Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised Research Articles

A Comprehensive Evaluation of Sexual Life in Women After Laparoscopic Sacrocolpopexy using PISQ-IR.

Although laparoscopic sacrocolpopexy is a recommended procedure for sexually active women, its full impact on sexual life remains underexplored. This study is aimed at comprehensively assessing changes in the quality of sexual life and the prevalence of dyspareunia in women 1 year after laparoscopic sacrocolpopexy. This prospective observational study enrolled women undergoing laparoscopic sacrocolpopexy for pelvic organ prolapse stage≥ 2. Included were women with a completed Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA Revised (PISQ-IR) questionnaire before and at 1 year after surgery. Individual domains of the PISQ-IR were compared separately. Dyspareunia, single summary PISQ-IR and PISQ-12 scores were additionally compared in sexually active women. Statistical analyses included paired signed rank, Wilcoxon, Median, Chi-squared, and Fisher tests (p < 0.05). Between February 2015 and December 2019, a total of 333 women were included. Mean age was 61.0 ± 11.2 and 141 (42%) reported being sexually active at baseline. At 12months postoperatively, sexual activity was preserved in 110 (78%) of these women and an additional 26 women (14%) became sexually active. Both single-summary PISQ-IR (3.4 vs 3.6, p < 0.01) and PISQ-12 (36.0 vs 38.1, p < 0.01) scores increased significantly. The only variable that was associated with deteriorated scores postoperatively was a higher BMI. Individual domain analyses revealed significant improvement in condition-specific and condition-impact domains, except for the desire domain, which deteriorated. Prevalence of dyspareunia decreased post-surgery from 21.8% to 16.4%, p < 0.05. Newly sexually active women were older, had shorter vaginal length preoperatively, but lower PISQ-IR scores postoperatively than sexually inactive women pre- and postoperatively. Women ceasing sexual activity were older and had lower preoperative PISQ-IR scores than sexually active women pre- and postoperatively. Although the overall rate of sexually active women and sexual desire declined 12months after sacrocolpopexy, overall sexual function scores improved and the prevalence of dyspareunia decreased.

(144) Clitoral Anatomy and its Relation to Sexual Function after Apical Prolapse Repair using Pelvic MRI

Abstract Introduction The clitoris is the primary sexual organ involved in the physiological changes that occur during the female sexual response. Sparse research and contradictory evidence concerning clitoral anatomy and its role in female sexual function exist, especially in the context of pelvic floor disorders and their surgical correction. Comprehensive description of clitoral anatomy and how it relates to postoperative sexual function in women surgically treated for pelvic floor disorders is necessary to better understand the pathophysiological mechanisms of female sexual dysfunction following gynecologic surgery. Objective To identify characteristics of clitoral anatomy (size, location, shape) associated with female sexual function in women after vaginal hysterectomy with uterosacral ligament suspension (native tissue repair, NTR) or transvaginal mesh (VM) hysteropexy for uterovaginal prolapse. We hypothesized that a smaller clitoris and clitoral components would correlate with poorer sexual function. Methods In this ancillary study of women enrolled in a randomized clinical trial, 30–42-month postoperative axial MRIs of 82 women surgically treated (41 NTR, 41 VM) were obtained at rest. The clitoral components (glans, body, crura) and vestibular bulbs were segmented to create 3D models of the “clitoral complex” (Figure 1). Using these models and computational morphometry, clitoral dimensions and position were computed with respect to a 3D pelvic coordinate system (Figure 2). After aligning, normalizing (scaling), and establishing corresponding points between models, statistical shape modeling was performed via Principal Component Analysis (PCA) to identify/quantify significant modes of anatomic variation of the clitoris. Participant data included demographics, medical history, sexual activity status, and Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). The relationships between clitoral measurements/shape and sexual function were evaluated using Spearman rank correlation. Results For this group of mostly postmenopausal women (80/82 [97.6%]), median (min-max) age was 65.3 (47-79), 15/82 (18.3%) were sexually active (SA), and 21/82 (25.6%) were not sexually active (NSA) postoperatively (46/82 [56.1%] did not respond). Among SA women, a smaller glans width correlated with overall poorer sexual function (lower PISQ-IR mean score) (r=0.74, p=0.002), frequent feelings of shame/fear with leakage of urine/stool during sex (r=0.69, p=0.004), and low sexual arousal (r=0.61, p=0.02). A smaller glans height correlated with dyspareunia (r=-0.64, p=0.02) and less intense orgasms postoperatively (r=0.64, p=0.01). A smaller glans volume correlated with low sexual arousal (r=0.60, p=0.02) and a clitoral complex farther away from participants’ midline (midsagittal plane) correlated with greater negative impact of incontinence/prolapse on sex life (r=-0.66, p=0.007). Among NSA women, a clitoris farther away from participants’ midline was associated with dyspareunia as a strong reason for sexual inactivity (r=0.49, p=0.03). From the PCA, 11 significant modes of shape variation were found. For SA women, Modes 5 and 8 correlated with leakage of urine/stool during sex (r=-0.65, p=0.009) and dyspareunia (r=-0.59, p=0.04), respectively (Figure 3). For NSA women, Mode 4 correlated with dyspareunia as a strong reason for sexual inactivity (r=0.46, p=0.04) (Figure 3). Conclusions Poorer sexual function was associated with a smaller clitoral glans (width, height, volume) among SA women and a clitoral complex positioned farther away from participants’ midline in SA and NSA women following prolapse surgery. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific Clarification Industry funding only - investigator initiated and executed study

