Sexual Function

Clearly, the assessment of sexual function "normality" is one of the greatest challenges to a pelvic floor clinician. The impact of sexual dysfunction on QOL has been the subject of many recent studies. This is particularly true as related to surgical therapy for prolapse and incontinence. There is not one tool or questionnaire that has gained foremost acceptance for assessment of this variable. Until such a tool is accepted, we have chosen to utilize two validated questionnaires for assessment of impact on sexual function. Although these tools contain more questions and/ or include more complex answers than other QOL tools, we find them useful in assessing severity and outcomes.

Interestingly, we find that approximately 60% of our patients are not sexually active because of individual or partner factors. This adds a greater level of complexity to the usage of a sexual function assessment tool. Does every patient get asked to complete the questionnaire, or only those who are sexually active? Are the patients not sexually active because of a pelvic floor problem, or is it just a cofac-tor? Would they resume sexual activity once the pelvic floor problem is corrected? In addition, there are great generational differences regarding attitudes toward sex. This has resulted in many patients being offended by the questions included in a questionnaire asking about issues such as masturbation or climax achievement. Frequently, widows are offended that we are even asking them about sexual function. We thus routinely ask patients to complete the questions that are "applicable to you."

The age of erectile dysfunction drugs has brought postreproductive age sexuality into the limelight. Unfortunately, the focus has been on male function. Assessing sexual function in this population of patients has demonstrated to us that there is a great variability in what is considered desirable.

At the current time, we are using two sexual function questionnaires, the Pelvic Organ Prolapse - Urinary Incontinence Sexual Function Questionnaire (PISQ-12) (Figure 14-3.4) in its short 12-item form, and the McCoy Female Sexuality Questionnaire (MFSQ) (Figure 14-3.5). These instruments were selected with the help of the sexual function member of our Pelvic Floor Center.

We selected the PISQ-12 because it has been validated in its long (31-item) as well as short forms, and has been used for postoperative outcome assessment.3,4 It has a good balance between physical and emotional aspects of sexual function.

We selected the MFSQ in its 7-item short form as a validated and widely used questionnaire with usage in multiple populations.5 It has a Likert scale design, which can be preferable in questions with a great degree of subjectivity. It was modified from its original composition of 19 items to a 9-item tool. Further modification led to the 7-item questionnaire we chose to use. It seems to complement the PISQ-12 fairly well, without significant overlap in the questions.

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