UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

SEXUAL HEALTH IN UROGYNECOLOGY

Onur Ada

University of Health Sciences, Tepecik Training and Research Hospital, Department of Gynecology and Obstetrics, İzmir, Türkiye

Ada O. Sexual Health in Urogynecology. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.51-60.

ABSTRACT

Urinary incontinence (UI) is a common health problem that significantly affects quality of life, especially in women, and is often associated with sexual dysfunction. Stress urinary incontinence (SUI) occurs as a result of weakened pelvic floor muscles and decreased urethral support or sphincter insufficiency. SUI negatively affects sexual function with psychosocial effects such as anxiety due to urinary incontinence during coitus, loss of self-confidence and decreased self-esteem. Decreased libido, vaginal dryness and dyspareunia due to irritation of the vaginal mucosa by urine are commonly reported symptoms. In addition, affecting the anterior vaginal wall innervation during surgical interventions may also affect sexual function. Urge urinary incontinence (UUI) is characterized by sudden urge to urinate and inability to reach. The etiology of UUI has not been fully elucidated and has been associated with factors such as recurrent urinary tract infections and menopause. In the literature, the prevalence of sexual dysfunction in women with UUI is around 56% and inadequate lubrication and dyspareunia are most commonly reported. Mixed urinary incontinence (MUTI) is characterized by the co-existence of symptoms of SUI and UUI. Sexual dysfunction findings of both incontinence types may be observed together in MTUI; however, dyspareunia and loss of lubrication specific to UUI are less commonly reported in MTUI. Urodynamic examinations performed at the diagnostic stage show that the diagnosis of MTUI may be overused.

The effects of mid-urethral sling (MUS) surgeries (TVT, TOT, SIMS) and laparoscopic Burch colposuspension used in the treatment of SUI on sexual function show various results in the literature. Recent meta-analyses have reported significant improvement in sexual function scores after these surgeries and decreased incontinence during coitus. However, in some studies, arousal and lubrication problems may persist due to vaginal nerve damage and decreased vaginal blood flow. It can be said that Kegel exercises should be added to the treatment of all types of incontinence, with or without surgery. Periurethral fillers are used as a minimally invasive alternative in the treatment of SUI and have been shown to improve sexual function similar to surgery. Decreased incontinence during coitus and increased self-confidence contribute to the improvement in sexual function. These methods are a promising option, especially for young, sexually active patients who are not suitable for surgery.

In conclusion, urinary incontinence is strongly associated with sexual dysfunction and it is important to plan treatment approaches to improve both symptom control and sexual function. With the development of current surgical techniques and the widespread use of minimally invasive procedures, positive effects on sexual function can be achieved.

Keywords: Urinary incontinence; Sexual dysfunction; Mid-urethral sling; Burch; Sexual questionnare; Periuretral fillers

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