Patient-reported goal achievements after pelvic floor muscle training versus pessary in women with pelvic organ prolapse. A randomised controlled trial

The aim was to assess the achievement by self-determined goals in pelvic organ prolapse (POP) participants receiving pelvic floor muscle training (PFMT) compared to vaginal pessary. Forty participants with POP stage II to III were randomly allocated to pessary or PFMT. Participants were asked to list up 3 goals they expected from treatment. Thai version of Prolapse Quality of Life Questionnaire (P-QOL) and Pelvic Organ Prolapse Incontinence Sexual Questionnaire, IUGA-revised (PISQ-IR) were completed at 0 and 6-week period. At 6-week post-treatment, they were asked if their goals had been achieved. The totally achieved goals in the vaginal pessary group were 70% (14/20) significantly higher than PFMT group at 30% (6/20) (p = 0.01). The mean ± SD of the post-treatment P-QOL score in the vaginal pessary group was significantly lower than the PFMT group (13.90 ± 10.83 vs 22.04 ± 5.93, p = 0.01), but not different in all PISQ-IR subscales. Pessary treatment for POP yielded better total goal achievements and better quality of life than PFMT for POP treatment at a 6-week follow-up. Impact statement What is already known on this subject? Pelvic organ prolapse (POP) can severely affect the quality of life, causing physical, social, psychological, occupational, and/or sexual dysfunction. Individual patient goal setting and goal achievement scaling (GAS) offers a new method of patient-reported outcome measurement (PRO) in therapeutic success such as pessary or surgery in patient with POP. But there is no randomised controlled trial comparing pessary vs pelvic floor muscle training (PFMT) using GAS as the outcome measurement. What do the results of this study add? The results showed that women with POP stage II to III who received vaginal pessary had higher totally goal achievements and better quality of life than the women received the PFMT at 6-week follow up. What are the implications of these findings for clinical practice and/or further research? The information about the better goal achievements by using pessary can be used as the tools for counselling for patients with POP for selecting the choices for the treatment in the clinical setting.

