Prevalence of Female Sexual Dysfunction among Women with Pelvic Organ Prolapse Diagnosed by Pisq-12 and Related Factors in Hung Vuong Hospital, Vietnam

Pelvic organ prolapsed is a common problem today, and it has been gradually increasing because of the longevity of women. Pelvic organ prolapse can result in negative psychological feelings that affect on women’s sexual activity. Methods: There is a cross-sectional study on sexual dysfunction in 296 women with pelvic organ prolapse grade II and III followed up at gynecolog-ical-pelvic floor unit of Hung Vuong hospital from 09/2017 to 06/2018. Results: The prevalence of female sexual dysfunction in PISQ-12 was 76.4% and 95% CI [71.6 - 81.2]. The rate of female sexual dysfunction in turn is: 1) Be-havioral-Emotional: 93.6% 95% CI [90.8 - 96.4]. 2) Physiology: 62.2% CI 95% [56.7 - 67.7]. 3) Relationship to partner: 89.5% 95% CI [86.0 - 93.0]. Factor related to sexual dysfunction in women with pelvic organs (p < 0.05) is general sexual dysfunction: 1) Age group: women over age 55 increased generally the risk of sexual dysfunction, OR = 5.89, 95% CI [1.38 - 25.20]. 2) Diabetes mellitus increased the risk of sexual dysfunction with OR = 5.03, 95% CI [1.42 - 17.82]. 3) Patients with previous abortions reduced the risk of sexual dysfunction with OR = 0.49 95% CI [0.27 - 0.90]. Conclusion: Research on quality of life in pelvic organ prolapse should be considered more in the future.


Introduction
Pelvic organ prolapse (POP) is a common problem nowadays, gradually increasing in the current economic and social life because of the increasing age of women. Most women are affected, and about 11% have to undergo surgery for treatment of POP. The awareness of women's sexual activity directly affects their own health and also affects their treatment.
Human sexual activity is instinctive and influenced by many biological, psychological, social and cultural factors and relationships with partners. When sexual function is disordered, the first negative effect will manifest in the physiological mind (such as sadness, depression, anger), and mental manifestations (such as restlessness, suspicion, depression, concerned). Sexual dysfunction also negatively affects the family atmosphere, productivity, as well as other relationships and above all affects the treatment process, treatment effectiveness, and as a result difficulties in treatment. Many studies have noted that sexual dysfunction affects overall woman's quality of life, so it is important to consider related factors to help them improve their quality of life. To assess this problem, a questionnaire on quality of life can be used. These questionnaires have been used in many studies on different subjects such as postoperative patients with POP, cardiac surgery, cancer pathology [1].
Hung Vuong Hospital is a specialized obstetric and gynecological hospital in Ho Chi Minh city, in the south of Vietnam. We have more than 200 doctors and 900 patient beds. The number of hysterectomy due to POP is about 100 cases per year among nearly 600 cases of hysterectomy.
POP can create negative feelings about psychology, affecting women's sexual activity. Researching this problem in the world is not much and gives many conflicting results about the relationship between pelvic organism and sexual dysfunction. The limitation in research may be due to the use of questionnaires about non-specific, non-specific sexual functions.
In recent years, pelvic experts have agreed to use the PISQ-12 questionnaire (Prolapse/Urinary Incontinence Sexual Questionnaire) to identify sexual dysfunction in proven pelvic patients. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 (PISQ-12) was developed from the data of 99 of 182 women surveyed to create the long form (PISQ-31) [2]. An additional 46 patients were recruited for further validation. All subsets regression analysis identified 12 items likely to predict PISQ-31 scores. Short form scores underwent correlation analysis with long form, Incontinence Impact Questionnaire-7 (IIQ-7), Sexual History Form-12 (SHF-12) and Symptom Questionnaire (SQ) scores.
Test-retest reliability was checked with a subset of 20 patients. All subsets regression analysis with R > 0.92 identified 12 items that predicted PISQ-31 scores.
Short form scores were highly correlated with long-form scores (R = 0.75 -0.95).
Correlations of the PISQ-12 with SHF-12 (R = -0.66 and -0.68) and IIQ-7 (R = -0.38 and -0.54) scores were similar to correlation of the PISQ-31 with these other measures. Reliability was moderate to high, with weighted j values from

Goals of the Study
1) Determine the prevalence of sexual dysfunction in patients with POP at Hung Vuong hospital, Ho Chi Minh city, Vietnam.
2) Identify the sexual disorder related factors in patients with POP such as age, ethnicity, smoking, pre-obstetric, birth, weight at the highest birth, body mass index, internal diseases, pre-surgery gynecology, menopause. Preparing the questionnaire PISQ-12 (Appendix 2) based on the International Committee's translation process of Questionnaire Evaluation Quality of Life, we perform the following steps in order to build the PISQ question set-12 Vietnamese, which applies to research.

