Sexual function in women with pelvic floor disorders who have sex with women: a qualitative study

Background: Urogynecologic literature confirms that pelvic floor disorders are detrimental to sexual function in heterosexual women and that sexual function improves following treatment. Few data exist regarding these issues in women who have sex with women, potentially affecting patient-provider interactions, treatment choices and outcomes. Objective: To describe sexual function concerns of women with pelvic floor disorders among women who have sex with women. Study Design: This was a multicenter qualitative study conducted to explore the sexual function of women who have sex with women and to investigate how pelvic floor dysfunction affected their sexual function. A semistructured interview guide was created to conduct one-on-one interviews via digital conferencing. The audio interviews were transcribed and deidentified. Transcripts were then analyzed with line-by-line coding by at least 2 independent researchers and organized into themes using a team-based approach. Interviews were conducted until thematic saturation was reached. Domains investigated included: knowledge and beliefs regarding pelvic floor disorders, impact of pelvic floor disorders on sexual function, and sexual function in general. Results: Eighteen women who have sex with women participated in cognitive interviews. Thematic saturation was reached. Participants' average age was 49.0 (±16.6) years, the majority self-identified as Non-Hispanic White, were healthy with minimal chronic medical conditions, and were married or living with a partner. Four major concepts emerged from the focus groups: (1) pelvic floor disorders resulted in fear and embarrassment and negatively affected sexual function, (2) women adapted their sexual lives to accommodate pelvic floor disorders, (3) partner choice & communication with that partner could ameliorate pelvic floor disorder effects on sexual function, and (4) women shared impressions potentially affecting future sexual function research and clinical care of women who have sex with women; a need for broader interpretation of sexual activity, the importance of nonjudgment and recognition of potential history of sexual trauma. Conclusion: A major theme reported by women with pelvic floor disorders who have sex with women mirrored those of heterosexual women; fear and embarrassment regarding their pelvic floor disorders and their effect on sexual function. These women also voiced novel viewpoints regarding sexual function and amelioration of pelvic floor disorder effects on sexual activity by partner choice and partner communication. Novel issues that could affect future sexual function research and clinical care of women who have sex with women include broadening the definition of sexual activity and emphasizing the importance of nonjudgmental and trauma-informed care.