1. International Continence Society Introduction and aim of the study
Tokyo september 2016
Coital incontinence: prevalence and risk factors in incontinent women
Costantini E1, Porena M1, Giannitsas K2, Athanasopoulos A2, Balsamo R3, Masiello G4, Natale F5, Carbone A6, Mahfouz W7, Finazzi Agrò E8, Kocjancic E9, Illiano E1 1. Urology and Andrology Clinic, Department of surgical and biomedical Science, University of Perugia Italy, 2. Department of Urology, University Hospital of Patras, Rio, Greece, 3. Division of urology,Magna Graecia University of Catanzaro,Campus of Germaneto,Italy, 4. "Don Tonino Bello " Hospital, Molfetta, Italy, 5. Urogynecology San Carlo-IDI Hospital Rome Italy, 6. Urology Unit, ICOT, Department of Medico Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina Italy, 7. Alexandria University, Egypt, 8. Department of Urology, Tor Vergata University Hospital, Rome, Italy, 9. University of Illinois at Chicago, Chicago, Illinois
Introduction and aim of the study
Materials and methods
This is an international, multicentre, cross-sectional study, performed in :
Italy, Greece, USA and Egypt.
It was registered on ClinicalTrials.gov: NCT
Inclusion criteria were: sexually active adult women with UI. Exclusion criteria were: sexually active adult women without UI, or sexually inactive adult women with UI. UI was classified in stress (SUI), urgency (UUI) and mixed incontinence (MUI) on the basis of the ICS standardization.
Women were asked about CI during penetration, intercourse and orgasm and its impact on the quality and frequency of their sexual life
The International Consultation on Incontinence Questionnaire (ICIQ-UI) and the Patient Perception of Bladder Condition (PPBC) were administered.
Statistical analysis was performed by using univariate and multiple logistic regression analysis at significance level of p<0.05
The incidence of coital incontinence (CI) in incontinent women is reported between 10% and 27% and few studies are designed to investigate this problem.
It is traditionally divided into two forms on the basis of the timing of occurrence during intercourse: (i) incontinence at penetration, and (ii) incontinence during orgasm.
The Primary objective of this study was to evaluate the prevalence of coital incontinence in a large series of women presenting to different urogynecological services with a complaint of urinary incontinence (UI) and to evaluate associated clinical risk factors.
Secondary objective was to measure the impact of CI on female sexuality and quality of life (QoL).
Results
749 women with mean age of 52.16±11.14 years were included.
39.9% of women had CI: 17.2% at penetration, 32.3% during intercourse, 18.4% at orgasm
A significant association emerged between :
CI and SUI (77.9% vs 58%, p=0.001)
MUI (38.7% vs 32.2%,p=0.031) and POP (46.3% vs35.4%,p=0.004)
In the different CI subgroups an association emerged between
CI during penetration and SUI (76.7% versus 63.7%, p=0.006)
CI during intercourse and MUI with predominant stress incontinence (42.3% vs 30.7%, p=0.004)
CI during orgasm and MUI with predominant urgency incontinence (38.2% vs 25.2%, p=0.004).
INTERCOURSE
ORGASM
Women with CI during orgasm had undergone more frequently previous anti-incontinence surgery (27.7% versus 14.6% p= 0.001) and previous hysterectomy (20.4% versus 12.6% p= 0.025).
Women with CI during intercourse had undergone more frequently :
previous anti-incontinence surgery (23.6% versus 14.0% p=0.002)
previous POP surgery (27.7% versus 14.6% p=0.001)
previous hysterectomy (19.5% versus 11.5% p=0.005).
SUI can be risk factor for CI during penetration (OR: 1.880), while MUI with predominant SUI and MUI with predominant UUI can be risk factors for CI during intercourse (OR:1.657) and CI during orgasm (OR1.835) respectively
POP and previous POP surgery can be risk factors for CI during intercourse (OR: 1569 and OR:2.240 respectively).
Previous hysterectomy and previous anti-incontinence surgery can be risk factors for CI during intercourse ( OR:1.892 and OR: respectively) and at orgasm (OR:1.775 and OR:1.619 respectively)
Age and caesarean delivery are a protective factors for the development of CI (OR: and OR: respectively)
According to ICIQ-UI scores, increased severity of UI positively correlated with CI (p= 0.001) and had a negative impact on the quality (p=0.001) and frequency (p=0.001) of sexual activity
Conclusion
CI is common in women with UI and significantly impacts their sexual life. Older age, POP, stress urinary incontinence, previous hysterectomy, anti-incontinence surgery, and POP surgery are significant risk factors. Further investigations on the epidemiologic associations of CI is warranted due the relative high incidence in women with UI. This symptom can affect sexual life and should be investigated during counselling in all the patients who refers to urogynecological centres.