Does Burch colposuspension cure coital incontinence?

doi:10.1016/j.ajog.2003.10.709

American Journal of Obstetrics and Gynecology

Volume 190, Issue 4, April 2004, Pages 1030-1033

https://doi.org/10.1016/j.ajog.2003.10.709 Get rights and content

Abstract

Objective

The purpose of this study was to evaluate the effect of Burch colposuspension for stress urinary incontinence on concomitant coital incontinence.

Study design

The urogynecology database was searched for sexually active women, who experienced coital incontinence on vaginal penetration, orgasm, or both and who had subsequently undergone Burch colposuspension for urodynamic stress incontinence. The women were interviewed or sent a questionnaire on postoperative bladder and sexual function after a minimum follow-up time of 6 months.

Results

Thirty of 43 women answered the questionnaire. Preoperatively, 22 women (73%) experienced urinary leakage during penetration, 3 (10%) during orgasm and 5 (17%) at both. Stress incontinence symptoms were successfully treated in 23 (77%). Coital incontinence was cured in 21 of 30 (70%) and improved in 2.

Conclusion

The results of this small series suggest that coital incontinence is likely to be cured or improved when stress incontinence has been successfully treated by Burch colposuspension.

Section snippets

Material and methods

The computerized data of all 1124 consecutively referred sexually active and stress and/or urge incontinent women since the start of the database in April 1996 were analyzed. A total of 3043 patients had attended the clinic in this period. A standardized questionnaire had been administered by the physician during the structured interview at the first clinical visit. The questionnaire included questions about bladder, bowel, and sexual function. It was noted whether urinary incontinence during

Results

At follow-up, 7 women were no longer sexually active (partner became impotent in 2, partner had died in 3, no interest unrelated to the operation in 2), 2 women did not return the questionnaire, and 4 could not be traced, leaving 30 women for analysis. The mean age was 51 years (range 29-73 years). Preoperatively, 22 of the 30 women (73%) experienced urinary leakage during penetration, 3 (10%) during orgasm, and 5 (17%) at both. Nineteen women underwent primary and 11 had secondary Burch

Comment

The results of our small series suggest that coital incontinence is very likely to be cured or improved when stress urinary incontinence has been successfully treated by Burch colposuspension. This is in accordance with empirical impressions,1., 5. though it has not been studied before. One prospective study exploring sexual function, including incontinence during intercourse before and after prolapse and/or incontinence surgery, did not distinguish between incontinence on penetration or orgasm

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Cited by (25)

