title: Evaluation of sexual dysfunction in female patients presenting with faecal incontinence or defecation disorder.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK.
authors.forename: Gianluca
authors.identifier: http://orcid.org/0000-0002-8322-6421
authors.initials: G
authors.lastname: Pellino
authors.affiliation: Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Ramage
authors.affiliation: Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Simillis
authors.affiliation: Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK.
authors.forename: Oliver
authors.initials: O
authors.lastname: Warren
authors.affiliation: Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK. c.kontovounisios@imperial.ac.uk.|Academic Surgery, 3rd Floor, Chelsea and Westminster Hospital, Imperial College London, Fulham Road, London, SW3 6JJ, UK. c.kontovounisios@imperial.ac.uk.
authors.forename: Christos
authors.initials: C
authors.lastname: Kontovounisios
authors.affiliation: Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK.|Department of Colorectal Surgery, Singapore General Hospital, Singapore, Republic of Singapore.
authors.forename: Emile
authors.initials: E
authors.lastname: Tan
authors.affiliation: Department of Surgery and Cancer, Chelsea and Westminster Hospital, Imperial College London, London, UK.
authors.forename: Paris
authors.initials: P
authors.lastname: Tekkis
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D003672:Defecation / Q000502:physiology*; D005242:Fecal Incontinence / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D016017:Odds Ratio; D011379:Prognosis; D012735:Sexual Dysfunction, Physiological / Q000503:physiopathology*; D011795:Surveys and Questionnaires
keywords: Constipation; Defecation disorder; Faecal incontinence; PISQ-12; Pelvic floor; Sexual function