Thai translation and validation of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR) and Pelvic Floor Distress Inventory (PFDI-20)

The Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA-Revised (PISQ-IR) and Pelvic Floor Distress Inventory (PFDI-20) are the questionnaires for evaluating sexual function and quality of life in women with Pelvic Flood Dysfunction (PFD). These two tools have been translated into many languages. The aims were to translate PISQ-IR and PFDI-20 into Thai and to assess their validity and test/re-test reliability. Two hundred Thai women with PFD were recruited from an outpatient gynecologic clinic at King Chulalongkorn Memorial Hospital during June-December, 2017. All women completed the Thai version of PISQ-IR and PFDI-20 twice at an interval of 2 weeks and completed the Thai version of FSFI and P-QOL questionnaires at first visit for analysis of criterion validity. For PISQ-IR, the internal consistency (Cronbach's alpha) ranged from 0.49 to 0.95 in the non-sexually active (NSA) group and 0.63 to 0.89 in the sexually active (SA) group. The test-retest reliability [intraclass correlation coefficients (ICCr)] of all subscales ranged from 0.79-0.96 in the NSA group and 0.92-0.96 in the SA group. For total PFDI-20 score, Cronbach's alpha was 0.93 and ICCr 0.83. The criterion validity (correlations of PISQ-IR subscales to FSFI) ranged from low to high correlation (r = 0.10-0.64) while the correlations of PISQ-IR subscales to PFDI-20 scores ranged from low to moderate correlation (r = 0.20-0.36). The Thai versions of the PISQ-IR and PFDI-20 proved to have good internal consistency with strong reliability. They are valid tools for evaluating sexual function and quality of life in Thai women with PFD.

Improved body image after uterovaginal prolapse surgery with or without hysterectomy.

The objective was to compare body image and sexual activity and function changes up to 3years after sacrospinous ligament fixation with graft hysteropexy or vaginal hysterectomy with uterosacral ligament suspension (hysterectomy). This was a planned secondary analysis of a multi-center randomized trial of women undergoing prolapse repair with mesh hysteropexy versus hysterectomy. Women were masked to intervention. The modified Body Image Scale (BIS), sexual activity status, and Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR) scores were reported at baseline and 1.5, 6, 12, 18, 24, and 36months after surgery. We compared mean BIS and PISQ-IR scores, the proportion of women whose BIS scores met a distribution-based estimate of the minimally important difference (MID), and sexual activity status. Comparisons were analyzed with linear and logistic repeated measures models adjusted for site, intervention, visit, and intervention by visit interaction. Eighty-eight women underwent mesh hysteropexy; 87 underwent hysterectomy. Women were similar with regard to baseline characteristics, mean age 65.9 ± 7.3years, and most had stage III or IV prolapse (81%). Baseline mean BIS scores were not significantly different, improved in both groups by 1.5months, and were sustained through 36months with no differences between groups (all p > 0.05). The estimated BIS MID was 3; and by 36months, more women in the mesh hysteropexy group achieved the MID than in the hysterectomy group (62% vs 44%, p = 0.04). The makeup of the sexually active cohort changed throughout the study, making function comparisons difficult. Body image improves following prolapse surgery whether or not hysterectomy is performed or transvaginal mesh is used at the time of repair; sexual activity status changes over time following prolapse surgery.

Female sexuality before and after sacrocolpopexy or vaginal mesh: is vaginal length one of the key factors?

We aimed to demonstrate that laparoscopic sacrocolpopexy/cervicopexy (LSC-Cx) versus anterior vaginal mesh (AVM) results in a longer vaginal length without impacting sexual activity or function. We performed a secondary analysis of sexual outcomes of a previous randomized control trial comparing LSC-Cx and AVM in 120 women (60/group) with symptomatic POP stage ≥ 3. We evaluated sexually active (SA) and non-sexually active women (NSA) using the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-IUGA-Revised (PISQ-IR) preoperatively and 1 year postoperatively. Multivariate logistic and linear regression models were built to assess the impact of different variables on sexual activity and function, respectively. Among 120 women included, no statistically significant differences were found between vaginal length and preoperative dyspareunia (20.7% AVM vs. 22,8% LSC-Cx) comparing SA to NSA women and LSC-Cx to AVM. Vaginal length was significantly longer after LSC-Cx versus AVM (p < 0.001). The postoperative dyspareunia rate was 17.2% AVM versus 10.5% LSC-Cx. Partnered women were significantly more likely to be SA than unpartnered women before (OR = 19.04; p = 0.006) and after surgery (OR = 36.28; p = 0.002). Only dyspareunia was independently associated with sexual function pre- (B = -0.431; p = 0.017) and postoperatively (B = -0.3 96; p = 0.007). Vaginal length was greater following LSC-Cx compared to AVM. While vaginal length has no impact on female sexuality pre- and postoperatively, the most important factors were "having a partner" for sexual activity and dyspareunia for sexual function. Persistence of dyspareunia was higher after AVM. LSC-Cx should be considered in women with POP undergoing mesh surgery with future sexual expectations.

