Adult spina bifida patients less sexually active

February 1, 2007

Atlanta-Sexual activity is lower and more disturbed in adult patients with spina bifida than it is in the general population, according to a recent study by researchers from the Children's Hospital of Philadelphia. Interestingly, however, this diminished sexual activity does not appear to significantly affect spina bifida patients' quality of life, researchers said at the 2006 American Association of Pediatrics Section on Urology annual meeting here.

"This was the first descriptive study to use validated questionnaires to assess how the growing population of adult spina bifida patients are doing in terms of sexual function and overall quality of life," said first author Jenny Lassmann, MD, a pediatric urology fellow who worked on the study with Howard M. Snyder, MD, and colleagues.

Because of advancements in the treatment of spina bifida, a far greater number of patients are progressing into adulthood. As these patients age, their needs change, a fact that is causing researchers to investigate quality of life indicators in such populations. One of these indicators, sexual function, is an important component, and has been noted to be disturbed in patients with other physically limiting diseases.

All patients underwent an interview to determine their method of bladder emptying and degree of urinary incontinence. Additionally, each patient completed two questionnaires. The Watts sexual function questionnaire (WSFQ) was used to assess four areas of sexual experience: desire, arousal, orgasm, and satisfaction. The second questionnaire, the Medical Outcomes Study 36-item short-form (SF-36), was used to measure general health-related quality of life.

Sexual activity delayed

Of the 76 patients evaluated, 24% were sexually active, defined as having had sexual intercourse at least once during the previous 2 months. Using historical controls, sexual activity in these patients was delayed when compared with other groups, including U.S. high school students (55%) and men diagnosed with exstrophy (77%).

"Our cohort of spina bifida patients is in continued follow-up at a tertiary pediatric center. The number of sexually active patients in our cohort was less than that published in other spina bifida series, perhaps due to the fact that our patients have more significant disease," Dr. Lassmann said.

Interestingly, no significant differences in quality of life measures were observed between sexually active and non-sexually active spina bifida patients.

"We were surprised to see the trend, though not statistically significant, that the mental health component of the quality of life score was lower (and therefore closer to that of the general population) in sexually active spina bifida patients than in those who are not sexually active," Dr. Lassmann noted. "Though this seems counterintuitive, it may suggest that sexually active spina bifida patients have a higher psychological and functional status that more closely mirrors the general population."

This was supported by the finding that sexually active spina bifida patients were more likely to have no hydrocephalus and to live independently. There was no association between sexual activity and age, gender, urinary incontinence, or degree of physical disability in this population.

In sexually active patients, their sexual function appears to be disturbed, as they scored slightly higher in the WSFQ assessment than did other published disease groups (including women with diabetes or breast cancer and patients with renal cancer or hypertension) and lower than a mixed control group. Dr. Lassmann noted that the mean age of all cohorts was higher than that of the presented spina bifida group.