Sexual Activity and Satisfaction in Women with Spinal Cord Disease: Influence of Urinary Incontinence and Other Predictors

Abstract Study design: Cross-sectional study. Objectives: Evaluate sexual activity and satisfaction in women with spinal cord disease (SCD) and their associations with urinary incontinence. Setting: Outpatient neuro-urology clinics at a tertiary rehabilitation center in Brazil. Methods: Ninety-eight women aged ≥18 years with traumatic or non-traumatic SCD were included. Clinical and demographic data were collected through structured interviews. Bladder symptoms were assessed with the Neurogenic Bladder Symptom Score–Short Form (NBSS-SF). Sexual function was evaluated with the Female Sexual Function Index (FSFI), and sexual satisfaction with the WHOQOL-BREF. Sexual activity was defined as intercourse within six months. Logistic regression identified predictors of sexual activity and satisfaction. Results: Mean age was 43.0 ± 12.1 years; most cases were non-traumatic (85.7%), mainly multiple sclerosis (55.9%). Urinary incontinence was reported by 52.0%, severe in 28.6%. Sexual activity was reported by 48 women (49.0%), of whom 58.3% had FSFI-defined dysfunction and 60.4% reported satisfaction. Incontinence was strongly associated with inactivity (72.5% vs. 27.5%, p < 0.001) and lower FSFI scores (16.2 ± 10.3 vs. 24.4 ± 9.1, p < 0.001). On multivariate analysis, urinary continence (OR 5.0, 95% CI 1.7–14.4), younger age (OR 0.93/year, 95% CI 0.89–0.98), and being married (OR 10.9, 95% CI 3.6–33.3) predicted sexual activity and satisfaction. Conclusions: Urinary incontinence is an independent barrier to sexual health in women with SCD. Targeted continence management may improve quality of life. Sponsorship: No external funding.