Responsiveness of two sexual function questionnaires: PISQ-IR and FSFI in women with pelvic floor disorders.

To assess responsiveness of sexual function questionnaires: Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR) and Female Sexual Function Index (FSFI) in women with pelvic floor disorders (PFD). The study included 261 subjects who completed PISQ-IR and FSFI at baseline and after treatment (median: 8 months). Standardized response mean (SRM) and effect size (ES) were calculated for sexually active (SA) and not-SA (NSA) women. Patient Global Impression of Improvement (PGI-I) was applied to assess treatment outcomes. A total of 184 women reported "very much better"/"much better" on the PGI-I scale posttreatment and were enrolled for further study. After treatment, 21.7% of the NSA women resumed sexual activity, 13.9% of the initially SA-abstained, and no change was reported for 152 (82.6%) subjects (87-SA and 65-NSA). Significant improvement in PISQ-IR SA domains was observed, with mild responsiveness for Arousal/Orgasm (SRM = 0.34, ES = 0.29, p = .003) and good responsiveness for Condition Specific, Global Quality and Summary Score (SRM = 0.51, ES = 0.50; SRM = 0.54, ES = 0.47; SRM = 0.75, ES = 0.63, p < .001). The Condition Impact domain demonstrated excellent responsiveness (SRM = 1.13, ES = 1.17, p < .001). In NSA, PISQ-IR had good responsiveness in Condition Impact (SRM = -0.76, ES = -0.59, p < .001), and mild in Condition Specific (SRM = -0.30, ES = -0.28, p < .03) domains. In FSFI, posttreatment sexual function in SA was improved in Desire, Arousal, Orgasm, Satisfaction, Pain domains and Total score, proving mild responsiveness (SRM, 0.24-0.48; p < .04). In NSA, FSFI proved nonresponsive. PISQ-IR and FSFI are responsive tools, useful to investigate the effects of treatment on sexual function in SA (both questionnaires) and NSA (only PISQ-IR) women with PFD.

Sexual activity and function in women with advanced stages of pelvic organ prolapse, before and after laparoscopic or vaginal mesh surgery

The differential impact of specific pelvic organ prolapse (POP) surgery on sexual activity and function is unknown. Our primary aim was to analyse sexual inactivity and function in women with symptomatic advanced stages of POP and the changes incurred after laparoscopic or vaginal mesh surgery. We performed a secondary analysis of sexual outcomes of a previously published randomised controlled trial comparing laparoscopic sacrocolpopexy/cervicopexy (LSC-Cx) and anterior vaginal mesh (AVM) in 120 women (60/group) with symptomatic anterior POP stage ≥ 3 and apical ≥ 2. Sexual activity and function were assessed preoperatively and 1 and 2years postoperatively using the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-IUGA-Revised (PISQ-IR). Sexual activity was recovered in 42.9% of non-sexually active (NSA) women 1year postoperatively, mainly in women with higher preoperative POP-related subscale scores of the PISQ-IR, which indicated a negative preoperative sexuality by POP. Recovery of sexual activity was greater after LSC-Cx, albeit not significantly (2years: 35.5% AVM vs. 45% LSC-Cx). Among sexually active (SA) women preoperatively remaining SA postoperatively, the difference in the mean PISQ-IR summary score significantly improved [mean baseline difference - 2years; all: 0.3 (95% CI 0.1 to 0.5) p = 0.001; AVM 0.19 (95% CI -0.1 to -0.5) p > 0.05; LSC-Cx 0.37 (95% CI 0.1 to 0.7) p = 0.003]. Preoperative dyspareunia was significantly reduced after LSC-Cx (baseline: 24.6%, 2years: 9.8%, p = 0.0448), but not after AVM (baseline: 20.7%, 2years: 18.2%, p = 0.7385). Most women reported improved sexual activity and function 2years after LSC-Cx or AVM, mainly because of enhanced POP-related subscales in both NSA and SA women. Recovery of sexual activity and improved sexual function were greater after LSC-Cx compared to AVM, likely related to less postoperative dyspareunia.

