Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim, Norway.
Department of Clinical and Molecular Medicine, Norwegian University of Technology and Science, Trondheim, Norway.
Acta Obstet Gynecol Scand. 2024 Aug;103(8):1664-1671. doi: 10.1111/aogs.14894. Epub 2024 Jun 13.
There has been increasing concern about potential negative impact of mid-urethral slings (MUS) on sexual life. Our aim was to study sexual activity 10-20 years after MUS surgery and changes in impact of incontinence on sexual life over time and to compare subjective cure, pain, satisfaction, and incontinence between sexually active and inactive women 10-20 years after MUS.
Historical cohort study using the Norwegian Female Incontinence Registry to identify women who underwent MUS between 2001-2006 and 2011-2012. They answered validated questionnaires about sexual activity, incontinence, pain, and satisfaction with MUS. We assessed changes in urinary incontinence during intercourse and compared symptoms and satisfaction between sexually active and inactive women. The study was registered in Clinical Trials (NCT04912830).
In total, 1210/1903 (64%) responded. Of women responding to questions about sexual activity, 63% (735/1166) were sexually active. 31.3% experienced negative impact of incontinence on sexual life preoperatively, decreasing to 5.9% at 10-20 years follow-up. A higher proportion of sexually inactive vs sexually active women had urinary incontinence (63.5% vs. 47.5%, aOR 1.60 [1.18-2.17]). In a subanalysis, only urgency and mixed urinary incontinence remained significant. A higher proportion of sexually inactive were dissatisfied with MUS (30.1% vs. 12.9%, aOR 2.53 [1.82-3.51]). Persistent pain after MUS was similar for sexually inactive and active women (4.0% vs. 3.2%, aOR 1.10 [0.55-2.19]). Furthermore, 3.4% of sexually inactive had persistent pain after MUS and stated pain as a reason for not being sexually active, whereas 1.7% of sexually active women had persistent pain after MUS and pain during intercourse.
Negative impact of incontinence on sexual life was less prevalent at 10-20 years follow-up after sling surgery compared to preoperative assessment. A higher proportion of sexually inactive had urgency and mixed urinary incontinence and were dissatisfied with MUS. Only 3%-4% of sexually active and inactive women had persistent pain after MUS and this was not associated with sexual activity. This indicates that incontinence has a greater negative impact on sexual activity than persisting pain after MUS at long-term follow-up.
人们越来越关注中尿道吊带（MUS）对性生活可能产生的负面影响。我们的目的是研究 MUS 手术后 10-20 年的性生活，并随着时间的推移研究尿失禁对性生活影响的变化，以及比较 MUS 手术后 10-20 年有性行为和无性行为的女性之间的主观治愈率、疼痛、满意度和尿失禁情况。
采用挪威女性尿失禁登记处的历史队列研究，以确定 2001-2006 年和 2011-2012 年期间接受 MUS 的女性。她们回答了关于性行为、尿失禁、疼痛和 MUS 满意度的验证问卷。我们评估了性交过程中尿失禁的变化，并比较了有性行为和无性行为的女性的症状和满意度。该研究已在临床试验（NCT04912830）中注册。
共有 1903 名女性中的 1210 名（64%）做出了回应。在回答性行为问题的女性中，63%（735/1166）有性行为。术前 31.3%的女性报告尿失禁对性生活有负面影响，10-20 年后随访时降至 5.9%。与有性行为的女性相比，无性行为的女性更易出现尿失禁（63.5% vs. 47.5%，优势比 1.60[1.18-2.17]）。在亚分析中，只有急迫性和混合性尿失禁仍然显著。无性行为的女性对 MUS 的满意度较低（30.1% vs. 12.9%，优势比 2.53[1.82-3.51]）。无性行为和有性行为的女性 MUS 术后持续疼痛相似（4.0% vs. 3.2%，优势比 1.10[0.55-2.19]）。此外，3.4%的无性行为女性在 MUS 术后仍有持续性疼痛，并表示疼痛是她们不进行性行为的原因，而 1.7%的有性行为女性在 MUS 术后和性交过程中存在持续性疼痛。
与术前评估相比，MUS 手术后 10-20 年随访时尿失禁对性生活的负面影响发生率较低。无性行为的女性中更常见急迫性和混合性尿失禁，且对 MUS 不满意。仅有 3%-4%的有性行为和无性行为的女性在 MUS 术后有持续性疼痛，且这与性行为无关。这表明在长期随访中，尿失禁对性生活的负面影响大于 MUS 术后持续疼痛。