Stress Urinary Incontinence: Slings, Single-Incision Slings, and Nonmesh Approaches
2021, Obstetrics and Gynecology Clinics of North America
Citation Excerpt :
Sexual function after retropubic colposuspension is inconsistently reported in the literature, with conflicting results. Coital incontinence is likely to be cured or improved postoperatively,43 and the addition of colposuspension to sacrocolpopexy in a randomized controlled trial did not adversely affect sexual function.44 Conversely, a small prospective study comparing colposuspension and midurethral sling found statistically significant decreases in multiple domains of sexual function.45
Coital Incontinence in Women With Urinary Incontinence: An International Study
2018, Journal of Sexual Medicine
Citation Excerpt :
The pathophysiology of urine leakage during sexual activity is not completely elucidated. Recent studies underline the importance of urethral insufficiency,3 contradicting beliefs that CUI is stress UI (SUI) if it occurs during penetration but related to detrusor overactivity when it occurs at orgasm.4,5 Several studies have demonstrated the impairment of sexual life by the presence of voiding symptoms,2 but the impact of UI during coitus, in particular, is difficult to assess given that it seldom presents as an isolated symptom.
Coital urinary incontinence (CUI) is not much explored during clinical history, and this could lead to an underestimation of the problem.
To evaluate the prevalence and clinical risk factors of CUI in women with urinary incontinence (UI), and to measure the impact of CUI on women’s sexuality and quality of life.
This was a multicenter international study, conducted in Italy, Greece, the United States, and Egypt. Inclusion criteria were: sexually active women with UI and in a stable relationship for at least 6 months. Exclusion criteria were: age <18 years and unstable relationship. The UI was classified as stress UI (SUI), urgency UI (UUI), and mixed UI (MUI). Women completed a questionnaire on demographics and medical history, in particular on UI and possible CUI and the timing of its occurrence, and the impact of CUI on quality and frequency of their sexual life.
To evaluate the CUI and its impact on sexual life we used the open questions on CUI as well as the International Consultation on Incontinence questionnaire and Patient Perception of Bladder Condition questionnaire.
In this study 1,041 women (age 52.4 ± 10.7 years) were included. In all, 53.8% of women had CUI: 8% at penetration, 35% during intercourse, 9% at orgasm, and 48% during a combination of these. Women with CUI at penetration had a higher prevalence of SUI, women with CUI during intercourse had higher prevalence of MUI with predominant SUI, and women with CUI at orgasm had higher prevalence of UUI and MUI with predominant UUI component. Previous hysterectomy was a risk factor for CUI during any phase, while cesarean delivery was a protective factor. Previous failed anti-UI surgery was a risk factor for CUI during penetration and intercourse, and body mass index >25 kg/m² was a risk factor for CUI at intercourse. According to International Consultation on Incontinence questionnaire scores, increased severity of UI positively correlated with CUI, and had a negative impact on the quality and frequency of sexual activity.
This study should encourage physicians to evaluate the CUI; in fact, it is an underestimated clinical problem, but with a negative impact on quality of life.
The strength of this study is the large number of women enrolled, while the limitation is its observational design.
CUI is a symptom that can affect sexual life and should be investigated during counseling in all patients who are referred to urogynecological centers.
Illiano E, Mahfouz W, Giannitsas K, et al. Coital Incontinence in Women With Urinary Incontinence: An International Study. J Sex Med 2018;15:1456–1462.
Coital incontinence
2018, Progres en Urologie
Au-delà du retentissement de l’incontinence urinaire sur la qualité de vie, l’image de soi et indirectement sur la vie sexuelle, des fuites urinaires peuvent électivement survenir au cours des rapports sexuels, définissant ainsi l’incontinence coïtale, et pouvant altérer spécifiquement la vie sexuelle.
Analyser la prévalence, les mécanismes physiopathologiques et les possibles options thérapeutiques de l’incontinence urinaire coïtale.
Nous avons effectué une recherche PubMed des termes liés à l’incontinence urinaire et à la dysfonction sexuelle.
L’incontinence coïtale était un symptôme peu rapporté de façon spontanée alors qu’elle était présente chez au moins 1/4 des femmes incontinentes. Certaines femmes n’avaient qu’une incontinence coïtale (7,6 à 20 % des cas). Chez l’homme, l’incontinence urinaire pendant les rapports sexuels s’observait principalement après prostatectomie dans 20 à 64 % des cas. Cette incontinence nécessite une analyse sémiologique fine car elle peut survenir à différentes phases du coït (stimulation locale 20–30 %, excitation 13–18 %, pénétration 62,9–68 %, mouvements de va et vient, orgasme 27–37,1 %) et correspondre ainsi à des mécanismes physiopathologiques différents (hypermobilité cervico-urétrale, incompétence sphinctérienne, instabilité urétrale, hyperactivité détrusorienne). Chez l’homme, l’étiopathogénie la plus fréquente était une incontinence d’effort par insuffisance sphinctérienne. Des thérapeutiques spécifiques ont montré leur efficacité. La rééducation périnéale (RR = 0,25, IC [0,06–1,01]), les thérapeutiques médicamenteuses (anticholinergiques efficaces dans 59 % des cas) ou chirurgicales (bandelettes avec une efficacité de 87 %) ont été proposées aux patients.
L’incontinence coïtale est un symptôme fréquent et gênant. Son évaluation permet une présomption physiopathologique et une adaptation des stratégies thérapeutiques.
Urinary incontinence may seriously impact quality of life, self-image and subsequently the sexual life. Beside this fact, urinary leakage can specifically occur during sexual intercourse, formally named coital incontinence, and thus lead to specific alteration of the sexual life.
To analyse the prevalence, pathophysiological mechanisms and possible therapeutic options for coital urinary incontinence.
Related terms to urinary incontinence and sexual dysfunction were search on PubMed database.
Whereas at least a quarter of incontinent women have a coital incontinence, this symptom was rarely spontaneously reported. Some women had only coital incontinence (7.6 to 20% of cases). In men, urinary incontinence during sexual intercourse was mainly observed after prostatectomy in 20 to 64% of cases. Coital incontinence requires precise assessment. Indeed, it can occur whatever the phase of coitus: local stimulation (20–30%), excitement (13–18%), penetration (62.9–68%), movements back and forth, orgasm (27–37.1%). Cervico-urethral hypermobility, sphincter incompetence, urethral instability, detrusor overactivity could be the principal physiopathological mechanisms. In men, the main cause was a stress incontinence secondary to sphincter deficiency. Specific therapeutic strategies have proved their effectiveness. The rehabilitative approach (RR = 0.25, CI [0.06–1.01]), medicinal (anticholinergic were effective in 59% of cases) or surgical therapeutic (slings with an efficiency of 87%) was proposed to patients.
