) Sexual Distress Scale (SDS) Two for male partners: International Index of Erectile Function (IIEF) Sexual Distress Scale (SDS)

6. Materials and Methods Each were instructed to answer the questionnaires in private at 3 intervals: pre- operatively, at 6 months, and 1 year. The initial questionnaire was filled out on the day of informed consent, the follow-up questionnaires were mailed out and sent back by self-addressed envelope. Each were instructed to answer the questionnaires in private at 3 intervals: pre- operatively, at 6 months, and 1 year. The initial questionnaire was filled out on the day of informed consent, the follow-up questionnaires were mailed out and sent back by self-addressed envelope.

7. Participants 14 total participants (11 patients and 3 partners) were enrolled in this pilot study from April 2007-2009. 6 patients and 1 partner were excluded from the study: One patient did not have surgery. Five patients and one partner withdrew from the study after obtaining only pre-operative surveys. (2 interstim, 2 TOT, 1 cystocele) 5 patients and 2 partners were included: Two patients and one partner withdrew after obtaining 6 month follow-up data. (TOT, periurethral injection) Two patients returned only their 1 year questionnaire. (Cystocele and TOT) One couple completed all questionnaires. (Periurethral injection) 14 total participants (11 patients and 3 partners) were enrolled in this pilot study from April 2007-2009. 6 patients and 1 partner were excluded from the study: One patient did not have surgery. Five patients and one partner withdrew from the study after obtaining only pre-operative surveys. (2 interstim, 2 TOT, 1 cystocele) 5 patients and 2 partners were included: Two patients and one partner withdrew after obtaining 6 month follow-up data. (TOT, periurethral injection) Two patients returned only their 1 year questionnaire. (Cystocele and TOT) One couple completed all questionnaires. (Periurethral injection)

8. Data for Patients The 19 question, FSFI data was scored using 6 domains Higher scores indicate high satisfaction in each domain: Desire (1.2-6.0) Arousal (0-6.0) Lubrication (0-6.0) Orgasm (0-6.0) Satisfaction (0-6.0) Pain (0-6.0) The 19 question, FSFI data was scored using 6 domains Higher scores indicate high satisfaction in each domain: Desire (1.2-6.0) Arousal (0-6.0) Lubrication (0-6.0) Orgasm (0-6.0) Satisfaction (0-6.0) Pain (0-6.0)

9. FSFI: 6 month data

10. FSFI: 6 month findings Desire: 54% decrease Arousal: 21% decrease Lubrication: 17% decrease Orgasm: 18% decrease Satisfaction: 6% decrease Pain:16% increase Desire: 54% decrease Arousal: 21% decrease Lubrication: 17% decrease Orgasm: 18% decrease Satisfaction: 6% decrease Pain:16% increase

11. FSFI: 1 year data

12. FSFI: 1 year findings Desire:10% increase Arousal:38% increase Lubrication:20% increase Orgasm:49% increase Satisfaction:22% increase Pain:27% decrease Desire:10% increase Arousal:38% increase Lubrication:20% increase Orgasm:49% increase Satisfaction:22% increase Pain:27% decrease

13. Data for Patients (SDS) The 12 question Sexual Distress Scale (SDS) was analyzed using total numbers. (0-48) Lower numbers are associated with less sexual distress Higher numbers indicate a more significant degree of sexual distress. The 12 question Sexual Distress Scale (SDS) was analyzed using total numbers. (0-48) Lower numbers are associated with less sexual distress Higher numbers indicate a more significant degree of sexual distress.

14. Patient SDS: 6 month and 1 year SDS total 6 month: 13% increase in distress SDS total 1 year: 3% decrease in distress

15. Data for Partners The 15 question, IIEF data was scored using 5 domains: A higher score indicates higher level of satisfaction. Erectile function (0-30) Orgasm (0-10) Desire (0-10) Intercourse Satisfaction (0-15) Overall Satisfaction (0-10) The 15 question, IIEF data was scored using 5 domains: A higher score indicates higher level of satisfaction. Erectile function (0-30) Orgasm (0-10) Desire (0-10) Intercourse Satisfaction (0-15) Overall Satisfaction (0-10)

16. IIEF: 6 month data

17. IIEF: 6 month findings Erectile function: 2% decrease Orgasm: 10% decrease Desire: no change Intercourse Satisfaction: no change Overall Satisfaction: no change Erectile function: 2% decrease Orgasm: 10% decrease Desire: no change Intercourse Satisfaction: no change Overall Satisfaction: no change

18. IIEF: 1 year data

19. IIEF: 1 year findings Erectile function: 3% decrease Orgasm:20% decrease Desire: 20% increase Intercourse Satisfaction: no change Overall Satisfaction: no change Erectile function: 3% decrease Orgasm:20% decrease Desire: 20% increase Intercourse Satisfaction: no change Overall Satisfaction: no change

20. Partner SDS: 6 month and 1 year SDS total 6 month: 3% increase in distress SDS total 1 year:6% increase in distress

21. Summary Patients An overall decrease in sexual satisfaction was noted in the 6 month group. An overall increase in sexual satisfaction was noted in the 1 year group. Partners An overall decrease in sexual satisfaction was found in the 6 month group. No definite trend in sexual satisfaction was found for the 1 year group. Patients An overall decrease in sexual satisfaction was noted in the 6 month group. An overall increase in sexual satisfaction was noted in the 1 year group. Partners An overall decrease in sexual satisfaction was found in the 6 month group. No definite trend in sexual satisfaction was found for the 1 year group.

22. Conclusion: The small amount of patients enrolled in this pilot study make it difficult to postulate any definitive conclusions. The intimate nature of these questions can be difficult for patients to answer, and may have attributed to our 50% drop-out rate. A larger number of participants, as well as a control group, would be recommended for further studies of this important topic. The small amount of patients enrolled in this pilot study make it difficult to postulate any definitive conclusions. The intimate nature of these questions can be difficult for patients to answer, and may have attributed to our 50% drop-out rate. A larger number of participants, as well as a control group, would be recommended for further studies of this important topic.