title: Biofeedback, electrical stimulation, pelvic floor muscle exercises, and vaginal cones: a combined rehabilitative approach for sexual dysfunction associated with urinary incontinence.
abstract: BACKGROUND
  Urinary incontinence (UI) is often associated with sexual dysfunction. We present our preliminary experience with a combined rehabilitative approach consisting of biofeedback, functional electrical stimulation, pelvic floor muscle exercises, and vaginal cones.
  
  
  OBJECTIVE
  The potential impact of such practice on UI and sexual function was analyzed in our case series and discussed.
  
  
  METHODS
  We evaluated three women affected by UI and sexual dysfunction. The patients underwent combined pelvic floor rehabilitation (PFR), kept voiding diaries, and filled out the Female Sexual Function Index (FSFI questionnaire) before and after the completion of PFR. We evaluated each domain score, including desire, arousal, lubrication, orgasm, satisfaction, and pain.
  
  
  RESULTS
  After the combined rehabilitation program, none of them had UI requiring pad use or referred urine leakage during sexual activity, including intercourse. Before PFR, FSFI score ranged from 16 to 21; after treatment, the FSFI score ranged from 22.1 to 29.3. There was an improvement in patients regarding desire, arousal, lubrication, orgasm, satisfaction, and pain.
  
  
  CONCLUSIONS
  A complete rehabilitation can provide a beneficial effect on sexual function. A larger trial, on a more extended female population, is currently in progress, in order to confirm our findings. The effectiveness of a complete PFR scheme, together with the lack of side effects, makes it a suitable approach to sexual dysfunction that is associated with UI.
authors.affiliation: Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Rivalta
authors.affiliation: Department of Urology, University of Modena and Reggio Emilia, Modena, Italy. Electronic address: sighinolfic@yahoo.com.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Sighinolfi
authors.affiliation: Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: De Stefani
authors.affiliation: Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Micali
authors.affiliation: Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mofferdin
authors.affiliation: Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Grande
authors.affiliation: Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bianchi
mesh_terms: D000328:Adult; D001676:Biofeedback, Psychology; D004414:Dyspareunia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D004558:Electric Stimulation / Q000379:methods*; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D009130:Muscle, Smooth / Q000503:physiopathology*; D017773:Pelvic Floor / Q000294:innervation* / Q000503:physiopathology*; D010549:Personal Satisfaction; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology*; D014621:Vagina / Q000294:innervation* / Q000503:physiopathology*; D055815:Young Adult