Department of Surgery, University of California, San Francisco-East Bay, Oakland, California, USA.
Dis Colon Rectum. 2012 Oct;55(10):1059-65. doi: 10.1097/DCR.0b013e318265795d.
The impact of anal incontinence on women's sexual function is poorly understood.
The aim of this study was to investigate the relationship between anal incontinence and sexual activity and functioning in women.
This is a cross-sectional study.
This investigation was conducted in a community-based integrated health care delivery system.
Included were 2269 ethnically diverse women aged 40 to 80 years.
Self-administered questionnaires assessed accidental leakage of gas (flatal incontinence) and fluid/mucus/stool (fecal incontinence) in the past 3 months. Additional questionnaires assessed sexual activity, desire and satisfaction, as well as specific sexual problems (difficulty with arousal, lubrication, orgasm, or pain). Multivariable logistic regression models compared sexual function in women with 1) isolated flatal incontinence, 2) fecal incontinence (with or without flatal incontinence), and 3) no fecal/flatal incontinence, controlling for potential confounders.
Twenty-four percent of women reported fecal incontinence and 43% reported isolated flatal incontinence in the previous 3 months. The majority were sexually active (62% of women without fecal/flatal incontinence, 66% with isolated flatal incontinence, and 60% with fecal incontinence; p = 0.06). In comparison with women without fecal/flatal incontinence, women with fecal incontinence were more likely to report low sexual desire (OR: 1.41 (CI: 1.10-1.82)), low sexual satisfaction (OR: 1.56 (CI: 1.14-2.12)), and limitation of sexual activity by physical health (OR: 1.65 (CI: 1.19-2.28)) after adjustment for confounders. Among sexually active women, women with fecal incontinence were more likely than women without fecal/flatal incontinence to report difficulties with lubrication (OR: 2.66 (CI: 1.76-4.00)), pain (OR: 2.44 (CI: 1.52-3.91)), and orgasm (OR: 1.68 (CI: 1.12-2.51)). Women with isolated flatal incontinence reported sexual functioning similar to women without fecal/flatal incontinence.
The cross-sectional design prevented evaluation of causality.
Although most women with fecal incontinence are at high risk for several aspects of sexual dysfunction, the presence of fecal incontinence does not prevent women from engaging in sexual activity. This indicates that sexual function is important to women with anal incontinence and should be prioritized during therapeutic management.
肛门失禁对女性性功能的影响尚未被充分了解。
本研究旨在探讨女性肛门失禁与性行为和性功能之间的关系。
这是一项横断面研究。
该研究在一个以社区为基础的综合医疗服务系统中进行。
纳入了 2269 名年龄在 40 岁至 80 岁之间的不同种族的女性。
自我管理问卷评估了过去 3 个月中气体（肛门排气失禁）和液体/黏液/粪便（粪便失禁）的意外泄漏情况。另外的问卷评估了性行为、性欲和满意度，以及特定的性问题（性欲减退、润滑、性高潮或疼痛）。多变量逻辑回归模型比较了 1）单纯肛门排气失禁、2）粪便失禁（伴或不伴肛门排气失禁）和 3）无粪便/肛门排气失禁的女性的性功能，同时控制了潜在的混杂因素。
24%的女性报告在过去 3 个月中有粪便失禁，43%的女性报告有单纯肛门排气失禁。大多数女性都有性行为（无粪便/肛门排气失禁的女性中 62%、单纯肛门排气失禁的女性中 66%、粪便失禁的女性中 60%；p=0.06）。与无粪便/肛门排气失禁的女性相比，粪便失禁的女性更可能报告性欲低下（比值比：1.41（95%置信区间：1.10-1.82））、性满意度低下（比值比：1.56（95%置信区间：1.14-2.12）），以及身体健康限制性行为（比值比：1.65（95%置信区间：1.19-2.28）），这些因素在调整了混杂因素后仍然存在。在有性行为的女性中，粪便失禁的女性比无粪便/肛门排气失禁的女性更可能报告润滑困难（比值比：2.66（95%置信区间：1.76-4.00））、疼痛（比值比：2.44（95%置信区间：1.52-3.91））和性高潮困难（比值比：1.68（95%置信区间：1.12-2.51））。单纯肛门排气失禁的女性报告的性功能与无粪便/肛门排气失禁的女性相似。
横断面设计限制了因果关系的评估。
尽管大多数有粪便失禁的女性存在多种性功能障碍的高风险，但粪便失禁本身并不会阻止女性参与性行为。这表明，性健康对患有肛门失禁的女性很重要，在治疗管理中应予以优先考虑。
