Pellino Gianluca, Ramage Lisa, Simillis Constantinos, Warren Oliver, Kontovounisios Christos, Tan Emile, Tekkis Paris
Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK.
Academic Surgery, 3rd Floor, Chelsea and Westminster Hospital, Imperial College London, Fulham Road, London, SW3 6JJ, UK.
Int J Colorectal Dis. 2017 May;32(5):667-674. doi: 10.1007/s00384-017-2795-7. Epub 2017 Mar 15.
Female patients with pelvic floor diseases may suffer from several sexual disorders and sexual life impairments. The aim of this manuscript was to evaluate sexual dysfunction in female patients presenting with faecal incontinence (FI) and defecation disorder (DD).
A retrospective review was performed of a prospectively collected database of sexually active women referred to the pelvic floor clinic, who completed the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-12 (PISQ-12) at first visit. Statistical analysis was performed to evaluate and compare sexual dysfunction between patients with FI and DD and with published data on the general population. Regression analysis was used to identify predictors of sexual dysfunction and surgery.
Three hundred thirteen patients were included, 192 (61%) with FI and 121 (39%) with DD. The patients with DD received more non-gynaecological surgical procedures (p = 0.023). More patients with DD received surgery for their current pelvic floor disease (p < 0.001). Major sexual impairment (PISQ-12 < 30) was found in 100 patients (31.9%). The mean PISQ-12 (33.2 ± 7.2) score was by 5 points lower than those reported in the general population from PISQ-validating studies. Prior anorectal surgery (odds ratio (OR) = 15.4), partner ejaculation problems (PISQ item 11, OR = 2.5), reduced sexual arousal (item 2, OR = 2.1), and orgasm perception (item 13, OR = 2.1) were the strongest predictors of worse sexual function in patients with FI. Patients with DD were almost 15 times more likely to receive subsequent surgery (OR = 14.6, p < 0.001), whereas fear of urine leakage almost doubled the risk.
Sexual dysfunction is prevalent among patients suffering from FI and DD, and questionnaires are useful in recognizing these patients. Subsequent surgery is more common for patients with DD compared to those with FI.
患有盆底疾病的女性患者可能会出现多种性功能障碍和性生活受损情况。本研究的目的是评估患有大便失禁（FI）和排便障碍（DD）的女性患者的性功能障碍。
对前瞻性收集的盆底门诊性活跃女性数据库进行回顾性分析，这些女性在首次就诊时完成了盆底器官脱垂/失禁性功能问卷-12（PISQ-12）。进行统计分析以评估和比较FI和DD患者之间的性功能障碍，并与已发表的一般人群数据进行比较。使用回归分析来确定性功能障碍和手术的预测因素。
共纳入313例患者，其中192例（61%）患有FI，121例（39%）患有DD。DD患者接受的非妇科手术更多（p = 0.023）。更多DD患者因当前的盆底疾病接受了手术（p < 0.001）。100例患者（31.9%）存在严重性功能障碍（PISQ-12 < 30）。PISQ-12的平均得分（33.2 ± 7.2）比PISQ验证研究中报道的一般人群低5分。既往肛肠手术（优势比（OR）= 15.4）、伴侣射精问题（PISQ第11项，OR = 2.5）、性唤起降低（第2项，OR = 2.1）和性高潮感知（第13项，OR = 2.1）是FI患者性功能较差的最强预测因素。DD患者接受后续手术的可能性几乎是前者的15倍（OR = 14.6，p < 0.001），而对尿失禁的恐惧使风险几乎增加一倍。
性功能障碍在FI和DD患者中普遍存在，问卷有助于识别这些患者。与FI患者相比，DD患者接受后续手术更为常见。
