Book review

Sexual Function and Pelvic Floor Dysfunction: A Guide for Nurses and Allied Health Professionals

Edited by Angie Rantell

Springer, Cham, 2021, 201 pages, paperback/ e-book, £59.99/£47.99

ISBN: 978-3-030-63842-9 (paperback)/ISBN: 978-3-030-63843-6 (e-book)

As pelvic health physiotherapists, we encounter a number of sexual function issues; for example, sexual pain and penetration disorders, anorgasmia, low libido, sexual trauma and male sexual problems (e.g. erectile dysfunction, premature ejaculation, penile pain and testicular pain). These symptoms regularly present accompanied by other medical diagnoses [e.g. pelvic organ prolapse (POP), urinary dysfunction and bowel dysfunction], or following surgery or cancer treatment (i.e. chemotherapy or radiotherapy).

The clinical toolbox that we utilize includes: exercise prescription [e.g. tailored pelvic floor muscle training (PFMT) programmes]; electrotherapy; transcutaneous tibial nerve stimulation; electrical muscle stimulation; toileting education; advice about pads and exercise garments; lifestyle modification; habit training; bladder training; dilator instruction; sex education; and advice about medications. Close communication and cooperation with the multidisciplinary team are also essential.

Because of the variety of ways that symptoms can present, and the complex background that these issues can have, there are very few standard or “go to” treatment options for this population. One document that most physiotherapists will be familiar with is the National Institute for Health and Care Excellence (NICE) clinical guideline on urinary incontinence and POP (NICE 2019). This recommends: trialling supervised PFMT for at least 3 months as the first-line treatment for women with stress or mixed urinary incontinence. Pelvic floor muscle training programmes should be comprised of at least eight contractions performed three times a day. Perineometry or pelvic floor electromyography should not be routinely used to provide biofeedback. The exercise programme should be continued if PFMT proves beneficial.

The NICE (2021) clinical guidelines for the prevention and non-surgical management of pelvic floor dysfunction state that women of all ages should be encouraged to do PFMT because this helps to prevent its symptoms. These patients should be encouraged to continue these exercises throughout their life because of the ongoing ben-

efits of long-term training.

Sexual Function and Pelvic Floor Dysfunction: A Guide for Nurses and Allied Health Professionals provides an overview of common conditions. The contributors review the assessment, diagnosis and management of those disorders, and discusses the impact that these have on sexual function. The book is also intended to help readers expand their knowledge of sexual function history taking/assessment and holistic treatments.

Angie Rantell, the editor, has been the lead nurse in the urogynaecological department of King’s College Hospital in London for more than 17 years, and is also a well-established and committed member of the International Continence Society. After her introductory chapter, the book breaks down into five sections.

In chapters 2 and 3, Rantell outlines the background, and discusses the many different models of the sexual response cycle. In fact, it was not until Whipple & Brash-McGreer (1997) developed their paradigm that the complexity of female sexuality was truly encapsulated. Rantell’s definitions are clear, and she divides each chapter into bite-sized sections that are easy to digest. Statistics are employed as required to help readers understand the complex nature of sexual dysfunction and the pathways that can lead to it.

Chapters 4–7 offer a detailed overview of the anatomy and physiology of specific pelvic floor conditions in females, and the impact that these have on sexual function and quality of life. The contributors highlight the correlation with over active bladder and sexual pain disorders, and how management of lower urinary tract symptoms is key to treating sexual dysfunction in women. They also clearly address: the sexual difficulties that women with POP face; the impact of the menopause, age-related issues and postpartum dyspareunia; and the effect that surgery can have on this patient group. Treatment suggestions are made, and first-line best practice is discussed.

Helpful diagrams are provided to aid both self-education and the teaching of colleagues. Simple, clinic-friendly outcome measures such as the Vaginal Health Index Score are suggested, and readers are clearly instructed on how to score and address findings. The contributors discuss different hormone treatment medications (e.g. intravaginal oestrogen and progesterone) and vaginal laser therapy, and the current evidence for the use and success of these treatment options. Once again, as in all well-practised medicine, the importance of a multidisciplinary approach as the best way of managing this client group is stressed.

