Hypothesis / aims of study
To describe the number and type of childhood traumas reported by women and men presenting with lower urinary tract symptoms (LUTS) and to describe associations between LUTS and the number, type, and self-reported impact of trauma experiences. We hypothesized that childhood traumatic events are common and associated with a person’s experience of LUTS.
Study design, materials and methods
This is a cross-sectional analysis of data prospectively collected in the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) Observational Cohort Study. Women and men with LUTS were recruited from 6 US tertiary centers and administered the LUTS Tool and Childhood Trauma Events Scale (CTES). The validated 22-item LUTS Tool surveys presence and bother of LUTS. The CTES asks about 6 traumatic events (death in family, divorce, sexual assault, violence, major illness, and other) that occurred prior to age 17 and their impact (rated 0-7, range 0-42) on the individual’s life. Baseline LUTS Tool results were combined to create a LUTS Severity Score, using the Euclidean distance between all questions, weighted by the inverse of the ratio of average correlation of each item to average correlation between all items, to account for redundancy between items. Comparisons were made using Kruskal-Wallis and Chi-square tests, and Pearson correlations were used to assess associations between scores.
1011 participants (520 [51%] women and 491 [49%] men) completed the CTES and LUTS Tool. Mean±SD age of the participants was 58±14, 82% were Caucasian and 66% had college degree or higher. Death of a close friend or family member, followed by parental separation, were the most commonly reported traumas in both women and men; however, 75% of women reported at least 1 trauma compared to 64% of men (p<0.001). Women were more likely to have experienced >3 traumatic events (26% vs 15%, p<0.001) and childhood sexual trauma (23% vs 7%, p<0.001). Women also reported a higher life impact from those traumatic events (median CTES score 10, IQR 5-15) compared to men (6, IQR 4-12, p<0.001). Of participants who experienced at least 1 childhood trauma, both women and men who reported sexual trauma were more likely to have reported at least 1 additional trauma than those with a different type of childhood trauma (women: 75% vs 51%, men: 81% vs 50%, p<0.001 for both).
Women with childhood sexual trauma had higher LUTS tool scores compared to those without (47±14 vs 42±14, p=0.003), and women with any childhood trauma had higher LUTS tool scores compared to those without (45±14 vs 40±12, p=0.008). These associations were not present for men. Among participants who experienced any childhood trauma, total CTES scores correlated with the severity of their LUTS (r=0.36 and 0.61, both p<0.001, for women and men respectively). For those with past sexual trauma, the self-reported impact of this trauma and severity of LUTS was not correlated (r=0.14, p=0.19 in women and r=0.33, p=0.08 for men).
Interpretation of results
While childhood trauma is common in both men and women presenting with LUTS, women are more likely to have experienced sexual trauma, multiple traumas and report a greater impact on their life due to trauma. In women, the experience of sexual trauma is specifically associated with more LUTS, although there is not a direct correlation between the patient’s self-reported impact from her trauma and her LUTS severity score. In men, there is a stronger correlation between the reported impact of trauma on their lives and the severity of their LUTS symptoms.