Assess Sexual Disorders and Urinary Incontinence among Asymptomatic Women

Discussion

The International Continence Society (ICS) defines urinary incontinence (UI) as a complaint of any involuntary loss of urine. Urinary incontinence is considered a public health problem and affects the quality of life (QoL) of thousands of women (Haylen, Ridder, and Freeman, 2010). These debilitating conditions interfere with social wellbeing, psychological, occupational and domestic aspects and are also related to sexual complaints (Santana, Aoki, and Auge, 2012). According to the World Health Organization, female sexual dysfunction (FSD) is defined as an inability to derive satisfaction from the sexual act (Abdo, et al., 2002). Female sexual dysfunction is a prevalent health problem that has been inadequately investigated in the Arab world. In Egypt, the prevalence of FSD among women is limited. (Hassanin, et al., 2010). So the aim of this study was to determine the various types of sexual and urinary disorders amongasymptomatic woman in different social levels and identify the high risk factors, which will be more likely to have these sexual and urinary disorders.

The present study pointed to the mean age of participants was 30.2 ± 6.3 years and more than half of them ranged between 35 – 40 years. This result accordance withEl-Mowafy et al., (2015) studied the prevalence of degree, duration and types of urinary incontinence among middle age women and the risk factors associated with urinary incontinence among middle age women. They found that that 37.7%, 31.4% of the study sample who had urinary incontinence was 45-49 & 55-60 years respectively.

This result in the same line with Milsom, (2009) mentioned that the prevalence estimates for middle-aged or older women are 25-45% for any urinary incontinence and 5–15% for daily incontinence.

Also concerning to residence of studied sample more than half of them come from urban area. This results in the same line with a recent study done by Ismail et al., (2017) investigated the prevalence and possible risk factors that may cause FSD Assiut University Hospital, Assiut, Egypt and to study women attitude towards their sexual dysfunction aged between 18 and 55 years who had visited the hospital for routine check-up, women accompanying other patients and non-medical female hospital staff, mentioned that more than half of women participated in their study come from urban area.

This result due to middle Egypt women not go to obstetric physician only if they suffering from severe illness.

Furthermore; concerning to age at marriage near to half of studied women 15- < 25 years with mean 21.1 ± 6.5 year and the highest proportion of women reported that they had been married for less than 5 years. This result consistence with Mamdouh et al., (2017) in a cross-sectional survey conducted in eight family planning clinics in Alexandria, Egypt to determine the prevalence and risk factors for FSD reported that nearly half of the women were married at age 20-29 years. The highest proportion of women (28.8%) reported that they had been married for five years or less. In addition study done by Ismail et al., (2017) mentioned near to one third of studied sample duration of marriage was less than 5 years.

This result due to obligatory rules from the governorate regarding age at marriage must be more than 18 years.

Regarding the most frequent domain of female sexual dysfunction in this result was sexual pain domain near to one quarter of the women studied followed by sexual desire domain then arousal domain and the minority have dysfunction in lubrication, orgasm and satisfaction domains. This result in the same line with Mollaoglu, Tuncay, and Fertelli, (2013) evaluated sexual dysfunction and the factors that affect sexual dysfunction in women with chronic disease in Cumhuriyet University’s internal medicine clinics, Turkey according to the Female Sexual Function Index (FSFI) Index component scores showed that the majority of women experienced pain during intercourse (80%), had orgasm (79%) and satisfaction (75%) problems and had loss of sexual desire (71%). In addition, there were also impairments of arousal (50%) and lubrication (46%).

Moreover, Ibrahim et al., (2013) assessed sexual function among married women and determined associated risk factors for sexual dysfunction among 509 married females 20–59 years old. Sexual dysfunction was assessed using female sexual function index (FSFI). Reported that desire and Orgasm domains were the most affected with 52.8 % of the participants having sexual dysfunction.

