Female stress urinary incontinence affects male partners’ sexual function

Stress urinary incontinence (SUI) in women appears to have a significant impact on their partners’ sexual function, suggests a study. Furthermore, female anti-incontinence surgery does not seem to improve the sexual function of their partners.

“[W]e demonstrated that males whose female partners had SUI may have issues with sexual function,” the researchers said. “[B]ased on their direct survey, male partners’ sexual function demonstrated statistically significant improvement after female patients with SUI underwent transobturator suburethral tape (TOT) surgery, but the improvements were of unclear clinical significance.”

The researchers did a comprehensive search of the databases of PubMed, Embase, Web of Science, Cochrane, and Scopus up to 6 September 2022. They identified studies that explored the effect of female SUI and related treatments on male partners’ sexual function.

A total of 2,294 citations were identified, of which 18 studies with 1,350 participants met the eligibility criteria. [J Sex Med 2023;20:1069-1077]

Two studies examined the effect of female SUI without treatment on their partners’ sexual function and found that male partners had more erectile dysfunction (ED), more sexual dissatisfaction, and less sexual frequency than partners of women without urinary incontinence.

Seven studies directly investigated the impact of female SUI treatments on male partners’ sexual function by surveying the male partners: four assessed TOT surgery, one assessed TOT and tension-free vaginal tape obturator surgery, and two assessed pulsed magnetic stimulation and laser treatment. Three of the four TOT studies used the International Index of Erectile Function (IIEF).

TOT surgery resulted in significant improvements in the total IIEF score (mean difference [MD], 9.74; p<0.00001), erectile function (MD, 1.49; p<0.00001), orgasmic function (MD, 0.35; p=0.001), sexual desire (MD, 2.08; p<0.00001), intercourse satisfaction (MD, 2.36; p<0.00001), and overall satisfaction (MD, 3.46; p<0.00001).

However, the clinical significance of the improvements in IIEF items remained unclear, since 4 points in the erectile function domain were defined as the minimal clinically important difference.

Nine studies did an indirect assessment of the impact of female SUI surgery on male partners’ sexual function through a survey that used the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. Based on the results, no significant differences were observed in erectile function (MD, 0.08; p=0.40) or premature ejaculation (MD, 0.07; p=0.54).

“[F]emale patients with SUI who underwent anti-incontinence surgery did not perceive significant improvement in their male partners’ erectile function or premature ejaculation,” the researchers said.

This study was limited by the small number of eligible studies, high heterogeneity of several outcomes, lack of standardized research, lack of discussion on treatment complications and long-term follow-up periods, and the absence of clear clinical recommendations, “given the complex nature of sexual function and the variety of anti-incontinence treatments.”

“Owing to the limitations of this study, additional studies are needed for validation: ones with high-quality design, large sample sizes, and longitudinal follow-up,” the researchers said.