Urinary Incontinence Tied to Impaired Sexual Health in Older People

NEW YORK (Reuters Health) – Urinary incontinence (UI) is associated with declines in sexual activity and function along with heightened sexual concerns, and these should be discussed with older people when managing the disorder, researchers in the UK say.

"While not life-threatening, UI is associated with social isolation, depression and reduced quality of life, and sexual health and satisfaction are increasingly recognized as positive indicators of quality of life and emotional well-being in older people," Dr. David Lee of Manchester Metropolitan University told Reuters Health.

"Both UI and later-life sexuality remain taboo subjects in society," he said by email, "and are likely to be under-reported as comorbid conditions."

Dr. Lee and colleagues analyzed data from 2012 on 3,805 community-dwelling women and men who reported any sexual activity in the last year. Participants were enrolled in the English Longitudinal Study of Ageing (ELSA), and their ages ranged from a mean of 63 to 67 at the time of analysis.

As reported online April 6 in BJU International, 391 (20.0%) women and 141 (6.9%) men had "any UI" in the past year.

After adjustment for demographic, health, and lifestyle factors, compared to women with no UI, those with sporadic UI had 50% lower odds of frequent sexual intercourse and 74% increased odds of vaginal dryness.

These women also reported significant declines in their frequency of sexual activities and their ability to become sexually aroused compared to the previous year, and were more concerned about the frequency of their sexual activities compared to women without UI.

Women with persistent UI had 56% higher odds of difficulty achieving orgasm and 69% higher odds of declines in frequency of sexual activities over the last year compared to women without UI. Those with persistent UI also were significantly more concerned about both the frequency of their sexual activities and their ability to become sexually aroused.

Compared to men without UI, men with sporadic UI reported 126% and 101% increased odds of declines in both their sexual desire and frequency of sexual activities, respectively, over the last year.

Men with sporadic UI also were more concerned about their sexual desire and their frequency of sexual activities. More significant associations were seen in men with persistent UI where, compared to men without UI, they additionally reported increased erectile and orgasm difficulties, declines in their ability to have an erection, and concerns about their current ability to have an erection.

"Given that the community-dwelling participants in ELSA are most likely to interface with general practitioners and practice nurses for the majority of their health care needs, primary care professionals need to be educated about and aware of the potential impacts (of UI) on quality of life and wellbeing, and recognize that sexual activity and satisfaction are key factors in this equation," Dr. Lee said.

"Short-term UI linked to urinary tract infections or fecal impaction may only impact transiently on sexual functioning," he noted, "while persistent UI may have longer term effects on sexual behaviors, satisfaction and expression."

"However, having frank and open discussions about sexual health as part of the clinical assessment of UI could result in more inclusive treatment options being offered to improve both outcomes, potentially leading to more satisfying intimate lives," he concluded.

Dr. Benjamin Brucker, a uro-gynecologist at NYU Langone Health in New York City, told Reuters Health he is "passionate about treating UI." The study data "supports the idea that urine leakage can have a profound impact on various health related domains," he said by email.

"We need to educate many physicians how and when to talk about sexual health," he agreed. "But I would take it a step further and consider that as a medical community, we still need to do a better job talking about UI."

“We need to remember patients may be shy or reluctant to discuss the subject and we may very well need to be the ones to screen or bring up the topic,” he said.

"Very often patients can adapt to illnesses," he added. "The question is, will these adaptations - in this case, perhaps avoidance of intimacy - have an overall negative impact on their well-being?"

"As clinicians, we are still expanding our understanding of the impact of urinary incontinence," Dr. Brucker said. "Our next challenge will be educating the public about the importance of discussing this 'taboo' subject."

"I think this association of UI with a negative impact on sexual health will actually help that process," he concluded. "Even though some people may not want to discuss leakage with their doctor, sex is something people comprehend."

SOURCE: https://bit.ly/2JByrJd

BJU Int 2018.