Strategies to Improve Sexual Health in Women with Urinary Incontinence: A Scoping Review

31 studies on UI and sexual function reviewed; inconsistent findings prevent any conclusions about what actually works

Journal: PLoS ONE | Published: 2026-04-17 | Type: Scoping Review | PMID: 41996393 Authors: Askarloo Z, Shahali S, Ahmadi F, Montazeri A (Tarbiat Modares University, Tehran; ACECR, Tehran) Funding/COI: Funding not reported; no competing interests declared

Summary

Urinary incontinence (UI) affects 3%–55% of women worldwide and frequently impairs sexual function, yet evidence on how UI treatments affect sexual outcomes remains thin. This Iranian-led scoping review pulled 31 studies (2015–2025) examining everything from pelvic floor muscle training (PFMT) to midurethral slings to cognitive-behavioral therapy. The bottom line from the authors themselves: effects were inconsistent, no intervention showed clear superiority, and no definitive conclusions can be drawn.

Claims

• UI prevalence in women ranges from 3% to 55% globally
• 31 studies included across surgical, pharmacological, behavioral, and psychological intervention categories
• PFMT showed heterogeneous effects on sexual function — some RCTs reported FSFI improvements in desire and satisfaction domains; others found no significant change
• Pulsed magnetic stimulation described as "novel and effective" in two studies (Lim et al., González-Isaza et al.) — exact effect sizes not extracted
• Midurethral slings and native tissue repairs: some studies reported improved sexual function and reduced coital incontinence; others reported deterioration
• Cognitive-behavioral therapy reported to improve sexual self-esteem in some studies
• Partner sexual function: addressed by only a small number of studies with modest sample sizes; no meaningful conclusions drawn
• Sample sizes ranged from 20 women (Vitale et al., 2018) to 1,210 women (Solhaug et al., 2024)
• Follow-up periods ranged from a few weeks to over 10 years

Study Quality

This is a scoping review — designed to map the breadth of evidence, not synthesize effect sizes. The authors follow Arksey and O'Malley's framework with JBI enhancements and report a PRISMA-ScR checklist. They searched six databases plus gray literature and had two independent reviewers screen and extract data.

The 31 included studies are themselves methodologically heterogeneous: varying in design (RCTs, cohort studies, case series), UI subtype (stress, urgency, mixed, pelvic organ prolapse), and outcome measurement tools (FSFI, PISQ-12, others). The authors correctly flag that sexual dysfunction was not consistently assessed at baseline in many included studies — meaning reported score changes may not reflect improvement from a clinically defined condition. This substantially limits interpretation of even the individual study findings.

Red Flags

• No meta-analysis possible; narratively synthesized evidence with no pooled effect sizes
• Funding source not reported
• Internal inconsistency: Results section uses language like "significant potential," "robust," and "effective" for PFMT and PMS; Discussion and Conclusion correctly walk this back and state no definitive conclusions can be drawn
• Restricted to English-language studies only — potential language bias
• Baseline sexual dysfunction status undefined in many included studies; FSFI score changes don't necessarily represent treatment of a clinically defined condition
• Gray literature search mentioned but methodology not detailed in the abstract
• Groups biologically distinct conditions (stress UI, urgency UI, pelvic organ prolapse) together, complicating comparisons

Strengths

• Covers the full intervention spectrum: surgical, non-surgical, pharmacological, psychological, and — unusually — partner sexual outcomes
• Includes large-registry studies (n=1,210) alongside small cohorts, giving a realistic sense of the evidence landscape
• PRISMA-ScR checklist completed and reported
• Identifies a specific, actionable methodological gap: absence of standardized baseline sexual dysfunction assessment across the field
• Honest conclusion that contradicts the optimistic framing in earlier sections

Verdict

This scoping review does what scoping reviews are supposed to do: map a messy field and explain why better evidence doesn't exist. The most credible sentence in the paper is buried in the Conclusion — "no definitive conclusions regarding effectiveness or comparative benefit can be drawn" — which is exactly right given what 31 heterogeneous studies produced. The Results section's language of "robust" effects and "significant potential" is not supported by the underlying evidence and reads like authors hedging against the honest conclusion they eventually reach. For anyone trying to understand why the literature on UI and sexual function is so frustratingly inconclusive, this is a useful map of the problem. It won't tell you what works. Neither will the 31 studies it reviewed.