SEXUALITY AND CHRONIC ILLNESS: A BIOPSYCHOSOCIAL MODEL OF SEXUAL SATISFACTION IN WOMEN WITH INTERSTITIAL CYSTITIS

Interstitial Cystitis (IC) is an incurable chronic illness that attacks urogenital functioning and consequently has a negative impact upon sexual functioning. In order to understand sexual satisfaction in women with IC, biological, psychological, and sociological/interpersonal factors must be considered.

This research investigated sexual functioning in 65 women with a diagnosis of IC within the context of a biopsychosocial model. It was postulated that pain, urinary urgency, and negative affect would have a significant and negative association with sexual satisfaction, and that sexual drive, variety of sexual experiences, sexual communication, and partner satisfaction would have a significant and positive association with sexual satisfaction. Previous level of sexual satisfaction was used as a covariate.

Information was acquired by means of validated instruments, measures designed for purposes of the study, and open-ended questions. The validated instruments were the Sexual Communication Inventory, the Lock-Wallace Marital Adjustment Test, and several subscales of the Derogatis Sexual Functioning Inventory. The self-designed measures were pain and urinary symptom scales, a quality of life scale, a sexual disruption scale, and a physician-patient relationship scale.

Results from regression analyses indicated several strong and positive significant predictors of sexual satisfaction: previous level of sexual functioning, sexual communication, range of sexual experiences, positive affect, and sexual drive. Pain was a significant negative predictor. In other words, women who reported high levels of sexual satisfaction prior to developing IC reported high levels of present sexual satisfaction. Women who scored high on sexual communication, range of sexual experiences, positive mood, and drive reported high levels of sexual satisfaction. Conversely, women who reported high levels of pain reported low levels of sexual satisfaction.

The open-ended questions revealed that most of the women are not only preserving their sexuality through the practice of non-intercourse activities, but also through love, intimacy and affection. Some women, however, described experiencing frustration with their partners when symptoms interfered with intercourse. It was noteworthy that some women described a pain-awareness-cycle; that is, once pain was associated with sexual activity, the fear of pain interfered with sexual excitement.

The open-ended questions provided several insights into the strategies women employ to achieve sexual satisfaction. Intercourse, as indicated by the study, was the most troublesome for women. By contrast, women reported that the following activities all contributed to achiveing sexual satisfaction: oral sex, mutual masturbation, certain positions, masturbation while mutually discussing fantasies, talking to each other, exploring different sensations of touch, breathing deeply together, massaging, touching, fondling, hugging, holding hands, and kissing. Additionally, women reported that condoms, antibiotics, pyridium, diet and acupuncture helped reduce symptoms and contributed to sexual satisfaction. Engaged in comfortable sex during pain-free times was another strategy that reduced pain during sex.

It is hoped that these findings will alert health practitioners to the importance of sexuality in the lives of women with IC. The goals of sexual rehabilitation should include: (a) discussion of physical symptoms such as pain and urinary urgency during specific stages of the sexual response cycle, (b) if necessary, counseling to diffuse negative interactions between the couple, (c) recommendation of a wider range of nonintercourse sexual experiences, (d) education about the pain-awareness-cycle, and (e) enhancement of couple communication about sexuality.