Patients presenting with lower urinary tract (LUT) symptoms may report a history of sexual abuse (SA), and conversely survivors of SA may report LUT symptoms, however the nature of the relationship is poorly understood.  The aim of this review is to systematically evaluate studies that explore LUT dysfunction in survivors of sexual abuse.

The systematic review conformed to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. A literature search was performed for studies published in the English language without date restrictions in the following: Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO databases. The following key words were used: “sexual dysfunction” OR “sexual abuse” OR “adult sexual abuse” OR “sexual trauma” OR “childhood sexual abuse” OR “CSA” OR “sexual maltreatment” OR “rape” OR “sexual offences” OR “sexual harassment” OR “sexual harm” OR urinary tract” OR “urologist” OR “urological dysfunction” OR “urological symptoms” OR “LUTS” OR “lower urinary tract symptoms” OR “lower urinary tract problems” OR “uroneurology” OR “urethral” OR “genitourinary” OR “urinary frequency” OR “urgency” OR “urinary infection” AND “treatment” OR “management” OR “symptoms”.     
Abstracts were imported into a bibliography management software and were independently evaluated by two reviewers.    Studies relevant to the review reporting the prevalence and symptoms of LUT symptoms in male and female patients who have experienced sexual abuse were included, whereas experimental studies in animals and studies primarily assessing interstitial cystitis, bladder pain syndrome and pain were excluded.  The results of the two reviewers were compared and consensus was achieved by discussion; unresolved differences were reviewed independently.
Accepted abstracts were retrieved in full text and assessed by the two reviewers. The following variables were assessed: setting and nature of cohort, definition of SA, assessment of SA, nature of abuse, other types of abuse, nature of LUT symptoms, assessment of LUT symptoms, diagnostic LUT symptoms test and findings and other co-morbidities.  The quality of the studies and risk of bias were assessed using a validated tool.

18 publications were identified: studies exploring LUT symptoms in SA survivors (n=2), studies exploring SA in patients attending clinics for their LUT symptoms (n=8), and large cross-sectional studies evaluating different health issues including SA and LUT symptoms (n=8).  Sexual abuse was variably assessed and the reported prevalences ranged between 1.3% and 49.6%.    A history of SA was found to be associated with concurrent psychosocial stressors, depression and anxiety, which could also contribute to LUT symptoms.   LUT symptoms were assessed differently, and included urinary storage symptoms (incontinence, frequency, urgency, stress urinary incontinence, nocturia), voiding difficulties, voluntary holding of urine and urinary tract infections.  Pelvic floor dysfunction, pelvic pain, dysuria and urogenital pain were also reported.  Most studies were of weak quality, assessment of SA and LUT symptoms often lacked standardisation, and none were designed to explore causality.

Despite the poor quality of most published studies, the prevalence of urinary storage  symptoms is likely to be high amongst sexual abuse survivors, often with co-occurring somatic and psychological sequelae.  We recommend screening for sexual abuse, particularly for patients presenting with LUT symptoms and who are refractory to treatment.

The review highlights the need for providing a holistic assessment of patients presenting with LUT symptoms that includes a standardised screening for sexual abuse in a “safe space” for patients to share sensitive information, and screening for concurrent inter-related factors such as trauma, affective symptoms and somatization which can impact LUT symptoms.  Well-designed studies are required to explore what impact such an assessment may have on the management of LUT symptoms.