• Anne-Marie Roos, Ranee Thakar, Abdul H Sultan, Curt W Burger, and Aggie T G Paulus.
• Department of Obstetrics and Gynaecology, Croydon University Hospital, Croydon, Surrey, UK; Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands.
• J Sex Med. 2014 Mar 1; 11 (3): 743-52.

IntroductionSexual function of women suffering from pelvic organ prolapse (POP) and/or urinary incontinence (UI) is adversely affected. However, our current understanding of the exact relationship between female sexual dysfunction and POP and/or UI is incomplete. A qualitative study can improve our understanding by describing what women themselves perceive as the real problem.AimTo gain a more in-depth understanding of the impact of POP and/or UI on the different categories of female sexual dysfunction by way of a qualitative study.MethodsQualitative semistructured interviews were conducted in 37 women scheduled for pelvic floor surgery, and one was excluded from analysis due to incomplete recordings.Main Outcome MeasuresThe impact of POP and/or UI on female sexual function.ResultsOnly 17% of women were completely positive about their sex life. Both POP and UI had a negative effect on body image. Women with POP had a negative image of their vagina, which caused them to be insecure about their partner's sexual experience, while women with UI were embarrassed about their incontinence and pad use, and feared smelling of urine. Worries about the presence of POP during sexual activity, discomfort from POP, and reduced genital sensations were the most important reasons for decreased desire, arousal, and difficulty reaching an orgasm in women with POP. Fear of incontinence during intercourse affected desire, arousal, and orgasm and could be a cause for dyspareunia in women with UI. Desire was divided into two main elements: "drive" and "motivation." Although "drive," i.e., spontaneous sexual interest, was not commonly affected by POP and/or UI, a decrease in "motivation" or the willingness to engage in sexual activity was the most common sexual dysfunction mentioned.ConclusionsBody image plays a key role in the sexual functioning of women with POP and/or UI with the biggest impact on women's "motivation."© 2013 International Society for Sexual Medicine.

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