Sexual Activity and Urinary Incontinence in Older Women
Sexual Activity and Urinary Incontinence in Older Women
Objectives:To determine whether continence status is associated with sexual activity in older women.
Design: Cross-sectional postal survey.
Setting: Random selection from a list of respondents to a Canada Post survey.
Participants: Community-dwelling women aged 55 to 95.
Measurements: The International Consultation on Incontinence Questionnaire Short Form measured the presence, severity, and type of incontinence. Sexual activity and marital status were assessed using single close-ended questions. The Medical Outcomes Study 12-item Short-Form Health Survey was used to query physical and mental health status.
Results: Data from 2,361 women (mean age 71) were available for analysis. Thirty-nine percent reported urinary incontinence (UI), and 27% were sexually active. UI was associated with sexual activity in crude logistic analyses (odds ratio (OR) = 0.82, 95% confidence interval (CI) = 0.68-0.98) but not in multivariate models adjusted for physical and mental health. Marital status and age were the strongest predictors of sexual activity (OR 8.94, 95% CI = 6.89-11.60 for married women; OR = 3.09, 95% CI = 2.57-3.73 for age ≤70), with significant relationships also observed with physical and mental health (OR = 1.04, 95% CI = 1.03-1.04 and OR = 1.02, 95% CI = 1.01-1.04, respectively). Frequency of UI was not related to being sexually active, although greater amounts of urine loss, stress incontinence, and nocturnal incontinence were independently associated with sexual activity (OR = 0.53, 95% CI = 0.33-0.85; OR = 1.40 95% CI = 1.01-1.94; and OR = 0.24, 95% CI = 0.10-0.61, respectively).
Conclusion: Many older women remain sexually active as they age regardless of continence status. Caution should be exercised in interpreting intervention studies aimed at improving sexual function in incontinent older women if marital status and physical and mental health are not considered.
Urinary incontinence (UI) occurs in 17% to 55% of older community-dwelling women, with variable but sometimes serious effects on quality of life and the ability to function physically and socially. An often-overlooked consequence of UI is potential interference with sexual activity. Population estimates of older women who are sexually active are 56% and 5% of married and unmarried women, respectively, with a mean prevalence of approximately 20%.
Sexually active women with UI report that it can deter sexual fulfillment in a number of ways, including low libido, fear of urine leakage during the sexual act, depression, or embarassment. Because UI is neither totally inevitable nor incurable in women of any age, treatment for UI would be expected to lessen or eliminate the negative effect UI has on sexual function, although results from studies examining the effect of behavioral and surgical treatments for UI on sexual function are conflicting, with some women showing improvements, the majority reporting no difference in the frequency of intercourse, and a few reporting occasional decrements in sexual function. One explanation for these discrepant findings is the heterogeneous nature of these small intervention studies, with most women seeking treatment for severe symptoms of UI. Another possibility is that UI does not impair sexual activity per se but is associated with a number of factors that influence sexual activity, such as age and physical and mental health. Poor physical and mental health are known correlates of UI and may also explain lowered interest or energy for sexual activity. To provide women with a realistic notion of how treatment for UI can be expected to improve sexual function, the direct causal attribution of UI to sexual inactivity must be clearly understood. The purpose of this study was therefore to examine the association between continence status and sexual activity in a large population-based sample of older community-dwelling women, while taking into account factors related to both of these conditions, including age and physical and mental health.
Objectives:To determine whether continence status is associated with sexual activity in older women.
Design: Cross-sectional postal survey.
Setting: Random selection from a list of respondents to a Canada Post survey.
Participants: Community-dwelling women aged 55 to 95.
Measurements: The International Consultation on Incontinence Questionnaire Short Form measured the presence, severity, and type of incontinence. Sexual activity and marital status were assessed using single close-ended questions. The Medical Outcomes Study 12-item Short-Form Health Survey was used to query physical and mental health status.
Results: Data from 2,361 women (mean age 71) were available for analysis. Thirty-nine percent reported urinary incontinence (UI), and 27% were sexually active. UI was associated with sexual activity in crude logistic analyses (odds ratio (OR) = 0.82, 95% confidence interval (CI) = 0.68-0.98) but not in multivariate models adjusted for physical and mental health. Marital status and age were the strongest predictors of sexual activity (OR 8.94, 95% CI = 6.89-11.60 for married women; OR = 3.09, 95% CI = 2.57-3.73 for age ≤70), with significant relationships also observed with physical and mental health (OR = 1.04, 95% CI = 1.03-1.04 and OR = 1.02, 95% CI = 1.01-1.04, respectively). Frequency of UI was not related to being sexually active, although greater amounts of urine loss, stress incontinence, and nocturnal incontinence were independently associated with sexual activity (OR = 0.53, 95% CI = 0.33-0.85; OR = 1.40 95% CI = 1.01-1.94; and OR = 0.24, 95% CI = 0.10-0.61, respectively).
Conclusion: Many older women remain sexually active as they age regardless of continence status. Caution should be exercised in interpreting intervention studies aimed at improving sexual function in incontinent older women if marital status and physical and mental health are not considered.
Urinary incontinence (UI) occurs in 17% to 55% of older community-dwelling women, with variable but sometimes serious effects on quality of life and the ability to function physically and socially. An often-overlooked consequence of UI is potential interference with sexual activity. Population estimates of older women who are sexually active are 56% and 5% of married and unmarried women, respectively, with a mean prevalence of approximately 20%.
Sexually active women with UI report that it can deter sexual fulfillment in a number of ways, including low libido, fear of urine leakage during the sexual act, depression, or embarassment. Because UI is neither totally inevitable nor incurable in women of any age, treatment for UI would be expected to lessen or eliminate the negative effect UI has on sexual function, although results from studies examining the effect of behavioral and surgical treatments for UI on sexual function are conflicting, with some women showing improvements, the majority reporting no difference in the frequency of intercourse, and a few reporting occasional decrements in sexual function. One explanation for these discrepant findings is the heterogeneous nature of these small intervention studies, with most women seeking treatment for severe symptoms of UI. Another possibility is that UI does not impair sexual activity per se but is associated with a number of factors that influence sexual activity, such as age and physical and mental health. Poor physical and mental health are known correlates of UI and may also explain lowered interest or energy for sexual activity. To provide women with a realistic notion of how treatment for UI can be expected to improve sexual function, the direct causal attribution of UI to sexual inactivity must be clearly understood. The purpose of this study was therefore to examine the association between continence status and sexual activity in a large population-based sample of older community-dwelling women, while taking into account factors related to both of these conditions, including age and physical and mental health.
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