Chapters 8–10 offer guidance on how to approach the topic of sexual problems with patients. These highlight that far fewer patients are em- barrassed to talk about the topic than people may believe. The authors provide great insights into the barriers that both clinicians and patients may find to discussing the subject. They also emphasize the importance of asking all women about this topic, even if they are not currently sexually active or in a relationship. This includes asking about sexual pain, satisfaction, arousal, the frequency of intercourse and a partner’s awareness of the issue. The reader is guided through preparing a patient for a potential discussion, and assessing the appropriate timing of questions. The clinician is urged to a have productive conversation that is free from assumptions about the information gathered. The Brief Sexual Symptom Checklist for women is a helpful tool. The importance of history taking is stressed. Clear guidance is given on the type of physical examination required in symptom- and condition-specific cases. The importance of outcome measures is underlined, and suggestions about when, how and where to use these are made.

The treatment options discussed in chapters 11–14 are clear, and there are a wide array of options and diagrams to assist the reader. The different ways in which women access information are also explored, such as discussions between friends, online chat rooms and Internet searches. Psychosexual therapy is described in detail in order to emphasize the role that it plays in the management of these patients. This section also addresses the importance of pelvic health physiotherapy as part of a multidisciplinary approach to the management of chronic pelvic pain in these patients. There is some overlap with the chapter on medical management discussed above.

Chapter 15, “The Impact of Partner/Male Sexual Problems on Female Sexual Function”, refutes the idea that women are the cause of the problem. It is also an interesting insight into the current assessment, treatment and management of sexual problems for men. The author highlights the importance of accurate questioning, and provides an insight into the masturbation practices of the sexes. The psychological effect of sexual dysfunction upon a partner is discussed. Male sexual dysfunction is very briefly addressed.

In the final chapter, “Access to Services and Help-Seeking Behaviour”, Rantell identifies some of the barriers that patients encounter when seeking help. Some patients fear that the health professional will not understand the significance of their sexual problems. She highlights the need to train healthcare providers to be more comfortable with discussing these topics. As pelvic health physiotherapists, we need to play an active role in the holistic care of women, and to do this, we need to thoroughly assess and address their sexual health.

Sexual Function and Pelvic Floor Dysfunction is well-written, which will facilitate the extrac tion of information in both clinical and academic settings. However, since the book predominantly deals with female sexual dysfunction, the title should reflect this, or the male aspect should be expanded in the next edition.

The contributors have adopted a holistic approach to understanding and managing patients with sexual dysfunction, and deals with the physical, diagnostic, psychological, clinical and

educational aspects of this subject. Excellent evidence-based treatment options, and how and why these work are discussed. Each chapter is written by an expert in their field, and includes a lengthy and comprehensive reference list to help support education and clinical best practice. The book features clear diagrams that are useful for both patient and clinician education. It also highlights the wider professional support network required to best manage these patients. Overall, this is a wonderful book. Sexual Function and Pelvic Floor Dysfunction should be on the reading list of every BSc and MSc physiotherapy degree, and also on every physiotherapist’s bookshelf.

Gráinne Walsh

Clinical Specialist Physiotherapist in Pelvic Health

(specialist interest in bowel, bladder and sexual dysfunction in men and women)

Book Review: Sexual Function and Pelvic Floor Dysfunction: A Guide for Nurses and Allied Health Professionals

References

National Institute for Health and Care Excellence (NICE)

(2019) Urinary Incontinence and Pelvic Organ Prolapse in Women: Management. [WWW document.] URL https://www.nice.org.uk/guidance/ng123/resources/urinary-incontinence-and-pelvic-organ-prolapse-in-women-management-pdf-66141657205189

National Institute for Health and Care Excellence (NICE)

(2021) Pelvic Floor Dysfunction: Prevention and Non-surgical Management. [WWW document.] URL https://www.nice.org.uk/guidance/ng210/resources/pelvic-floor-dysfunction-prevention-and-nonsurgical-management-pdf-66143768482501

Whipple B. & Brash-McGreer K. (1997) Management

of female sexual dysfunction. In: Sexual Function in People with Disability and Chronic Illness: A Health Professional’s Guide (eds M. L. Sipski & C. J. Alexander), pp. 509–534. Aspen Publishers, Gaithersburg, MD.