In addition; In Japanese study by Sako, et al., (2011) that assessed whether lower urinary tract symptoms (LUTS) affect sexual function in Japanese females by using a multi-component questionnaire was mailed to 576 female hospital workers. They reported sexual pain disorders were the most frequent domain 58% of the 101 women.  Finally study done in El Fayoum city by El-Tahlawi, et al., (2018) reported the most frequently dysfunction was pain domain (43.3%).

Contradicted with this result El Atrash et al., (2014); Mamdouh et al., (2015) they reported sexual desire disorders were the most frequent domain (86%& 82.2% respectively) also, Esfehani, et al., (2016) Sexual dysfunction was observed to be most frequent in domains of sexual desire (49.2%), sexual arousal (43.2%), orgasm (38.6%), lubrication (36%), sexual pain (35.2%) and sexual satisfaction (26.1%), respectively.

It may be due to difference in level of education and awareness regarding the sexuality subject, the nature of studied populations and  methods of data collection.

Concerning mean score of total FSFI was 56.9 ± 17.4 among studied sample, satisfaction domain was 10.8 ± 2.9, pain domain was 7.3 ± 3.5 desire and arousal domain were 6.6 ± 1.9. These results in the same line with Alataş,  Özkan, and  Öğce, 2013 assessed  the effect of overactive bladder syndrome (OAB) on the sexual life in asymptomatic continent women,  reported that patients were determined as 28 continent women with OAB, 89 women without OAB. In the women without OAB mean scores of arousal , orgasm, and total FSFI are the same with these results  while mean scores of desired and satisfaction domain in this study was simply  higher than them also, pain sensation was lower among this sample .

It may be due to difference in level of education and awareness regarding the sexuality subject, the nature of studied populations and methods of data collection.

Concerning to prevalence of female sexual dysfunction was estimated at 10.0% of the studied women has it. This result accordance with Burri and Spector, (2011) estimated the prevalence and comorbidity of recent and lifelong FSD and identified potential psychosocial and behavioral risk factors in a nationally representative sample of UK women. Reported that female sexual dysfunction has been estimated at 5.8% in the United Kingdom.

Contradicted to this result study done by Mamdouh et al., (2017) in a cross-sectional survey conducted in eight family planning clinics in Alexandria, Egypt to determine the prevalence and risk factors for FSD. They found that FSD in more than half of the women surveyed (53.7%). In additional study done by Mostafa et al., (2018) assessed the prevalence and patterns of female sexual dysfunction (FSD) among overweight and obese premenopausal women in Beni-Suef, Egypt reported precisely, 42 (28%) of women had FSD.Finally a recent study done by El-Tahlawi,  et al., (2018) estimated prevalence of FSD and its related factors in El Fayoum city  included 508 married females (above 21 years old) from the attendants of the health care facilities (outpatient clinic of Dermatology, STDs and andrology of faculty of medicine, El Fayoum University, Primary health care and Maternity and child health in EL Fayoum city) found that the prevalence of FSD among studied group was 61.2% versus 38.8% had normal sexual function.

It could be due to variations in diagnostic criteria, types of studied populations, and data collection methods used.

Concerning women who were sexually active, more than three quarters of studied sample was sexually active and near to one quarter of them did not. This result consistent with Karbage et al., (2016) assessed the impact of socio-demographic characteristics in the sexual function of Brazilian women with UI. Reported that 70.1% of their studied sample with sexual activity and 29.9% of them without sexual activity.

Regardingleakage of urine and/or stool with any type of sexual activity among participants those sexually active the minority reported usually or always fears from it. This result contradict with Karbage et al., (2016) demonstrated that among sexually active women, approximately 58% of respondent women answered that the fear of leakage interferes negatively during the sexual intercourse sometimes, usually or always. These differences may be due to different environmental and cultural factors.

