Study design, materials and methods
All sexually active women with urinary incontinence (diagnosed as self-reported ) attending the out-patient gynecology clinic of a county state hospital were consecutively interviewed about their experience with regards to coital incontinence from September 2017 to September 2018. Clinical evaluation consisted of medical history, physical examination, and urine analysis. Face-to-face interviews were conducted by the same clinician and assistant nurse in a quiet room in the clinic. The women were asked questions about their experiences with regards to coital incontinence. A 5-point scale evaluated the frequency of coital incontinence (Never, Rarely, Sometimes, Often, and Always). Women who had urinary incontinence without coital incontinence were recruited as a comparison group. Patients underwent pelvic examination for the staging of prolapse according to the pelvic organ prolapse quantification (POP-Q) system and a validated questionnaire to evaluate the quality of sexual life, including the form of the Female Sexual Function Index Questionnaire (FSFI). Patients who did not complete all of the evaluations , who had urinary tract infection, any significant medical condition (any chronic illness, such as diabetes, cardiovascular disease such as hypertension, cancer), having stage 3 or more prolapse , were excluded from the study. Written informed consent form was gained from all the patients who had been interviewed.
Female Sexual Function Index is made up of 19 items encompassing the six domains: desire (items 1– 2), arousal (items 3– 6), lubrication (items 7– 10), orgasm (items 11– 13), satisfaction (items 14– 16), and pain (items 17– 19). The total FSFI score is the sum of all points, and the higher the score, the better the sexuality. Sexual dysfunction was defined as an FSFI score < 26.55, based on the published validation studies. An excellent discriminate validity and ability to predict the prevalence of sexual problems have been reported. The FSFI form was validated for the Turkish population and was used to assess female sexual function among women.
All 64 women with urinary incontinence included in the study responded to FSFI forms, and none of them had a chronic disease that prevented them from participating in the study.
Twenty-two of the 64 women who participated in the study were diagnosed with coital incontinence and the remaining 42 women were planned to be compared. 42 women were included in the control group, and 22 women were defined as the study group.
The groups did not differ regarding age, parity, cigarette usage, menopause status, birth type, and pelvic floor muscle strength value. The women with coital incontinence had a significantly higher stress test positivity than the control group. (p<0,01)
While none of the women with urge urinary incontinence were defined as coital incontinence, the statistically significant percentage of those who described it was found in the stress urinary incontinence group. (p<0,01)
Before determining groups accurately, it was whether there is a significant difference between the FSFI scores with incontinence types. As there was no statistically significant difference, all incontinence patients without coital incontinence were included in the control group. Kruskal Wallis test was used for independent three groups. One way- Anova test was not used because of the number of patients for each group (n<30). In all sub-domains and total scores, p values were found to be > 0.05, and no statistically significant difference was found between the incontinence types.FSFI scores were compared between women reporting Coital incontinence and the control group. Women with CI had significantly lower FSFI scores than the controls in all domains (p<0.05).
No significant differences in the frequency of CI about incontinence type were found. The chi-square test was applied, and the p-value was <0.05. So there was no statistically significant relationship between the type of incontinence and the frequency of coital incontinence.
As the frequency of coital incontinence increased, there was a statistically significant decrease in FSFI scores. Pearson's rho correlation test indicates this, p values and r values are as shown in table 5. Accordingly, as the frequency increases, the decrease in scores is statistically significant (p<0.05 in all domains).
Interpretation of results
This study was the first study to investigate this effect using FSFI forms. At the same time, the relationship between the incidence of coital incontinence, and the FSFI scores was examined and a decrease in the scores was observed with increasing frequency, and this was confirmed statistically by correlation tests.
The main weakness of this study is that it is an observational study. When looking at the effects of sexual functions, which are the main purpose of the study, it should be investigated whether external factors have an effect, but in this study, there was no statistically significant difference between the demographic, and clinical characteristics of the groups compared to the elimination of this handicap.
Another weakness of this study, data on when coital incontinence occurred, either during penetration or at orgasm, as not obtained. In the literature, many studies have been done on this subject, and an idea about the etiology of coital incontinence has been tried to be obtained, but it has not been questioned because it is not one of the aims of this study and the completed questionnaire forms have not been selected for this purpose.
The sample size might be larger to generalize the findings but the study was made in a county state hospital and the topic is not frequent, that is why more patients could not be collected.
In conclusion, as shown in this study, coital incontinence is much more present than expected and has serious adverse effects on sexual functions. Therefore, it is necessary to focus more on this situation, which should be avoided, to use questionnaire forms when necessary and to encourage patients to express these problems more efficiently.