How cystectomy affects female sexual function and body image in patients with benign conditions

Recent data suggest that both female sexual function and body image are affected by urinary diversion after cystectomy for patients with benign conditions.¹

“Simple cystectomy with urinary diversion is the favored option for treating conditions responsible of neurogenic bladder dysfunction after failure of conservative treatments,” wrote the authors of this study . “Despite the existence of validated assessment tools, the impact of cystectomy on female sexual function remains scarcely investigated.”

Thirty-six women were enrolled in the study, all of whom underwent urinary diversion with or without cystectomy between January 1, 2007, and December 15, 2019.

Patients filled out Female Sexual Function Index (FSFI), Body Image Scale (BIS), and Stoma Quality of Life (StomaQOL) questionnaires. The surveys assessed sexual activity, body image, and quality of life related to a noncontinent stoma, respectively. Investigators also assessed pre- and postoperative information that was collected from patient computerized medical records.

Results showed that the most frequent cause of bladder dysfunction was multiple sclerosis (n=14, 38.9%). In addition, 80.6% (n=29) of patients were sexually active following cystectomy, and the mean overall FSFI score was 15.2 (range, 2-33.3).

Compared with the 14 patients in this study with a continent stoma or native urethra, however, the 14 patients with an ileal conduit had a lower mean overall FSFI score [11.1 (range, 2-33.3) vs 19.2 (range, 2-29.3); P = .04 and 3.15 (range, 0-54); P = .014].

Twenty-seven patients (79.4%) also reported that they had not received any sexual counseling prior to surgery and thus were not made aware of the potential consequences on their sexual activity. Thirty-one patients (91.2%) were not asked about their sexual activity during follow-up either.

With regards to BIS and StomaQOL, patients with an ileal conduit had a higher BIS score vs those with a continent stoma or native urethra (14.8 vs 9.7 vs 5.1, respectively; P = .002), and they had a mean StomaQOL score of 52.56.

“The main strength of this study lies in the use of validated standardized questionnaires, including the FSFI that is considered as the most relevant tool for assessing female sexual function. Limitations include the small number of patients and the potential memory bias,” added the authors.

The main conclusions of this study revolved around the present impact of urinary diversion on sexual function and body image, reinforcing the need for management of “at least, routine assessment of sexual function prior to simple cystectomy and screening for sexual dysfunction during follow up,” the authors said.

Reference

1. Louar M, Morel-Journel N, Ruffion A, et al. Female sexual function and body image after urinary diversion for benign conditions. J Sex Med. 2022 Feb;19(2):263-269. Epub 2021 Dec 17. doi: 10.1016/j.jsxm.2021.11.007