Abstract
To assess the sexual function of women with spina bifida (SB), and to verify the factors that influence their sexual function. A cross-sectional study in which a validated female-specific questionnaire was applied to 140 SB female patients from four different cities (Porto Alegre, Brazil; and Barcelona, Madrid, and Málaga, Spain) between 2019 and 2020. The questionnaires collected data on the clinical characteristics of SB, and female sexual function was assessed using the 6-item version of the Female Sexual Function Index (FSFI-6) validated to Portuguese and Spanish. Half of the patients had had sexual activity at least once in the life, but most (57.1%) did not use any contraception method. Sexual dysfunction was present in most (84.3%) patients, and all sexual function domains were impaired compared those of non-neurogenic women. The presence of urinary and fecal incontinence significantly affected the quality of their sexual activity based on the FSFI-6. The specific clinical aspects of the SB patients, such as urinary and fecal incontinence, should be properly addressed by their doctors, since they are associated with reduced sexual activity and lower FSFI-6 scores in the overall or specific domains. There is also a need to improve gynecological care among sexually-active SB patients, since most do not use any contraceptive methods and are at risk of inadvertent pregnancy.
Highlights
IntroductionSpina bifida (SB) is the main neurological birth defect that occurs due to an impaired closure of the neural tube, leading to multi-systemic dysfunctions such as neurogenic bladder. The life expectancy of SB patients has increased as a result of improved medical care; adult-life issues, such as social life and sexuality, have become growing concerns among this population. There is consistent data associating the complications of SB, such as urinary incontinence (UI) and fecal incontinence, with negative effects on socialization. Sexuality among SB patients is considered an important topic of discussion, and it lead to many studies on the male population. Studies on female SB patients, are limited, and most have small sample sizes, are singleinstitution surveys, or use non-validated questionnaires. These studies revealed that women with SB present higher sexual dysfunction rates than the general female population, and they suggest that some clinical factors, such as spinalcord level and UI, could predict their sexual outcomes
The specific clinical aspects of the Spina bifida (SB) patients, such as urinary and fecal incontinence, should be properly addressed by their doctors, since they are associated with reduced sexual activity and lower FSFI-6 scores in the overall or specific domains
urinary incontinence (UI) occurred in 83.6% of the patients, fecal incontinence was present in 64.3%, and 16.4% claimed a history of psychological disorder
Summary
Spina bifida (SB) is the main neurological birth defect that occurs due to an impaired closure of the neural tube, leading to multi-systemic dysfunctions such as neurogenic bladder. The life expectancy of SB patients has increased as a result of improved medical care; adult-life issues, such as social life and sexuality, have become growing concerns among this population. There is consistent data associating the complications of SB, such as urinary incontinence (UI) and fecal incontinence, with negative effects on socialization. Sexuality among SB patients is considered an important topic of discussion, and it lead to many studies on the male population. Studies on female SB patients, are limited, and most have small sample sizes, are singleinstitution surveys, or use non-validated questionnaires. These studies revealed that women with SB present higher sexual dysfunction rates than the general female population, and they suggest that some clinical factors, such as spinalcord level and UI, could predict their sexual outcomes. The life expectancy of SB patients has increased as a result of improved medical care; adult-life issues, such as social life and sexuality, have become growing concerns among this population.. Sexuality among SB patients is considered an important topic of discussion, and it lead to many studies on the male population.. Studies on female SB patients, are limited, and most have small sample sizes, are singleinstitution surveys, or use non-validated questionnaires.. Studies on female SB patients, are limited, and most have small sample sizes, are singleinstitution surveys, or use non-validated questionnaires.6–9 These studies revealed that women with SB present higher sexual dysfunction rates than the general female population, and they suggest that some clinical factors, such as spinalcord level and UI, could predict their sexual outcomes. The aim of the present study was to assess the sexual function of women with SB and to verify the factors that influence their sexual function
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