Assessment of sexual function in women attending a urogynaeoclogy clinic using an electronic questionnaire TG Gray*, J Money-Taylor, PC Campbell, SC Radley.

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Assessment of sexual function in women attending a urogynaeoclogy clinic using an electronic questionnaire TG Gray*, J Money-Taylor, PC Campbell, SC Radley Urogynaecology Unit, Jessop Wing, Sheffield Teaching Hospitals, S10 2SF *thomas.gray@nhs.net Introduction Results Sexual problems are well known to be prevalent in women attending urogynaecology clinics, with prevalence ranging from 36-64% in previous studies1,2. Stress incontinence, overactive bladder and pelvic organ prolapse are known to be associated with sexual dysfunction in women attending urogynaecology clinics2,3,4. ePAQ-PF is an electronic online patient assessment questionnaire5, it is used in the routine assessment on women attending the urogynaecology clinic at Sheffield Teaching Hospitals (STH). The aim of this study was to evaluate the prevalence of both sexual function and sexual dysfunction in women attending the urogynaecology clinic at STH, and assess compliance and acceptance of the Sexual Dimension of ePAQ-PF. During the study period 1975 women attending the urogynaecology clinic at STH completed ePAQ-PF and gave their consent to use the data they recorded. 24.6% felt that bladder or urinary problems interfered with their sex life ‘moderately’ or ‘a lot’ and 24% avoided sexual activity most or all of the time because of bladder or urinary symptoms. 13.3% felt that bowel problems interfered with their sex life ‘moderately’ or ‘a lot’ and 13.3% avoided sexual activity most or all of the time because of bowel symptoms. 33.75% felt that vaginal problems, including prolapse, interfered with their sex life ‘moderately’ or ‘a lot’ and 32.4% avoided sexual activity most or all of the time because of vaginal symptoms. 22.6% overall reported dyspareunia, 10% of women aged over 60 reported dyspareunia compared with 28.4% of women aged under 60. Are you willing to consider answering some questions about your sex life? Yes 1462 (74%) No 373 (18.9%) Not sure 37 (1.9%)  Some questions may be important, even if you are not in a relationship at present. If you don't want to answer, a 'SKIP' button is provided with each question. Are you willing to look at the questions first and then decide? Initial Answer Subsequent Answer % change No Yes 26% Not sure 91% Discussion and Conclusions ePAQ-PF ePAQ-PF is a validated symptom-specific and quality of life patient assessment questionnaire used in clinical practice5,6. It is electronic and is self-administered online prior to attendance in the urogynaecology clinic at Sheffield Teaching Hospitals. The instrument uses multiple-choice (MCQ) components, to establish the frequency and impact of symptoms across four different dimensions (bladder, bowel, vaginal and sexual). The sexual dimension of ePAQ-PF has four domain areas- urinary, bowel, vaginal and dyspareunia. The majority of women (74%) are willing to answer questions about their sexual life on an electronic questionnaire. This increases to 80% when women who answered ‘no’ or ‘not sure’ are given a second chance and more details about the value of these questions to their assessment in clinic. Rates of sexual activity decline with age, but a significant number of women remain sexually active into their 60s, 70s and 80s. These numbers were slightly lower than in previous studies, but the sample size was considerably larger7. Urinary, bowel and vaginal problems have a significant impact on sexual life and overall rates of sexual dysfunction in women attending the urogynaecology clinic at Sheffield Teaching Hospitals are high. 47% of women overall were ‘moderately’ or ‘very’ dissatisfied with their sexual life. This number fell to 44.7% in those aged over 60. Electronic questionnaires are valuable tools for encouraging disclosure of sexual dysfunction and allowing further detailed assessment of these problems, as well as enabling outcome assessment. 76% aged under 60 reported that it was ‘quite’ or ‘very’ important to be sexually active, compared with 36% of those aged 60+. Methods All new patients attending the urogynaecology clinic at Sheffield Teaching Hospitals between October 2012 and December 2014 were invited to complete ePAQ-PF. Data used for this study were obtained from patients who gave consent via ePAQ-PF. Statistical analysis was with Microsoft Excel. References Roos AM, Sultan AH, Thakar R (2012) Sexual problems in the gynecology clinic: are we making a mountain out of a molehill? Int Urogynecol J;23(2):145-152 Pauls RN, Segal JL, Silva WA, Kleeman SD, Karram MM (2006) Sexual function in patients presenting to a urogynecology practice. Int Urogynecol J.;17:576-580 Barber MD, Visco AG, Wyman JF, Fantl JA, Bump RC (1999) Sexual function in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol;(2):281-9 Yip SK, Chan A, Pang S, Leung P, Tang C, Shek D, Chung T (2003) The impact of urodynamic stress incontinence and detrusor overactivity on marital relationship and sexual function. Am J Obstet Gynecol;188(5):1244-8 Radley SC, Jones GL, Tanguy EA, Stevens VG, Nelson C, Mathers NJ (2006) Computer interviewing in urogynaecology: concept, development and psychometric testing of an electronic pelvic floor assessment questionnaire in primary and secondary care. BJOG;113(2):231–238 Schussler-Fiorenza Rose SM, Gangnon RE, Chewning B, Wald A (2015). Increasing Discussion Rates of Incontinence in Primary Care: A Randomized Controlled Trial. Journal of Women’s Health;24:11 Gordon D, Groutz A, Sinai T et al (1999). Sexual Function in Women Attending a Urogynaecology Clinic. Int Urogynecol J;10:325-328