Lower urinary tract symptoms and especially urinary incontinence are common among patients with multiple sclerosis (MS). Moreover, coital incontinence (CI), defined as incontinence during vaginal intercourse, may be present in women with MS, deteriorating their sexual life and activity [1]. In our study, we examined the effect of pelvic floor muscle training (PFMT) on the improvement of sexual life in women with MS and CI.

This is an observational study, including sexually active women with MS and CI have been pooled from the Neuro-urology office of our Department. Patients have been evaluated at the baseline with bladder diary (BD) and questionnaires; International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), King’s Health Questionnaire (KHQ) and Female Sexual Function Index (FSFI). Then, they were referred to a specialized physiotherapy center in order to undergo PFMT and biofeedback (BFD). All women underwent the same program for nine months. Patients’ re-evaluation has been performed after 4 (endpoint 1) and 9 (endpoint 2) months respectively, with the same questionnaires. Finally, collected data has been statistically analyzed with SPSS v.22, using the appropriate methods for non-parametric samples.

Eventually, 18 women with a mean age of 31.5y.o. completed the study. At baseline, all patients documented CI on their BD, while the mean ICIQ-UI SF score was 15.5. Regarding KHQ, all women referred that CI deteriorated their sexual life. More specifically, 1 (5.6%) of them CI had a low impact, 8 (44.4%) a moderate and 9 (50%) of them had a high impact in their sexual activity. The mean FSFI score was 18 and more specifically for the desire domain, the mean sub-score was 1.8. At endpoint 1, again all women reported CI on their BD, the mean ICIQ-UI SF was 12, not significantly changed (p= 0.12) and in KHQ again all women mentioned an impact of CI in their sexual activity. However, 6 (33.3%) of them felt a low impact, 10 (55.6%) a medium and only 2 (11.1%) a high impact. The mean FSFI was 21.6 and the specific mean desire sub-score was 2.4, both not significantly changed (p= 0.18 and p= 0.09 respectively). At endpoint 2, only 9 (50%) women reported CI on their BD and the mean ICIQ-UI SF was 7, significantly changed from baseline (p= 0.02). In KHQ, 9 women (50%) referred no impact of CI in their sexual life, 8 (44.4%) a medium and only 1 (5.6%) referred a high impact in sexual activity. The mean FSFI was 23.4, not significantly changed to the baseline (p= 0.08), while there is a significant improvement in desire domain sub-score, counted at 4.2 (p= 0.01).

Coital incontinence remains a significant factor forcing sexually active women with Multiple Sclerosis to avoid sexual activity [2]. Pelvic floor muscle training combined with biofeedback techniques are usually effective in incontinence manipulation and this study examines their possible results on CI [3]. Interestingly, a prolonged PFMT and BFD program has been found to reduce the severity of incontinence symptoms during vaginal intercourse and consequently this way of treatment could be suggested in these patients.

Management of CI with PFMT and BFD seems to have a positive impact in sexually active women with MS after a nine-month intervention. The main influence is focused on the elimination of CI, with a parallel improvement of sexual activity.

Rogers RG, Pauls RN, Thakar R, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the assessment of sexual health of women with pelvic floor dysfunction. Neurourology and Urodynamics. 2018;1–21.
Serati M, Salvatore S, Uccella S, Nappi RE, and Bolis P. Female urinary incontinence during intercourse: A review on an understudied problem for women’s sexuality. J Sex Med 2009;6:40–48.
Zahariou AG, Karamouti MV, Papaioannou PD. Pelvic floor muscle training improves sexual function of women with stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2008 Mar;19(3):401-6.