URINARY INCONTINENCE AFFECTS SEXUAL FUNCTION AND SATISFACTION IN SPINAL CORD INJURED MEN

Abstract

Introduction and Objectives: After spinal cord injury (SCI)sexual and voiding functions may be affected depending on the level and completeness of theneurological injury. In this study, we investigated sexual function and satisfaction in men with SCI, according to the urinary continence status. Methods: In a cross sectional study we evaluated 330 men with SCI (> 12 months) with a mean age of 41.2 14.8. Median time from SCI was 3.8 years [1–27]. The injury level was cervical, thoracic, lumbar and sacral in144 (43.6%), 152 (46.0%), 33 (10.0%) and 1 (0.3%), respectively. The American Spinal Injury Association (ASIA) impairment scale was A in 213 (63.4%), B in 34 (10.2%), C in 28 (8.4%), D in 43 (12.9%) and E in 11 (3.3%). Urinary incontinence was defined as any complaint of urinary leakage during the last month. Two groups were created, comprising 173 (52%) continent and 157 (48%) incontinent patients. A structured questionnaire was applied to all subjects including a detailed sexual anamnesis regarding orgasmic and ejaculatory functions, frequency of sexual intercourses and the subjective satisfaction with sexual life. In addition, the International Index of Erectile Function (IIEF–5) and the Male Sexual Quocient (MSQ) were applied to all subjects. Results: Ninety nine (57.2%) continent and 70 (44.6%) incontinent patients claimed to be sexually active (p = 0.003). Both groups demonstrated similar prevalence of anorgasmy (33.3% and 35.2% in continent and incontinent patients, respectively; p = 0.745). Of the incontinent patients, 72.8% had anejaculation as opposed to 52.5% of the continent subjects (OR 2.4, 95% IC 1.25–4.68, p = 0.010). Forty six (26.6%) continent patients and 23 (15.0%) incontinent patients considered their satisfaction with sexual life as ‘‘excellent’’or ‘‘good’’(OR 2.0, 95% IC 1.17–3.57, p = 0.01). Mean IIEF–5 was 9.7 ± 8.0 in continent and 7.7 ± 7.3 in incontinent patients (p = 0.01). However, both groups presented similar prevalence of erectile dysfunction, defined as IIEF–5 < 17 (72.3% in continent and 79.6% in incontinentpatients, p = 0.15). MedianMSQ was higher among continent patients (48 [8–69] and 20 [0–58] in continent and incontinent patients, respectively; p = 0.001). Conclusions: Erectile dysfunction and anorgasmy seem to similarly affect continent and incontinent SCI male patients. However, urinary incontinence had an independent negative impact in sexual function and satisfaction with sexual life in this population.