Coital incontinence is a common and troublesome symptom. Its precise assessment may suggest a specific mechanism and thus a specific treatment.
Contemporary Review of Male and Female Climacturia and Urinary Leakage During Sexual Activities
2018, Sexual Medicine Reviews
Citation Excerpt :
An alternative surgical approach is the Burch procedure. In a retrospective study, Baessler and Stanton89 assessed 30 women and found preoperatively that 73% experienced urinary leakage during penetration, 10% had leakage during orgasm, and 17% at leakage at the two occasions. SUI was successfully treated in 77%, with resolution of CI in 70% and improvement in 7%.
Urinary leakage during sexual activity is a prevalent and often distressing condition that is under-addressed despite having a range of reasonable treatment options.
To review the available literature on prevalence, pathophysiology, and treatment of urinary leakage during sexual activities.
A literature review was performed through PubMed from 1996 to 2017 regarding urinary leakage during sexual activities for men and women including foreplay incontinence, coital incontinence, and climacturia.
To assess various physiologic and social factors of urinary leakage during sexual activities for men and women, treatment options, and their reported outcomes.
Urinary leakage during sexual activity is a prevalent condition that is underdiagnosed and undertreated. The pathophysiology of sexual incontinence is very similar between men and women and is influenced by injury to the pelvic and pudendal nerves, pelvic floor and external sphincter incompetence, and detrusor overactivity. There are different treatment options that are effective and should be offered to patients bothered by their symptoms.
Improved awareness is critical for better addressing the issue of sexual incontinence. There is likely a common pathophysiologic pathway between men and women and many treatment options are effective. However, further study is required to better elucidate this disease process and most effective treatment options.
Mendez MH, Sexton SJ, Lentz AC. Contemporary Review of Male and Female Climacturia and Urinary Leakage During Sexual Activities. Sex Med Rev 2018;6:16–28.
Impact of Incontinence Surgery on Sexual Function: A Systematic Review and Meta-Analysis
2012, Journal of Sexual Medicine
Urinary incontinence has an adverse impact on sexual function. The reports on sexual function following the treatment of urinary incontinence are confusing.
To investigate the impact of surgery for stress incontinence on coital incontinence and overall sexual function.
Cochrane Incontinence Group Specialized Register of Controlled Trials, The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched for trials of incontinence surgery assessing sexual function and coital incontinence before and after surgery. Observational studies and randomized controlled trials investigating the impact of surgical correction of stress urinary incontinence on sexual function were included. Surgical interventions included tension‐free vaginal tape (TVT), Tension Free Vaginal Tape‐Obturator (TVT‐O), transobturator tape (TOT), Burch, and autologous fascial sling (AFS). Studies that included patients undergoing concurrent prolapse surgery were excluded from the analysis. Data extraction and analysis was performed independently by two authors. Coital incontinence was analyzed separately and odds ratios (ORs) with 95% confidence intervals (CI) calculated. The data were analyzed in Review Manager 5 software.
Changes in sexual function and coital incontinence following surgery for urinary incontinence.
Twenty‐one articles were identified, which assessed sexual function and/or coital incontinence following continence surgery in the absence of prolapse. Results suggest evidence for a significant reduction in coital incontinence post surgery (OR 0.11; 95% CI 0.07, 0.17).
Coital incontinence is significantly reduced following continence surgery. There were several methodological problems with the quality of the primary research particularly related to heterogeneity of studies, use of different outcome measures, and the absence of well‐designed randomized controlled trials. Jha S, Ammenbal M, and Metwally M. Impact of incontinence surgery on sexual function: A systematic review and meta‐analysis. J Sex Med 2012;9:34–43.
Sexual outcome after pelvic reconstructive surgery
2009, Gynecologie Obstetrique et Fertilite
La sexualité est un paramètre important de la qualité de vie des patientes. Elle peut être altérée par un prolapsus et/ou une incontinence urinaire mais aussi être modifiée par la chirurgie réparatrice elle-même. Les dysfonctions sexuelles secondaires à nos interventions ont longtemps été peu documentées mais des questionnaires spécifiques et validés ont été développés qui permettent une meilleure évaluation des résultats de la chirurgie du prolapsus et/ou de l’incontinence sur la sexualité. Cet article propose une mise au point des résultats disponibles dans la littérature et aborde notamment les conséquences sexuelles de la chirurgie avec renforcement prothétique qui restent aujourd’hui une des préoccupations majeures des chirurgiens urogynécologues notamment vaginalistes.
Sexual well-being is an important parameter of women's health and quality of live. Sexual disorders may occur in women with pelvic organ prolapse and/or stress urinary incontinence and also after pelvic reconstructive surgery. Sexual dysfunction after POP or SUI surgery has been poorly documented but new condition specific questionnaires have been developed to help us to better evaluate such consequences. This paper reports available data and highlights more specifically consequences of surgery with mesh reinforcement which is, currently, an important issue particularly when performing by vaginal approach.

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General obstetrics and gynecology: gynecologyDoes Burch colposuspension cure coital incontinence?☆

Abstract

Objective

Study design

Results

Conclusion

Section snippets

Material and methods

Results

Comment

Obstet Gynecol

Obstet Gynecol

Urinary incontinence during sexual intercourse: a common, but rarely volunteered, symptom

BJOG

A glance at the urodynamic database

J Reprod Med

Social context, social abstention, and problem recognition correlated with adult female urinary incontinence

Dan Med Bull

Sex and the bladder

BMJ

Sexual function after colpo-urethrocystopexy in middle-aged women

Urol Int

General obstetrics and gynecology: gynecology
Does Burch colposuspension cure coital incontinence?☆