The prevalence of female sexual dysfunction ranges from 38 to 85.2% (1). The menopausal transition phase contributes to female sexual dysfunction regardless of chronological age (1). The literature shows that after menopause, there may be a decrease in pelvic floor muscle (PFM) function due to estrogen deficiency (2). Although post-menopause is considered a risk factor for the development of sexual dysfunction, the sexual function and PFM strength is poorly studied. This study aimed to evaluate the sexual function and PFM strength in non- and postmenopausal incontinent women.

A cross-sectional observational study was undertaken with two groups of non- and postmenopausal women with stress urinary incontinence as determined by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-IU SF). Participants included had to be heterosexual, with sexual intercourse defined as penile penetration of the vagina in the previous four weeks and the criterion for postmenopausal status being cessation of menstrual cycles for more than 12 months. Participants with chronic degenerative diseases, neurologic or psychiatric diseases, inability to contract the PFM, participated in previous pelvic floor re-education programmes and/or had previous pelvic floor surgeries were excluded. Demographic and clinical data were collected for all participants (age, marital status, ethnicity, educational level, body mass index (BMI), urinary incontinence, parity, sexual and PFM function). Sexual function was evaluated using the Female Sexual Function Index (FSFI) questionnaire (19 multiple choice questions grouped into the six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain). A total score of the FSFI of 26.5 was considered the cut-off point for the differentiation between women with and without sexual dysfunction (a total score of 26.5 or less is considered to indicate sexual dysfunction). The PFM function was evaluated by PERFECT scheme (Power by Oxford scale 0-5; muscular endurance (maintenance of the contraction in seconds); and fast-twitch contractions (number of fast maximal PFM contraction can be repeated-Up to 10 seconds) and manometry (maximum voluntary contraction of the PFM in cmH2O). Descriptive statistics were obtained for demographics and clinical data. Mann-Whitney U test, Pearson's chi-square and t-test were used to compare the non- and postmenopausal groups for demographics and clinical data. Mann-Whitney U test were used to compare the continent and UI groups for sexual and PFM function. A correlation analysis was performed, using the Spearman test, to verify whether the menopause time was correlated with the scores of FSFI questionnaire. The p-value threshold was 0.05 and SPSS v25 for MAC software was used for statistical analyses.

One hundred and ninety-seven women were initially evaluated by the urogynecologist. A total of 134 women fulfilled the eligibility criteria and were included in the study (63 were not eligible because they had not had sexual intercourse in the previous 4 weeks). Excluding age (non-menopausal 46 years; and postmenopausal 61 years), there were no statistically significant differences between the groups in demographic and clinical data.
In accordance with the cut-off point for the sexual dysfunction, the non-menopausal group does not have sexual dysfunction (table 1). When sexual function was compared between the non-menopausal and postmenopausal groups, better sexual function in the non-menopausal group was identified, with significant differences in the desire, arousal and lubrication domains and in total FSFI score (table 1). A significant correlation with the time of exposure to the menopausal state was found for the desire, orgasm, satisfaction, pain and total score domains (Table 2). There was no significant difference in the PFM function (PERFECT scheme and Manometry) between the two groups (p>0.05).

The postmenopausal status seems to interfere in the sexual function of incontinent women, as these women had sexual dysfunction according to the FSFI questionnaire when compared to the postmenopausal ones. Desire, arousal and lubrication are the most affected components of sexual function. The results also show that the longer the period of menopause, the greater the impact on sexual function.
PFM function was equally lower in both groups, demonstrating that postmenopausal status does not interfere in the muscle function. The literature reported that PFM function is deficient in urinary stress incontinent women (3).

The results suggest that the postmenopausal state impacts the sexual function of women with stress urinary incontinence and the longer the exposure time, the greater the impairment. The postmenopausal does not interfere in the PFM function.

Thomas HM, Bryce CL, Ness RB, Hess R. Dyspareunia is associated with decreased frequency of intercourse in the menopausal transition. Menopause. 2011;18(2):152–157.
Rahn DD, Ward RM, Sanses TV, Carberry C, Mamik MM, et al. Vaginal estrogen use in postmenopausal women with pelvic floor disorders: systematic review and practice guidelines. Int Urogynecol J. 2015;26(1):3–13.
Morin M, Bourbonnais D, Gravel D, Dumoulin C, Lemieux MC. Pelvic floor muscle function in continent and stress urinary incontinent women using dynamometric measurements. Neurourol Urodyn. 2004;23(7):668-74.

Continence 7S1 (2023) 100888
DOI: 10.1016/j.cont.2023.100888