Surgery Department, Universidade Federal de Santa Maria, Santa Maria, Brazil; Postgraduate Program in Health Sciences: Gynecology and Obstetrics, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.
Pediatric Urology Department, Fundació Puigvert, Barcelona, Spain.
J Pediatr Urol. 2021 Jun;17(3):288.e1-288.e6. doi: 10.1016/j.jpurol.2021.01.016. Epub 2021 Jan 20.
The sexual life of Spina Bifida (SB) women may be affected by their physical impairments. Data has consistently associated symptoms such as urinary and fecal incontinence with negative effects on social and intimate life.
To analyze the female spina bifida patient sexual life and assess which factors - including bladder bowel dysfunction and bladder augmentation - influenced in the sexual function of patients in a multi-center cross-sectional study.
A cross-sectional survey with validated female-specific questionnaire was applied in 140 spina bifida female patients from four different cities (Porto Alegre/Brazil; Barcelona, Madrid and Málaga/Spain) between 2019 and 2020. Questionnaires collected data on spina bifida clinical characteristics and sexuality, which was assessed using the 6-item version of the Female Sexual Function Index (FSFI-6) in the Portuguese and Spanish validated versions. Female sexual dysfunction was defined as a FSFI-6 total score ≤19.
Sexual dysfunction was present in most (84.3%) patients with a median overall FSFI-6 total score of 14.5 (range 4-26), being all sex domains impaired. Bladder augmentation, type of spina bifida, spinal cord level, hydrocephalus, use of wheelchair and psychological disorder were not statistically associated with differences among rates of sexual activity or female sexual dysfunction. The presence of urinary incontinence (UI) showed both significant lower sexual intercourse and higher dysfunction rates (Summary Table). Urinary and fecal incontinence were significantly associated with worst scores in all domains, except for pain.
Urinary incontinence status was the most relevant factor since it impaired either female sexual dysfunction and sexual activity rates, as well as the FSFI-6 overall and specific domains. These findings are consistent with previous studies who also observed that desire, arousal and lubrication domains had negative effects from urinary loss on SB patients. Fecal incontinence status did not influenced in sexual activity of female sexual dysfunction rates, nevertheless it promoted lower scores in the overall and specific sexual domains.
Spina bifida is a complex condition that demands proper care to achieve a satisfactory sexual life, specially regarding neurogenic bladder and bowel dysfunction. Clinical aspects in the SB patient, such as urinary and fecal incontinence, should be properly addressed by pediatric urologists since they are associated with female sexual dysfunction and reduced sexual activity, as well as lower FSFI-6 scores in the overall and specific domains. There is also a need to improve communication about sexuality, because only 18.6% of the patients considered it that had received sufficient sex information from physicians.
脊髓脊膜膨出（SB）女性的性生活可能会受到身体损伤的影响。数据一直表明，尿失禁和粪便失禁等症状会对社交和亲密生活产生负面影响。
在一项多中心横断面研究中，分析女性脊髓脊膜膨出患者的性生活，并评估包括膀胱肠道功能障碍和膀胱扩张在内的哪些因素会影响患者的性功能。
2019 年至 2020 年期间，在来自四个不同城市（巴西阿雷格里港/巴西；西班牙巴塞罗那、马德里和马拉加）的 140 名女性脊髓脊膜膨出患者中进行了一项横断面调查，并使用了经过验证的女性专用问卷。问卷收集了脊髓脊膜膨出临床特征和性生活的数据，使用葡萄牙语和西班牙语验证过的女性性功能指数（FSFI-6）的 6 项版本评估了性生活。女性性功能障碍定义为 FSFI-6 总分≤19。
大多数（84.3%）患者存在性功能障碍，中位 FSFI-6 总分 14.5（范围 4-26），所有性领域均受损。膀胱扩张、脊髓脊膜膨出类型、脊髓水平、脑积水、使用轮椅和心理障碍与性活动或女性性功能障碍的发生率差异无统计学意义。尿失禁（UI）的存在表明，无论是在性交还是性功能障碍的发生率方面，都有显著的下降（摘要表）。尿失禁和粪便失禁与所有领域的最差评分均显著相关，除了疼痛。
尿失禁状态是最重要的因素，因为它会损害 SB 患者的女性性功能障碍和性活动发生率，以及 FSFI-6 的总体和特定领域。这些发现与之前的研究一致，之前的研究也观察到，尿失禁会对 SB 患者的欲望、唤起和润滑等领域产生负面影响。粪便失禁状态不会影响女性性功能障碍的性活动发生率，但会导致总体和特定的性领域评分降低。
脊髓脊膜膨出是一种复杂的疾病，需要适当的护理才能获得满意的性生活，特别是在神经源性膀胱和肠道功能障碍方面。儿科泌尿科医生应妥善处理 SB 患者的临床问题，如尿失禁和粪便失禁，因为它们与女性性功能障碍和性活动减少以及 FSFI-6 的总体和特定领域的评分降低有关。还需要改善对性的沟通，因为只有 18.6%的患者认为从医生那里获得了足够的性信息。
