Six Out of Ten Women with Recurrent Urinary Tract Infections Complain of Distressful Sexual Dysfunction – A Case-Control Study

www.nature.com/scientificreports OPEN received: 05 October 2016 accepted: 07 February 2017 Published: 15 March 2017 Six Out of Ten Women with Recurrent Urinary Tract Infections Complain of Distressful Sexual Dysfunction – A Case-Control Study Luca Boeri1,2, Paolo Capogrosso1,3, Eugenio Ventimiglia1,3, Roberta Scano1, Alessandra Graziottin4, Federico Dehò1, Emanuele Montanari2, Francesco Montorsi1,3 & Andrea Salonia1,3 Uncomplicated recurrent urinary tract infections (rUTIs) are common among reproductive-aged women. We aimed to assess the prevalence and predictors of sexual dysfunction (FSD) in a cohort of women with rUTIs and compare their psychometric scores to those of matched controls. Data from 147 rUTIs women and 150 healthy controls were analysed. Participants completed the International Prostatic Symptoms Score (IPSS), the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (SDS). Descriptive statistics and logistic regression models tested prevalence and predictors of distressful FSD. Women with rUTIs had lower FSFI scores (p < 0.001) and a greater proportion of pathological FSFI (78.9% vs. 21.4%; p < 0.001) and SDS scores (77.8% vs. 21.4%; p < 0.001) than controls. Of rUTIs patients, 88 (60%), 77 (52.2%), and 75 (51.1%) reported pathological scores for FSFI-pain, lubrication and arousal, respectively; moreover, 64% had concomitant pathological FSFI and SDS scores. Age, IPSS severity, rUTIs, a history of ≥6 UTIs/year and a history of constipation were independent predictors of pathologic FSFI and SDS (all p ≤ 0.05). In conclusion, up to 80% of women with rUTIs showed pathologic FSFI and SDS scores, with 60% reporting scores suggestive of distressful FSD. Having ≥6 UTIs/year and a history of constipation independently predicted distressful FSD. Uncomplicated urinary tract infections (UTIs) are among the most common bacterial infections encountered by women. Approximately 50% to 60% of women develop a UTI over their lifetime1, with one-third experiencing at least one by age 262. A recurrent UTI (rUTI) is widely defined as more than two episodes of uncomplicated UTI within 6 months or more than three within 12 months, as documented by urine culture3,4. It has been reported that nearly 20–30% of women with an episode of UTI will have a further episode, and around 25% of these will develop rUTIs2. Uropathogenic Escherichia coli (UPEC) is the pathogen responsible 70–95% of both sporadic and rUTIs5. Despite being considered a mild and self-limiting condition, rUTIs have a detrimental impact on a patient’s quality of life (QoL)6,7, producing disabling effects on women’s health, intimate and social relationships, self-esteem, and capacity for work6, as well as irritability, tiredness and an inability to concentrate7. Increasing evidence shows that sexual and urinary problems are often comorbid and possibly synergic with UTIs in women8–10. Moreover, 60% of rUTIs in women are postcoital5. Despite being clinically meaningful that urinary symptoms may be associated with sexual dysfunction and sexual bother, to the best of our knowledge no clinical study has examined the impact of rUTIs on women’s sexual functioning using validated psychometric questionnaires. Given the significant prevalence of female sexual dysfunction (FSD) in the context of urologic disorders8–10 and clinical observations of sexual complaints from women with rUTIs, we cross-sectionally sought to determine the prevalence and predictors of FSD in a cohort of white–European, heterosexual, sexually active women seeking medical help for rUTI as their primary complaint, and we compared their psychometric scores with those from a group of race- and age-matched women without rUTIs. 1 Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, 20132, Italy. Department of Urology, IRCCS Fondazione Ca’ Granda – Ospedale Maggiore Policlinico; Milan, 20122, Italy. 3 University Vita-Salute San Raffaele, Milan, 20132, Italy. 4Ospedale San Raffaele Resnati, Milan, 20132, Italy. Correspondence and requests for materials should be addressed to A.S. (email: ) 2 Scientific Reports | 7:44380 | DOI: 10.1038/srep44380 1 www.nature.com/scientificreports/ p value (F)* −rUTIs +rUTIs 150 (50.5%) 147 (49.5%) Mean (SD) 34.5 (6.0) 35.3 (9.2) Range 24–48 19–50 Mean (SD) 21.3 (2.3) 22.0 (3.7) Range 17.6–29.4 15.6–35.4 18.5–24.9 139 (92.9) 124 (84.4) 25–29.9 11 (7.1) 16 (10.9) ≥30 0 (0.0) 7 (4.8) 0.29 (0.6) 0.26 (0.6) 0–2 0–3 0 118 (78.6) 124 (84.4) ≥1 32 (21.4) 23 (15.6) Stable sexual relationship 61 (41.5) 32 (21.4) No stable sexual relationship 86 (58.5) 118 (78.6) Primary/Secondary school 16 (10.7) 35 (23.8) High school 91 (60.7) 69 (46.9) University+ 43 (28.6) 43 (29.3) Normal 91 (60.7) 49 (33.3) Constipation 59 (39.3) 98 (66.7) Current smokers [No. (%)] 79 (52.8) 94 (63.9) 0.02 (X2 =  7.98) Alcohol drinkers [No. (%)] 100 (66.6) 90 (61.2) 0.46 (X2 =  1.55) 5.29 (6.0) No. of patients Age (years) BMI [kg/m2] 0.32 (0.99) 0.39 (X2 =  1.85) BMI (NIH classification) [No. (%)] CCI Mean (SD) Range 0.71 (0.13) 0.83 (0.43) 0.45 (X2 =  0.56) CCI categorized [No. (%)] 0.04 (X2 =  4.01) Relationship status [No. (%)] 0.25 (X2 =  2.77) Educational Status [No. (%)] 0.006 (X2 =  7.51) Bowel History [No. (%)] No. of UTI episodes (prior 12 months) Mean (SD) — Median — 6 Range — 3–8 Table 1. Baseline characteristics and descriptive statistics of participants (No. = 297). Keys: -rUTIs = Negative for recurrent urinary tract infections; +rUTIs = Positive for recurrent urinary tract infections; BMI = body mass index; CCI = Charlson Comorbidity Index. *P value according to chi-square test or analysis of variance (ANOVA), as indicated. Results Table 1 lists the characteristics and descriptive statistics of the entire cohort of individuals. Overall, patients with rUTIs had experienced a mean (median) of 5.29 (6) UTI episodes throughout the previous 12 months. Out of 147 women with rUTIs, 79 (53.7%) reported postcoital rUTIs. Almost 86.5% suffered from UPEC-related rUTIs, with other uropathogens (Enterococcus faecalis, Ureaplasma urealyticum, Klebsiella, Proteus Mirabilis) equally distributed (data not shown). Patients with rUTIs did not differ from controls in terms of age, BMI and CCI scores. Conversely, women with rUTIs more frequently showed a history of constipation (p = 0.006), were more frequently current smokers (p = 0.02) and were less likely to be in a stable sexual relationship (p =  0.04). Table 2 depicts the descriptive statistics of the psychometric scores assessing sexual functioning and sexual distress among the cohort. Women with rUTIs showed significantly lower mean FSFI scores (p <  0.001) and had pathological FSFI scores more often than controls (78.9% vs. 21.4%; p < 0.001). When stratified, all FSFI sub-domains were significantly lower in the rUTIs than in –rUTIs individuals, with the ex (...truncated)