Identification of the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-IUGA Revised (PISQ-IR) Cutoff Scores for Impaired Sexual Function in Women with Pelvic Floor Disorders.

The aim of this cross-sectional study was to determine the cutoff scores for sexual dysfunction in disease-specific Pelvic Organ Prolapse/Incontinence Sexual Questionnaire—IUGA Revised (PISQ-IR) for women with pelvic floor disorders (PFD). Medical history and urogynecological data of 521 women with PFD were collected. The subjects provided information about their sexual activity and completed Female Sexual Function Index (FSFI) and PISQ-IR questionnaires. Sexually active (SA) women were further analyzed and categorized using their FSFI scores: <26.55—sexual dysfunction, >26.55—no sexual dysfunction. Receiver operating characteristics (ROC) curve tested how well PISQ-IR allowed to discriminate between patients with and without sexual disorders. Area under curve (AUC) was calculated to measure the PISQ-IR Summary Score efficiency in the prediction. The cutoff values which minimalize (1-specifity) and maximize sensitivity were selected. In the analyzed cohort, 250 (48%) women were SA and a total of 226 SA were recruited for the study: 143 (63.3%) with <26.55 FSFI and 83 (36.7%) with >26.55 FSFI (response rate: 90.4%). Using ROC curve analysis, PISQ-IR Summary Score of 2.68 was determined to be the optimal cutoff for distinguishing between dysfunctional and nondysfunctional women (AUC = 0.85), allowing to diagnose sexual dysfunction in SA women with PFD, with 90% sensitivity and 71% specificity.

Is voluntary pelvic floor muscles contraction important for sexual function in women with pelvic floor disorders?

To investigate relationships between pelvic floor muscles (PFM) and sexual function (SF) in sexually active (SA) and not-SA (NSA) women with pelvic floor disorders (PFD). In 350 women with PFD: 173(49.4%) SA, 177(50.6%) NSA, Pelvic Organ Prolapse (POP)-Quantification, PFM tone, and strength were evaluated. Transperineal ultrasound (TPS) measured genital hiatus (GH) diameter, bladder neck (BN) movement. Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), and Female Sexual Function Index (FSFI) were used. SA women were dichotomized according to muscle strength (weak/strong) and tone (normal/hypoactive). FSFI scores reflected sexual dysfunction in 63.5% SA women. 32.2% partnered NSA stated PFD the reason for sexual inactivity. NSA women had higher POP stages and hypoactive PFM rates compared to SA: 72 (40.7%) vs 52 (30.1%), P = .04. TPS GH diameter did not differ between SA and NSA at rest, contraction, and did not correlate with SF. BN length was longer in SA at rest (15.0 ± 7.0 vs 13.1 ± 9.4, P = .03) and contraction (19.7 ± 7.0 vs 16.7 ± 10.2, P = .006); 30 (8.6%) subjects depressed BN during contraction. GH change at contraction correlated with Oxford Grading Scale (rps = 0.41; P < .001), and was smaller in women with nonfunctioning vs normal/underactive PFM (P < .001). Women with hypoactive PFM had lower SF in PISQ-IR Global quality and FSFI Desire domains vs normal tone. BN length at rest, contraction, and total mobility correlated with several PISQ-IR and FSFI domains. In SA women with PFD, lower rates of hypoactive PFM tone were found. The ability to contract PFM did not influence SF. Greater mobility of BN correlated with lower SF.

