Urinary incontinence (UI), according to the International Continence Society (ICS), is the objectively provable involuntary loss of urine which causes a social or hygienic trouble. 
Epidemiological studies show that it is a more frequent problem in women than in men (between 15% and 55%) and the incidence increases with age (the peak of maximum frequency is between 50 and 60 years of age). Sexual dysfunction, social isolation and poorer quality of life (QOL) are the biggest problems among women with urinary incontinence symptoms. Only one in four women with urinary incontinence seeks medical help. Women do not usually look for advice regarding incontinence. They put up with it without medical assistance, either because of embarrassment, because they consider it inevitable or because they believe that it is an inherent consequence of aging and therefore there is no solution. 
Female Sexual Dysfunctions (FSD) are frequent in incontinent patients, generating several alterations (psychological, fear of urine loss during sexual intercourse, loss of desire...). This causes up to 50% of these patients to refuse any sexual activity. 
Multiple studies have shown a decrease in sexual function regardless of the type of urinary incontinence. The most frequent sexual dysfunctions are dyspareunia, hypoactive sexual desire, arousal syndrome and orgasm disturbances. Orgasmic or coital incontinence causes sexual dysfunction in up to 68% of women with urinary incontinence.
It is essential to use urinary incontinence and sexual function questionnaires for women to assess impact on quality of life. 
UI and FSD are two underdiagnosed and undertreated conditions in women, yet both are associated with a decrease in QoL. They are two conditions that are interrelated. However, when a woman consults for lower urinary tract symptoms, three out of four women are not asked about their sexual health.
Up to 38-70% of the general female population present sexual dysfunctions, age being a risk factor for presenting them, and finding the highest prevalence in perimenopausal women.
Secondary to UI, 5-38% of women avoid sexual intercourse altogether. What is most striking is that while 50% of incontinent women report that their urinary symptoms have a negative effect on their sex life, partners report this in only 20% of cases. 
Our objective is to evaluate the prevalence of female sexual dysfunction in patients with urinary incontinence attending a rehabilitation service in a tertiary hospital. We also intend to evaluate the prevalence of sexual dysfunction regarding to the variables under study.

The study is a prospective observational quasi-experimental study. Data was collected from incontinent women, who met the inclusion criteria, in a monographic consultation of pelvic floor rehabilitation in the Physical Medicine and Rehabilitation department of a tertiary hospital, from October 1, 2022 and March 20, 2023. 
In this study there is no control group, the sociodemographic data and the results obtained from the questionnaires prior to the rehabilitation treatment will be collected, as well as the analysis of these data. 
The prevalence of sexual dysfunction in incontinent women was determined using the FSM scale, and the prevalence of urinary incontinence using the ICIQ-SF, CACV and Sandvick test scales.
Inclusion criteria were: over 18 years of age, female sex and diagnosis of UI. 
Exclusion criteria were previous pelvic floor surgery, previous pelvic floor rehabilitation, previous radiotherapy, psychiatric pathology limiting the course of rehabilitation and neurogenic urinary incontinence. 
The main variable of the study will be the sexual function of the patients, measured by FSM scale.
The secondary variables studied include: age, employment status, marital status, menopause, type of UI, coital incontinence, time of UI symptoms, containment measures and number, number of deliveries, modification of sexual relations due to incontinence, and sexual relations.

The sample size was 70 patients initially, and 5 patients had to be excluded because they did not complete the questionnaires properly. 
A total of 65 patients were analyzed. 
The mean age of the patients was 48.65 years (SD ±9.66), with a minimum of 35 years and a maximum of 76 years. 
Related to sociodemographic data, 87.69% were in working age, and 12.31% were retired. A total of 75.38% were married, 6.15% were in a couple and 18.46% were single. A total of 72.31% of the women were in fertile period, while 27.69% were in the menopausal period. 100% of the patients had given birth, of which 12 women by cesarean section, 45 women delivered vaginally, and 8 women delivered by both routes. 
Regarding the type of urinary incontinence found in our sample, 52.3% had stress urinary incontinence, 18.46% had urgency urinary incontinence and 29.23% had mixed urinary incontinence, with coital incontinence accounting for 12.31%. 
If we evaluate the data obtained taking into account sexual activity of our sample, we can observe that 11 women (16.92%) had not had intercourse in the previous 4 weeks, while 54 (83.08%) had had sexual relations, it being understood that sexual activity can be with a partner or through sexual stimulation, including caresses, games, penetration, masturbation. 
Of these 54 women who had had sexual intercourse, 20 had not had penetrative sex, 65% of which was due to a lack of interest in penetration, 15% because of pain with penetration and 20% because they did not have a sexual partner. Of the 34 patients who did have sexual intercourse with penetration, only 5 had sexual dysfunction, and interestingly around orgasm. 
When women were asked if they had decreased their sexual relations due to incontinence, 15 of them reported that they had decreased their sexual relations secondary to urinary leakage, of which 12 of them had sexual dysfunction and 9 of them did not. 
The prevalence of sexual dysfunction in our sample of incontinent and sexually active patients is 38.89% (21 patients). 
All women in the sample who presented with IUC had sexual dysfunction. 
Out of the sample of patients with sexual dysfunction, 20 of the 21 women had UUI (associated or not with SUI). 
Regarding menopause, 57.14% of the women with sexual dysfunction were in the menopausal period and 42.85% in the fertile period. 
The degree of sexual communication with partners is a factor to take into account when assessing sexual dysfunction. The group of women with the worst sexual communication with their partners all had sexual dysfunction due to a moderate lubrication disorder. 
Evaluating the most frequent sexual dysfunction in our sample, we found that it was lubrication dysfunction (27.66%) followed closely by desire dysfunction (25.53%). We should also bear in mind that some patients with sexual dysfunction presented up to four sexual dysfunctions simultaneously.

The prevalence of urinary incontinence in our patients is similar to that reported in the literature, as is the prevalence of sexual dysfunction in incontinent women. The highest prevalence of sexual dysfunction occurs in the sample of menopausal women. 
Sexual dysfunctions and urinary incontinence are a tandem that is frequently found in the female population. In view of the results, we should focus our attention on patients with UUI and IC. 
We believe it is necessary to pass specific questionnaires on coital incontinence. 
The sample size is not large enough to perform a statistically significant study.

It is important when assessing women in our practice, who present with incontinence, to bear in mind their sexual sphere and the possibility of alteration sin this area, to offer a holistic treatment.

Verbeek, M., & Hayward, L. (2019). Pelvic Floor Dysfunction And Its Effect On Quality Of Sexual Life. Sexual Medicine Reviews, 7(4), 559-564. https://doi.org/10.1016/j.sxmr.2019.05.007
Mestre, M., Lleberia, J., Pubill, J., & Espuña-Pons, M. (2015). Questionnaires in the assessment of sexual function in women with urinary incontinence and pelvic organ prolapse. Actas Urologicas Espanolas, 39(3), 175-182. https://doi.org/10.1016/j.acuro.2014.05.008
Duralde, E. R., & Rowen, T. S. (2017). Urinary Incontinence and Associated Female Sexual Dysfunction. Sexual Medicine Reviews, 5(4), 470-485. https://doi.org/10.1016/j.sxmr.2017.07.001