Pelvic disorders involve variety of different conditions such as bladder and bowel dysfunctions along with pain or sexual problems. The problem of sexual dysfunction is one of the symptoms associated with pelvic organ prolapse that motivates women to seek medical attention. Coital urinary incontinence reduces women’s sexual activity and leads to significant psycho-emotional
problems. The objective of this study is to assess the severity and prevalence of sexual dysfunction in patients with pelvic floor disorders.

A study was conducted from March to October 2023 in the Female urology department of tertiary public University center. In total of 150 patients admitted for the pelvic surgery were screened, data of 105 patients were collected and analyzed. All patients completed questionnaires prior to surgery: PISQ 12 (Pelvic Organ Prolapse Incontinence Sexual Questionnaire), PFIQ-7 (Pelvic Floor Impact Questionnaire-7), PFDI 20 (Pelvic Floor Distress Inventory), ICIQ-SF (International Consultation Incontinence Questionnaire Short-Form).

he total number of patients operated was 105, with an average age of 55.7 years (±12.6). The average BMI was 28.6 kg/m2. The mean value of the PISQ 12 questionnaire was 31,6±6,85 with a maximum value of 48.0. Patients who completed the questionnaire were diagnosed with stress urinary incontinence (44.8%), a mixed incontinence (41.0%) and pelvic organ prolapse (26.7%). Of these, 13% had rectocele, 65.2% with cystocele and 7.1% with a combination of cystocele and rectocele. Sixty-seven
women (72%) were sexually active. The reasons for sexual cessation were as follows: absence of sexual partner and pelvic organ prolapse. For the last 6 months, PISQ-12 assesses the following: behavioral-emotional sphere (items 1-4), physiological (items 5-9), relationship with sexual partner (10-12). The highest score - 48. Patients experienced sexual desire “sometimes”: the average score was 2. 9.2% of women with pelvic dysfunction "never" experienced sexual desire, 18.4% experienced sexual desire
“seldom”, 50.0% responded “sometimes”, 19.7% experienced “usually” sexual desire, and 2.6% responded "always". Patients also experienced orgasm during sexual intercourse with a partner “sometimes” (average score: 2. 12.0% - “never” experienced orgasm, 21.3% - “seldom”, 22.7% -“sometimes”, 29.3% - “usually”, 14.7% - “always”. Patients frequently felt sexually aroused – 3 points:
9.3% – “never” felt sexually aroused, 18.7% and 33.3% – “sometimes” and “usually” felt sexually aroused respectively, 29.3% – answered “always”. Patients were sometimes satisfied with the variety of sexual activity – 2 points. Regarding the physiological aspect of sexual life, pain during sexual intercourse was frequent - 3 points. 2,7% - “always” experienced pain during sexual intercourse, 2.7%- “usually”, 28.0% -“sometimes”, 29.3%- “often”, 37.3% - “never”. Episodes of loss of urine during intercourse were
observed on average-often (3 points; 5.3 % - “always”, 16.0% - “often”, 17.3% -“sometimes” lost urine during intercourse), but urinary or fecal incontinence rarely affected sexual activity - an average of 2 points. The genital prolapse in a 66.7% of women was always considered the primary reason for avoiding sexual intercourse. The percentage of women with negative emotions during sex was 36.0%. The intensity of orgasms experienced by patients in the past were less intense compared to the time of the study. As sexual abstinence is recommended for all patients to reduce the risk of dyspareunia in the postoperative period, a long-term follow-up study of the sexual function in postoperative female patients at least 2–3 months after surgery is necessary.

Patients with pelvic disorders most often experienced pain during sexual intercourse and urinary incontinence. Sexual dysfunction in females includes lack of sexual desire, sexual pain disorders (as dyspareunia), anorgasmia, and sexual arousal dysfunction. Sexual dysfunction increases with age and pelvic disorders such as urinary incontinence and pelvic organ prolapse.

Patients should be prepared to discuss with surgeons the most common pelvic problems, especially sexual function. Using validated
questionnaires reduces the risk of incorrect assessment of the severity of symptoms.