Sacral neuromodulation versus onabotulinumtoxinA for refractory urgency urinary incontinence: impact on fecal incontinence symptoms and sexual function

Women with refractory urgency urinary incontinence can be treated with onabotulinumtoxinA or sacral neuromodulation. Little data exists on the comparative effects of treatment of refractory urgency urinary incontinence on other pelvic floor complaints, such as bowel and sexual function. The objective of this study was to compare the impact of these treatments on fecal incontinence and sexual symptoms. This was a planned supplemental analysis of a randomized trial in women with refractory urgency urinary incontinence treated with onabotulinumtoxinA (n= 190) or sacral neuromodulation (n= 174). Fecal incontinence and sexual symptoms were assessed at baseline and at 6, 12, and 24 months. Fecal incontinence symptoms were measured using the St Mark's (Vaizey) Fecal Incontinence severity scale. Sexual symptoms were measured using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) and the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). The PISQ-IR allows measurement of sexual symptoms in both sexually active and non-sexually active adults. Primary outcomes were change in Vaizey and PISQ-12 scores between baseline and 6 months. Secondary outcomes were change in PISQ-IR total and subscores between baseline and 6 months and change in Vaizey, PISQ-12, and PISQ-IR scores between baseline and 12 and 24 months. Intent-to-treat analysis was performed using repeated measures mixed model to estimate change in all parameters from baseline while adjusting for the baseline score. A subgroup analysis of women with clinically significant bowel symptoms was conducted based on baseline Vaizey score of ≥12. At baseline, mean Vaizey scores were indicative of mild fecal incontinence symptoms and were not different between onabotulinumtoxinA and sacral neuromodulation groups (7.6 ± 5.3 vs 6.6 ± 4.9, P= .07). The proportion of sexually active women (56% vs 63%, P= .25), mean PISQ-12 score (33.4 ± 7.5 vs 32.7 ± 6.7, P= .55), or PISQ-IR subscores were also not different between the onabotulinumtoxinA and sacral neuromodulation groups at baseline. There was no difference between women treated with onabotulinumtoxinA and those treated with sacral neuromodulation at 6 months in terms of improvement in fecal incontinence symptom score (Vaizey: -1.9, 95% confidence interval -2.6 to -1.2 vs -0.9, 95% confidence interval -1.7 to -0.2, P= .07) or sexual symptoms score (PISQ-12: 2.2, 95% confidence interval 0.7 to 3.7 vs 2.2, 95% confidence interval 0.7 to 3.7, P= .99). There was no difference in improvement between groups in the sexual symptom subscores in sexually active and non-sexually active women at 6 months. Similar findings were noted at 12 and 24 months. In a subgroup (onabotulinumtoxinA= 33 and sacral neuromodulation= 22) with clinically significant fecal incontinence at baseline (Vaizey score ≥12), there was a clinically meaningful improvement in symptoms in both groups from baseline to 6 months, with no difference in improvement between the onabotulinumtoxinA and sacral neuromodulation groups (-5.1, 95% confidence interval -7.3 to -2.8 vs -5.6, 95% confidence interval -8.5 to -2.6, P= .8). There were no differences in improvement of fecal incontinence and sexual symptoms in women with urgency urinary incontinence treated with onabotulinumtoxinA or sacral neuromodulation. Women with significant fecal incontinence symptoms at baseline had clinically important improvement in symptoms, with no difference between the treatments. Our findings can help clinicians counseling women considering treatment for refractory urgency urinary incontinence.

