Pelvic floor maladies can impact women's sex life

NEW YORK (Reuters Health) - Incontinence and other disorders of the pelvic organs can take a toll on a woman's sex life, a new study suggests.

Researchers found that among 300 women age 40 and older, those with symptoms of a pelvic floor disorder were more likely to have a diminished libido, pain during sex, or problems reaching orgasm.

Pelvic floor disorders refer to problems with a woman's pelvic organs -- the uterus, bladder and rectum -- and the muscles and connective tissue that support them. Among the most common of these are urinary incontinence and pelvic organ prolapse, where weakened muscles and supporting tissue allow one or more pelvic organs to drop down and protrude into the vagina.

Some symptoms of prolapse include pressure in the vagina, pain in the lower abdomen or lower back, and chronic constipation.

It has been estimated that one-third of U.S. women have at least one type of pelvic floor disorder, but studies have come to conflicting conclusions as to whether the conditions hinder women's sex lives.

The new findings, reported in the journal Obstetrics & Gynecology, suggest that many women with these disorders do, in fact, have problems with sexual function.

However, the risk of sexual dysfunction was not elevated among women who had mild prolapse that was not causing symptoms, lead researcher Dr. Victoria Handa told Reuters Health.

This is important, she explained, because it indicates that women who have sexual complaints but no other potential symptoms of pelvic organ prolapse do not need to be evaluated for the disorder.

"Sexual function is unlikely to be impacted by mild prolapse," said Handa, an associate professor of gynecology and obstetrics at Johns Hopkins University in Baltimore.

The findings are based on 301 patients recruited from gynecology offices affiliated with Johns Hopkins. Eighty women were seeking care for a pelvic floor disorder, including bladder control problems and pelvic organ prolapse. The rest of the women had other conditions or were getting a routine checkup.

All of the women completed questionnaires on their overall health, pelvic symptoms and sexual function.

Overall, the researchers found, women with pelvic floor disorders were more likely to have symptoms of a decreased sex drive, pain during sex and infrequent orgasms -- regardless of age and whether they had gone through menopause.

The study does not prove that the pelvic floor disorders caused the women's sexual problems, Handa said. However, the conditions could impair women's sexual function for a number of reasons, from diminished body image to problems with muscle and nerve function.

According to Handa, women with pelvic floor disorders should talk with their doctors about any sexual difficulties they have.

In an earlier study, she and her colleagues found that women's sexual function often improved after having surgery to correct significant prolapse. But more research is needed into this area, Handa said.

If certain treatments for pelvic floor disorders are better than others for improving sexual function, she noted, that will be important to know.

SOURCE: Obstetrics & Gynecology, May 2008.