Older people with urinary disorders are more prone to sexual dysfunction according to a study published in BJUI (official journal of several urological associations) in April 2018.

“There is a fairly clear link between urinary incontinence and a number of negative consequences for sexual health. But as a taboo subject, urinary incontinence and its effect on late sexuality remains under-reported as health problems,” says David Lee of Manchester Metropolitan University, the lead author of the study.

Summary

Participants were community‐dwelling women and men aged 50–90+ years from the English Longitudinal Study of Ageing (ELSA) who reported any sexual activity in the last year. The prevalence of UI was assessed both cross‐sectionally (ELSA Wave 6; 2012) and retrospectively over the preceding 8 years (ELSA Waves 2–6; 2004–2012).

At Wave 6, 391 (20.0%) women and 141 (6.9%) men reported ‘any UI’ in the last 12 months. Compared to those without UI, women with UI reported declines in sexual activity and arousal over the last year, and increased concern about their frequency of sexual activity and ability to become sexually aroused. Men with ‘any UI’ reported declines in sexual desire, increased erectile and orgasm difficulties, and were more concerned about these sexual functions compared to men without UI. Differences in the patterns of association with sexual health were seen, dependent upon whether UI was reported as sporadic or persistent, and also with respect to the duration of retrospectively reported UI.

Prevelance of UI

As one might suspect, the prevelance of UI increased with age with a significantly significant age difference between those with “no UI” and “persistent” UI.

UI and Sexual Health

Women

After adjustment for demographic, health, and lifestyle factors, compared to women with no UI, women with sporadic UI reported a 50% reduced odds of frequent sexual intercourse and a 74% increased odds of vaginal dryness. …

Compared to women without UI, women with persistent UI reported a 56% increased odds of difficulty achieving orgasm and a 69% increased odds of decline in frequency of sexual activities over the last year. …

Women who reported UI for ≤4 years had a 40% reduction in odds of frequent sexual intercourse, a 102% increase in odds of frequent masturbation, and a 92% increase in odds of experiencing vaginal dryness compared with women free of UI.

Men

Compared to men free from UI, men with sporadic UI reported 126% and 101% increased odds of declines in both their sexual desire and frequency of sexual activities over the last year. …

Compared to men with no UI, those with UI for ≤4 years reported increased chance of decline in sexual desire (70%), decreased sexual frequency (79%), and decreased ability to have an erection (80%) over the last year. Men who reported persistent UI were less likely to report any sexual activity in the last 12 months compared to men without UI.

Review

This study used an available data set, the English Longitudinal Study of Ageing (ELSA). As such, it is a large population sample from England. The plus is the large N (1792 women and 2013 men). The downside is the inability to ask questions specific to the study. For example, while the article reports no effect of prostate cancer, I do wonder if the UI is a result of prostate cancer in men, the larger issue is the Prostate Cancer causing both the UI and decrease in sexual health.

Additionally, like many research studies, minorities are under sampled (2.1% report as non-White).

Thus, being a study of European English whites may make generalizability suspicious.

So What? …

This largely goes in the “good to know” category and may prompt an additional question in your Sexual History assessment. Asking about urinary incontinence may be valuable, especially for those who are older or have risk factors (prostate cancer, vaginal childbirth, etc.).

Citation

Lee, D. M., Tetley, J. and Pendleton, N. (2018), Urinary incontinence and sexual health in a population sample of older people. BJU Int. . doi:10.1111/bju.14177