Polish translation and validation of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR)

Introduction and hypothesisThe aim of the study was to translate into Polish the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR), which evaluates sexual function in sexually active (SA) and not SA (NSA) women with pelvic floor disorders (PFD), and to validate the Polish version.MethodsAfter translation, back-translation and cognitive interviews, the final version of PISQ-IR was established. The study group included 252 women with PFD (124 NSA and 128 SA). All women underwent clinical evaluation and completed the PISQ-IR. For test–retest reliability, the questionnaire was administered to 99 patients twice at an interval of 2 weeks. The analysis of criterion validity required the subjects to complete self-reported measures. Internal consistency and criterion validity were assessed separately for NSA and SA women for the PISQ-IR subscales.ResultsThe mean age of the women was 60.9 ± 10.6 years and their mean BMI was 27.9 ± 4.9 kg/m2. Postmenopausal women constituted 82.5% of the study group. Urinary incontinence (UI) was diagnosed in 60 women (23.8%), pelvic organ prolapse (POP) in 90 (35.7%), and UI and POP in 102 (40.5%). Fecal incontinence was reported by 45 women (17.9%). The PISQ-IR Polish version proved to have good internal consistency in NSA women (α 0.651 to 0.857) and SA women (α 0.605 to 0.887), and strong reliability in all subscales (Pearson’s coefficient 0.759–0.899; p < 0.001). Criterion validity confirmed moderate to strong correlations between PISQ-IR scores and self-reported measures in SA subscales, as well the SA summary score, and weak to moderate correlations in NSA women.ConclusionsThe PISQ-IR Polish version is a valid tool for evaluating sexual function in women with PFD.

Spanish version of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire IUGA-Revised (PISQ-IR): Transcultural validation

The aim of this study was to transculturally adapt the Pelvic Organ Prolapse/Incontinence Sexual QuestionnaireIUGA-Revised (PISQ-IR) into Spanish and to validate the new version. We carried out a two-stage observational cross-sectional study: translation and back-translation, followed by a validation stage in which the final version was administered to 268 consecutive women (118 not sexually active [NSA] and 150 sexually active [SA]) older than 18 from an Urogynecology Unit. Besides PISQ-IR, women also completed the following questionnaires: Incontinence Severity Index (ISI); Female Sexual Function Index (FSFI); Pelvic Floor Distress Inventory (PFDI-20); and question #35 from the Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ). Feasibility (percentage of valid cases), internal consistency (Cronbach's alpha), and construct validity (structural, by factor analysis, and convergent validity by Spearman's Rho) were evaluated. The sample was formed by 118 NSA and 150 SA women, with a mean age (SD) of 59.2 (11.5) years; mean body mass index (BMI) of 29.6kg/m2 (5.6), and mean parity of 2.6 deliveries (1.2). PISQ-IR showed a high response rate (98.3% NSA and 94.7% SA), and elevated internal consistency (Cronbach's alpha for NSA and SA of 0.79 and 0.91 respectively). Factor analysis confirmed the structure of the original questionnaire and the convergent validity showed moderate to strong correlation between PISQ-IR and the ISI, PFDI-20, and FSFI scores, in addition to item #35 of the EPIQ. The Spanish version of the PISQ-IR has adequate psychometric properties; therefore, it can be a useful tool for assessing sexual function in women with pelvic floor disorders.

A strong pelvic floor is associated with higher rates of sexual activity in women with pelvic floor disorders

