Beyond the bladder: incontinence-specific, physical, and psychological contributors to sexual function in women with urinary incontinence

OBJECTIVE: Urinary incontinence (UI) can interfere with sexual activity in women, yet sexual function may be shaped by a more complex interplay of physical and psychological factors in women with frequent UI. We aimed to assess the associations of incontinence-specific, physical function-related, and psychological factors with multidimensional sexual function in midlife and older women with UI. METHODS: We conducted ancillary analyses of sexual function data from a multicenter randomized trial of a pelvic floor yoga intervention versus physical conditioning intervention in women aged 45 years or older with at least daily UI. Urinary incontinence symptoms were assessed using validated voiding diaries at baseline and 6, 12, 24, and 36 weeks. Physical and psychological function were assessed by standardized performance tests and questionnaires (including the Patient-Reported Outcomes Measurement Information System physical function profile short-form, 2-minute step testing, Center for Epidemiological Studies Depression scale, and Hospital Anxiety and Depression Scale-Anxiety Subscale). Sexual function was evaluated using the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised scales for condition-specific impact on sexual activity (CS), condition-specific impact on sexual quality (CI), and global sexual quality rating (GQ). Repeated-measures mixed linear regression models were used to compare mean sexual function scores across different incontinence-specific, physical, and psychological factors, while adjusting for the influence of all other factors. RESULTS: Of the 240 participants, 129 (54.7%) were sexually active at baseline. Among sexually active participants, UI frequency was associated with worse mean CS scores (90.9 vs. 86.9 vs. 86.2, P = .03), depression symptoms were associated with worse CS scores (89.8 vs. 86.2, P = .049), and anxiety symptoms were associated with worse CI scores (82.0 vs. 77.1, P = .04). Among non-sexually active participants, depression symptoms were associated with worse GQ (35.0 vs. 44.8, P = .01) and CI scores (7.9 vs. 18.5, P = .01), and lower physical function was associated with worse CI scores (18.1 vs. 12.2 vs. 9.3, P = .04). No significant differences in sexual function were associated with clinical type of UI (eg, urge-dominant, stress-dominant) after adjustment for physical or psychological factors. CONCLUSION: Even among women with daily UI, incontinence-specific factors were not major determinants of sexual function, nor was their physical function status. Instead, variations in sexual function were more consistently associated with psychological function. Recognizing sexual function and UI concerns as distinct processes and addressing overlapping psychological symptoms may offer the greatest value in women with poor sexual function and UI.Clinical trial registration number: NCT03672461.