Exploring sexual health challenges in women with pelvic floor disorders

Many women experience problems due to a weakened or damaged pelvic floor. These ailments are most common in pregnant women, women who have recently given birth, and menopausal women. However, pelvic floor disorders can affect all women.

Among other things, the pelvic floor plays a role in a woman's sex life. Studies have shown that women with pelvic floor disorders are less sexually active than others.

A group of researchers has taken a closer look at this phenomenon.

We investigated women with pelvic floor disorders and identified which factors affect sexual function in sexually active women and which affect sex avoidance."

Signe Nilssen Stafne, lead author, researcher at St. Olavs Hospital

The researchers are affiliated with St. Olavs Hospital, the Norwegian University of Science and Technology (NTNU) and the University Hospital of Northern Norway. Their results have been published in the Sexual Medicine journal.

Several pelvic floor disorders

The pelvic floor plays an important role in the ability to control the release of urine, faeces and flatus. It also supports internal organs such as the bowel, bladder and uterus. Different pelvic floor disorders can therefore result in a wide range of symptoms and effects in women.

"We analyzed responses from 157 women with symptoms such as leakage of urine, flatus, faeces, or pelvic organ prolapse," said Associate Professor Susan Saga at the Department of Public Health and Nursing at NTNU.

Of these, 111 (71 per cent) were sexually active, either with or without a partner. 46 (29 per cent) stated they were not sexually active. All the women responded anonymously to a questionnaire, and none of them was pregnant at the time of the study.

Up to four times more likely to avoid sex

The researchers have found several patterns:

• On average, the women who are not sexually active are around 8 to 10 years older than those who are sexually active. Approximately 4 out of 5 are menopausal, compared to only 1 out of 2 among the women who are sexually active. In addition, they are more likely to have experienced onset of symptoms during the past year.
• The sexually inactive women report more severe pelvic floor disorders than the sexually active women do. This mainly involves pelvic organ prolapse, a condition where the uterus, bladder, or bowel slip down from their normal position and bulge into the vagina.

This creates significant differences among the various groups of women with pelvic floor disorders.

In general, women who have reached menopause or had onset of symptoms within the past year are four times more likely to be sexually inactive than women who have not yet reached menopause and whose symptoms began more than one year ago," said Stafne.

Colorectal-anal distress affects sexual function the most

Pelvic floor disorders do not necessarily lead to avoidance of sexual contact, but they can have a significant impact on the individual's sex life. Among the various pelvic floor disorders, colorectal-anal distress has the greatest impact on sexually active women.

"Among the sexually active women, those with colorectal-anal distress experienced the greatest negative impact on their sex life. Previous research indicates that the fear of faecal incontinence affects the sexual experience. We know that recently developed problems lead to uncertainty among women about whether intercourse may worsen the condition. In addition, a prolapse can lead to a negative self-image and altered sensitivity," said Stafne.

Consequences for health professionals

The researchers believe that the results should serve as a reminder for health professionals who treat women with these disorders.

"We should discuss sexual function with patients who have pelvic floor disorders. This is especially true for menopausal women and women who have bowel problems," said Saga.

It is worth noting that the researchers initially asked 625 women if they would be willing to complete the questionnaire. Of these, only 200 responded, corresponding to 32 per cent. In addition, many of them did not answer all the questions, undermining the reliability of the results.

Sexual health and sexual function are still taboo areas, and the researchers concluded that many of the women probably felt too uncomfortable answering the questions.

A research article by Saga and Stafne about the results was awarded the ISSM Journal Best Paper Bronze Prize (SMOA).