Sexual function is typically evaluated using self-administered questionnaires, with the disease-specific Pelvic Organ Prolapse/Incontinence Sexual Questionnaire – IUGA Revised (PISQ-IR) being used more frequently. The aim of the study was to analyze the distribution of PISQ-IR and Female Sexual Function Index (FSFI) scores in women with pelvic floor disorders (PFD).

A cross-sectional study was conducted in 518 women referred to a gynecology clinic due to PFD. Medical history was taken and urogynecologic examination was performed according to the ICS standards. The degree of prolapse was assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system. All participants provided information about their sexual activity and completed two questionnaires: general (FSFI) and disease-specific (PISQ-IR). The three-level Sandvik severity index (ISI), which categorizes urinary incontinence (UI) into slight (1–2), moderate (3–4), and severe (6–8), and a single prolapse question (#35) from the Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ) were also used. In EPIQ Question #35, the sensation of a bulge in the vagina and the bother (0 - not at all, 10 – greatly bothersome) were reported. Based on the POP-Q assessment, cough stress test, ISI, EPIQ Question #35 and the main symptoms, the women were subdivided into three groups of diagnoses: UI, POP, and POP+UI. Medical history, urogynecologic examinations, and questionnaire results were compared. The questionnaire results were analyzed for sexually active (SA) and not-SA (NSA) women separately. 
In order to test for significant differences in group characteristics, a series of Chi-square tests were applied for categorical variables and one-way ANOVA for continuous variables. ANCOVA was conducted as the distribution of age, BMI, and menopausal status was statistically significantly different between the groups. Homogeneity of variance was tested with the Leven's test, and the majority of questionnaire results fulfilled this assumption. Generalized eta squared (ges) measured the effect size and the Tukey test was used for conducting post-hoc test when global ANCOVA results were significant.

Out of 518 (255(49.2%) – SA and 263(50.8%) – NSA) women with PFD, 114 (22.0%) were diagnosed with UI, 240 (46.3%) with POP, and 164 (31.7%) with POP+UI. No differences were found in education and parity. Women with POP were older, more often postmenopausal, and had a history of vaginal delivery (p<0.02). Women with UI had higher BMI (p<0.0001), and more often had only cesarian section delivery (p=0.04) (Table 1). Women with UI, POP, and POP+UI had mean ISI of 5.48±2.3, 0.65±0.9, and 4.31±2.3, respectively (p<0.0001) and EPIQ Question #35 scores of 0.27±1.2, 7.64±2.7 and 7.28±3.3, respectively (p<0.0001). The scores for all FSFI domains in SA and PISQ-IR domains in SA and NSA women such as: Arousal/orgasm, Partner-related, Global quality, Condition impact, Desire and PISQ-IR Summary score did not differ between the three groups (Table 2). Significant differences were found in PISQ-IR Condition specific (CS) scores between the three groups in SA and NSA women (F=5.19, p=0.006, and F=3.87, p=0.02, respectively). In SA women, a comparison of the estimated marginal means revealed the most impaired sexual function in the UI group (mean=3.96) as compared to POP or POP+UI (mean=4.39, 4.13, respectively). The effect size was small (ges=0.04). Post-hoc tests revealed significant differences between UI and POP groups (p=0.006). In NSA women, a comparison of the estimated marginal means revealed the smallest impact of PDF on sexual inactivity in the UI group (mean=1.79) as compared to POP and POP+UI (mean=2.1, 2.22 respectively). The effect size was small (ges=0.03). Post-hoc tests in the NSA-CS domain showed significant differences between UI and POP+UI groups (p=0.02). All questions in the Condition-specific domains were checked for statistically significant differences between the groups. Question #9 in the SA-CS domain and Question #2e in the NSA-CS showed statistically significant differences between the three groups (p<0.0001 and 0.003, respectively).

Sexual function assessed with FSFI did not differ between the groups. PISQ-IR scores, including the Summary score, did not differ between the groups, except for the Condition-specific domains in SA and NSA women. In the SA-CS domain, patients with UI had the most impaired sexual function as compared to POP. As for Question #9 in SA-CS regarding coital incontinence (CI) for SA patients, UI patients more often reported the influence of CI on the sexual function, which was reflected in the overall result of the SA-CS domain. In the NSA-CS domain, the results showed a statistically significantly greater impact of PFD on sexual function in women with POP+UI as compared to UI. After a detailed analysis, Question #2e, about the impact of pain on sexual function, proved to be significant. However, only 3% and 4% of the PISQ-IR scores in Condition-specific domains (in NSA and SA, respectively) were explained by an independent variable – group membership.

Sexual function analyzed with the use of FSFI and PISQ-IR did not differ between the study groups, apart from Condition-specific domain for SA and NSA women. However, the effect sizes were small. The present study confirms the possibility of applying the questionnaires in different PFDs populations.