Concerning factors that disturb urinary and sexual function among woman there was statistically significance differences between female sexual dysfunction and their age in which women aged between 35 – 40 years. This result due to mean age of participant was 30.2 ± 6.3 years that lead to increase risk factor to FSD

This result in consistent with Hassanin et al. (2010) patients with FSD were significantly more likely to be older than 40 years, have sexual intercourse fewer than 3 times a week, have been married for 10 years or more, and have 5 children or more. Age of the women maintained a statistically significant positive relationship with FSD in the regression model (odds ratio 1.39; 95% CI, 1.26–1.53). In additional to study done by Ibrahim et al., (2013) mentioned the total FSFI score of B 26.55 was the cutoff value for diagnosis of FSD and female age, duration of marriage were found to be significant associated factors with FSD, in Tekin, et al., (2014) study, evaluated women in the reproductive ages, and although their participants were not in menopause, observed that advancing age in women negatively affected the sexual functions. Also, Mamdouh et al., (2015) reported that age above 40 years (odds ratios [OR] 3.1; 95% CI 1.9to 4.8) was the potential predictors for the presence of possible FSD among the current sample after using logistic regression.

In the Esfehani, et al., (2016) reported that there were a significant correlation was observed between duration of relationship with partner, increase female age and prevalence of FSD. Common belief suggests that sexual disorders tend to be more prevalent in middle-aged women, as well as those ageing ≥27 years (Aslan, et al., 2008, Ibrahim, 2013). Increased prevalence of FSD is mainly associated with age due to decreased sex drive, reduced sexual intercourse and vaginal dryness caused by menopause (i.e., low estrogen secretion) (Castelo-Branco, Cancelo, Chedraui, 2007).

Regarding women educational level as factors disturb urinary and sexual function among woman there was no statistically significance differences between female sexual dysfunction and their educational level. Contradicted to this resultmany studies performed abroad have shown the association of low educational level with sexual dysfunction (Chedraui, etal., 2009& Safarinejad, 2006).

This simple discrepancy and variations with our findings could be due to some factors. For example due to differences in ethnicity and culture

Studies from India & Brazil suggested that the prevalence of FSD rises with woman’s lower education attainment (Singh, etal., 2009; Aggarwal, etal.,  2012) However, some other research from developing countries reported an association between higher education and the reported rates of FSD (Sidi et al., 2007; Fajewonyomi BA, Orji EO, Adeyemo, 2007) and Echeverry et al., 2010) which identified low education level as a predictor for sexual complaints, and this finding was confirmed by another study in this regard, Esfehani, et al., (2016) study revealed that low education level has a significant effect on the manifestations of FSD.

Another factors that disturb urinary and sexual function among woman is duration period of marriage there was negative fair association between female sexual dysfunction and its.  This finding correlates well with that of Ozerdoğan et al., (2009) who showed that an increase in parity negatively affected the sexual functions. As factors associated with the number of children, also the woman’s advancing age and type of delivery negatively affected the sexual functions. Likewise, Tekin, et al., (2014) showed that with an increase in the number of children, the sexual functions decreased (p=0.049).

Conclusion

Based on the findings of the current study the following conclusions can be drawn: The most frequent dysfunction domains among studied group were sexual pain 22.0%, followed by 16.0% sexual desire, then 14.0% sexual arousal, 11.0% lubrication domain, 10.9% orgasm, 5.0% satisfaction domain, and 10.6% of them had FSD. The main risk factor can lead to FSD were age of studied group and duration period of marriage. Moreover, there were negative fair association between studied age and sensation of pain during sexual activity, and the marriage period with desired, arousal, satisfaction domain, and total FSFI.

Recommendations

Based on the study findings, the following recommendations are proposed:

• Develop training program for asymptomatic women with sexual disorders and urinary incontinence to know the most frequent dysfunction and how to deal with it.
• All asymptomatic women with sexual disorders and urinary incontinence should identify their age is main risk factors of FSD.

• Expand public awareness through mass media about sexual disorders and urinary incontinence among asymptomatic women.