Department of Physical Medicine & Rehabilitation and Rush University Medical Center, Chicago, Illinois, USA.
Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA.
J Womens Health (Larchmt). 2023 Mar;32(3):293-299. doi: 10.1089/jwh.2022.0211. Epub 2023 Feb 3.
Research has shown a link between childhood sexual abuse (CSA) and lower urinary tract and sexual disorders in clinical settings. We examined whether CSA was associated with two specific aspects of high tone, elevated resting tension pelvic floor dysfunction (PFD) in community-dwelling women. Data were from 2068 participants (25.5% Black, 9.6% Chinese, 10.8% Japanese, 5.0% Hispanic, and 49.1% Non-Hispanic White) in the Study of Women's Health Across the Nation (SWAN), a multirace/multiethnic longitudinal observational study of women's midlife health. At baseline, enrolled women were 42-52 years old and premenopausal or early perimenopausal. Annual or biennial assessments conducted over 20 years (1996 through 2017) included single-item queries about urgency urinary incontinence and pain with sexual activity used to assess PFD outcomes. The 12th follow-up visit conducted in 2009-2011 assessed the primary exposure, history of CSA, using a single-item response. Multivariate logistic regression models tested study objectives. The prevalence of CSA was 15%, self-reported in 313/2068 women. CSA and PFD, both pain with sexual activity (odds ratio [OR] = 1.56 confidence interval [95% CI = 1.12-2.18]) and urgency urinary incontinence (OR = 1.87 [95% CI = 1.29-2.71]), were significantly associated in unadjusted models. The final adjusted model that included sociodemographic variables and physical and behavioral risk factors was significant for pain with sexual activity (OR = 1.48 [95% CI = 1.08-2.02]), but not for urgency urinary incontinence (OR = 1.38 [95% CI = 0.96-1.98]). In midlife women, pain with sex, but not urgency urinary incontinence, was associated with a history of CSA. A multidisciplinary diagnostic and therapeutic approach to PFD is key, inclusive of CSA screening.
研究表明，儿童期性虐待（CSA）与临床环境中的下尿路和性障碍之间存在关联。我们研究了 CSA 是否与社区居住的女性中两种特定的高张力、静息张力升高的骨盆底功能障碍（PFD）方面有关。 数据来自妇女健康跨民族研究（SWAN）中的 2068 名参与者（25.5%为黑人，9.6%为中国人，10.8%为日本人，5.0%为西班牙裔，49.1%为非西班牙裔白人），这是一项针对女性中年健康的多种族/多种族纵向观察性研究。在基线时，入组的女性年龄在 42-52 岁之间，处于绝经前或绝经早期。在 20 年的时间里（1996 年至 2017 年）每年或每两年进行一次评估，包括使用单项查询评估 PFD 结果的急迫性尿失禁和性行为疼痛。2009-2011 年进行的第 12 次随访评估了主要暴露因素，即 CSA 史，使用单项回答。多变量逻辑回归模型检验了研究目标。 CSA 的患病率为 15%，有 313/2068 名女性报告。在未调整模型中，CSA 和 PFD 与性行为疼痛（比值比 [OR] = 1.56，95%置信区间 [CI] = 1.12-2.18）和急迫性尿失禁（OR = 1.87 [95% CI = 1.29-2.71]）均显著相关。纳入社会人口统计学变量以及身体和行为危险因素的最终调整模型在性行为疼痛方面具有统计学意义（OR = 1.48 [95% CI = 1.08-2.02]），但在急迫性尿失禁方面没有统计学意义（OR = 1.38 [95% CI = 0.96-1.98]）。 在中年女性中，性行为疼痛与 CSA 史相关，而急迫性尿失禁则不然。对 PFD 采用多学科诊断和治疗方法是关键，包括 CSA 筛查。