We evaluated the associations between pelvic floor muscle strength and tone with sexual activity and sexual function in women with pelvic floor disorders. This was a secondary analysis of a multicenter study of women with pelvic floor disorders from the USA and UK performed to validate the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Participants were surveyed about whether they were sexually active and completed the PISQ-IR and the Female Sexual Function Index (FSFI) questionnaires to assess sexual function. Physical examinations included assessment of pelvic floor strength by the Oxford Grading Scale, and assessment of pelvic floor tone as per ICS guidelines. The cohort of 585 women was middle-aged (mean age 54.9 ± 12.1) with 395 (67.5 %) reporting sexual activity. Women with a strong pelvic floor (n = 275) were more likely to report sexual activity than women with weak strength (n = 280; 75.3 vs 61.8 %, p < 0.001), but normal or hypoactive pelvic floor tone was not associated with sexual activity (68.8 vs 60.2 %, normal vs hypoactive, p = 0.08). After multivariable analysis, a strong pelvic floor remained predictive of sexual activity (OR 1.89, CI 1.18-3.03, p < 0.01). Among sexually active women (n = 370), a strong pelvic floor was associated with higher scores on the PISQ-IR domain of condition impact (parameter estimate 0.20± 0.09, p = 0.04), and the FSFI orgasm domain (PE 0.51 ± 0.17, p = 0.004). A strong pelvic floor is associated with higher rates of sexual activity as well as higher sexual function scores on the condition impact domain of the PISQ-IR and the orgasm domain of the FSFI.

Sexual function in women with anal incontinence using a new instrument: the PISQ-IR.

Anal incontinence (AI) has been associated with sexual complaints. The Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-IUGA Revised (PISQ-IR) has been validated to measure sexual function in sexually active (SA) and non-SA (NSA) women with pelvic floor disorders (PFD) including AI. We describe symptoms in women with PFDs including AI using this instrument. This was a planned secondary analysis of data collected for the validation of the PISQ-IR. SA and NSA women with symptoms of pelvic organ prolapse, urinary incontinence (UI) and/or AI at 12 US and 5 UK sites were recruited. The Female Sexual Function Index (FSFI) and PISQ-IR were completed in addition to the Pelvic Floor Distress Inventory (PFDI), and other measures. Of 872 women enrolled, 90 (10%) reported AI. Compared with women without AI, women with AI were more likely to report stress UI (p = 0.007), urgency UI (p < 0.001), mixed UI (p < 0.001), diabetes (p = 0.036) and depression (p < 0.001), and to show larger genital hiatus measurements (p = 0.005) and more underactive pelvic floor muscles (p = 0.011). Furthermore, scores on the PFDI showed greater bother (p = 0.013), particularly the colorectal subscale (p < 0.001). While sexual activity was similar between the groups, FSFI desire (p = 0.016), PISQ-IR 'condition-specific' (p = 0.03) and 'global quality' (p = 0.046) domains were worse in women with AI. In logistic regression analysis, only the PISQ-IR 'condition-specific' domain was associated with AI when controlling for other confounders (OR 0.27, 95% CI 0.10 - 0.72, p = 0.009). Women with AI have similar rates of sexual activity but poorer sexual function than women without AI. The PISQ-IR may be most appropriate to characterize these conditions.

The PISQ-IR: considerations in scale scoring and development

This paper provides a detailed discussion of the psychometric analysis and scoring of a revised measure of sexual function in women with pelvic floor disorders (PFD): the Pelvic Organ Prolapse Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Standard tools for evaluating item distributions, relationships, and psychometric properties were used to identify sub-scales and determine how the sub-scales should be scored. The evaluation of items included a nonresponse analysis, the nature of missingness, and imputation methods. The minimum number of items required to be answered and three different scoring methods were evaluated: simple summation, mean calculation, and transformed summation. Item nonresponse levels are low in women who are sexually active and the psychometric properties of the scales are robust. Moderate levels of item nonresponse are present for women who are not sexually active, which presents some concerns relative to the robustness of the scales. Single imputation for missing items is not advisable and multiple imputation methods, while plausible, are not recommended owing to the complexity of their application in clinical research. The sub-scales can be scored using either mean calculation or transformed summation. Calculation of a summary score is not recommended. The PISQ-IR demonstrates strong psychometric properties in women who are sexually active and acceptable properties in those who are not sexually active. To score the PISQ-IR sub-scales, half of the items must be answered, imputation is not recommended, and either mean calculation or transformed sum methods are recommended. A summary score should not be calculated.