Urinary incontinence (UI) negatively affects the quality of life and sexual health. On the other hand, sexuality has an important impact on woman's physical and mental health. The objective of our study was to investigate the association between level of education and sexual activity in premenopausal and postmenopausal women with different types of urinary incontinence.

This study was multicentric, clinical-epidemiological and cross-sectional. A consecutive sample of 547 female patients, average age 58.3±11.2 years with different types of urinary incontinence attending the Clinic of urology and urological department of general hospital were invited to participate in this study. The criterion for inclusion in the study were: age over 18 years, was not pregnant, presence of prolapse, urinary or fecal incontinence (or any combination). Criteria for exclusion from the study were women with vesicovaginal fistula, women with history of pelvic/gynecological radiation, vulvodynia, painful bladder syndrome and chronic pelvic pain syndrome (defined as pelvic pain for more than 6 months). Sexual abstinence was defined as the absence of any sexual activity with a partner for more than 6 months. Sexual activity includes any kind of activity aimed at experiencing sexual satisfaction and enjoyment. The term sexual activity does not necessarily include sexual intercourse (vaginal or anal penetration). Avoidance of sex was defined as the extent to which a female partner is actively avoiding having sex. Sexual inactivity included women who avoided sex and abstained from sex. A chi-square test is used to see if there is a relationship between two categorical variables.

Demographic and clinical characteristics of sexually active and sexually inactive women with different types of incontinence are presented in Table 1. Chi-square test result shows there is significant relation between sexual activity and education (p-value=0.000) (Graph 1.)

Table 1. Demographic and clinical characteristics of sexually active and sexually inactive women with different types of incontinence
	                                                                 Sexually active	                                            p value
	                                                 No (n=240)   	     Yes (n=307)	

Age (years)	                                 66.2±8.0 (1)*  	           52.3±9.3	                              <0.001
BMI (kg/m2)	                                 28.6±12.9 (7)*	   26.7±4.2 (6)*	                                0.017
Parity	                                           1.7±0.7 (3)*	             2.0±0.7 (1)*	                      <0.001
Smoking			
     Current	                                 44 (19%)	                   75 (25%)	                               0.147
     Past	                                          24 (10%)	                   22 (7%)	
Education			
     Primary	                                   62 (26%)	                   49 (16%)	                               0.004
     Secondary	                          113 (48%)	             185 (61%)	
     Further Education           	       61 (26%)	                70 (23%)	
Marital status			
     Married or in relationship	132 (55%)	              266 (87%)                          	       <0.001
     Single or divorced	                   37 (15%)	                 30 (10%)	
     Widow	                                    71 (30%)	                    8 (3%)	
Delivery			
     Vaginal	                                   201 (84%)	                272 (89%)	                                 0.333
     Vacuum	                                        1 (0.4%)                      0	
     Forceps	                                         0 (0%)	                      1 (0.3%)	
     CS	                                               12 (5%)	                      8 (3%)	
Menopause	                                     233 (98%) (3)*	          193 (63%)	                                 <0.001
Type of incontinency		
     Stress	                                        52 (22%)	           111 (36%)	                                   0.003
     Mix	                                              126 (53%)	           133 (43%)	
     Urgent	                                        49 (20%)	              53 (17%)	
Coital incontinency		                                                     162 (52%)                                   <0.001
Diabetes mellitus	                                56 (24%)	                25 (8%)                            	   <0.001
Systemic arterial hypertension	      170 (73%)	             127 (42%)                         	   <0.001
The data presented are number (%) or mean ± SD. *Represents number of missing data.

Women with more education maintain sexual activity despite having urinary incontinence, probably because they better understand and accept the problem of urinary incontinence.

Higher education in women with urinary incontinence significantly affects their continued sexual activity despite the presence of incontinence.