Steps to Proceed
Step 1: Screening subjects: Researchers will conduct interviews and examine patients at the gynecological and pelvic clinic of Hung Vuong hospital from the time they visit.
Step 2: Invite subjects to participate in the study: These patients, after being well advised about the purpose, the way to proceed, the benefits and disadvantages of the study will sign a consensus to participate in the study when they agree to participate, time for each object about 10 minutes. Only those who agree to participate in the study will begin conducting interviews.
Step 3: Interview and collect information: face-to-face interviews. All research subjects will be interviewed according to the questionnaire in two parts: 1) Questionnaire on research variables. 2) Sex function evaluation questionnaire including: Questionnaire PISQ-12. Examination, classifying POP-Q accordingto pelvicorgans prolapse.
Data in the study will be coded, imported, managed, and analyzed based on SPSS 20 software.

Comment
The sample had an average age of 48.2 ± 9.0, the youngest age was 30, the high-

Comment
One subject may have many sexual disorders at the same time, so the total number of women with sexual disorders is more than the total number of 296 women in the study.

Comment
After

Discussion
Sexual issues of people began to be interested in around the XVIII century, when some authors learned about the psychological aspect of sexual behavior. Many researchers have tried to understand and identify "normal" sexual behavior through the use of a number of different survey methods. In 1997, urologists were the first to use the term "female sexual disorder" to refer to the pathophysiology of female genital organs.
Female sexual disorders are repeated problems in sexual response, affecting psychology and relationships with partners, which is a complex, not well known and influential disease of all ages [5]. Sexual dysfunction is common in women suffering from pelvic prolapse. It is often caused by many factors including psychosocial factors, urinary tract atrophy, advanced age, male sexual dysfunction [6].
Research design: with the aim of finding the rate of female sexual dysfunction, at the same time identifying factors related to sexual disorders in patients with Open Journal of Obstetrics and Gynecology  give an average score, thereby comparing and determining sexual dysfunction.
The general form of sexual disorder is also a collection of the meanings of the three small morphologies above, describing the most important factors to assess the sexual life of a specific subject, the siblings. Behavioral-emotional disturbances, or physiological or merely disordered disorders due to partners, just one of the three factors on the disorder can lead to other forms of confusion. disorder and reduce the quality of the sexual life of a woman with pelvic organs.
In multivariate regression analysis (Table 3), a real correlation was found between the age group and sexual dysfunction (p < 0.05), as follows: Women over 55 years of age had an increased risk of confusion. general sexual dysfunction with OR = 5.89 95% CI [1.38 -25.20]. Patients 55 years and older increase the risk of physiological disorders OR = 5.85; 95% CI [2.31 -14.78]. The association between age groups and sexual dysfunction according to PISQ-12 on pelvic subjects is also determined by several studies worldwide [7] [8]. According to research by Sylvia M. Botros (2006), there is a correlation between the age group above 50 and the low PISQ-12 index (difference in average score −5.4 with p = 0.019) [9].
The older the patient, the more likely he is to suffer from diseases, the organs in the body and the structures that support the pelvic area weaken, and the physiological problems also change in the downward direction. The advanced age is the factor of pelvic organ, the higher the age, the more likely it is that the pelvic organ will become more severe. According to the POSST study [10], 100% of the  [12]. The relationship between chronic diseases such as diabetes and sexual dysfunction is determined by several studies worldwide [7]. In our study, precursor abortion was a factor in reducing sexual dysfunction with OR = 0.49 and p < 0.05. This may be due to an increase in abortion rates, a reduction in birth rates, especially vaginal births, thereby reducing the incidence of pelvic spleen as well as pelvic floor prolapse, which may reduce dysfunction sex.

Limitation of the study:
Cross-sectional design should be limited in deducing the causal factors of female sexual disorders. In the future, prospective, longitudinal design studies are needed to investigate causal factors related to female sexual disorders, across different female subjects.
The questionnaire of PISQ-12 surveyed sexual life in the past 6 months, suitable for the group of pelvic subjects, who had low frequency of sexual intercourse, however, it was difficult to avoid recall due to time is too long.
Some related factors have not been surveyed: sexual harassment/sexual abuse history, sexual preference. This is a complicated issue, very difficult to conduct research, because most people want to avoid, want to not remember, or do not want to mention.

Conclusions
Through 296 cases of pelvic organ prolapse grade II and III at Hung Vuong hospital, we draw some conclusions as follows: 1) The prevalence of female sexual dysfunction in pelvic organ prolapse according to PISQ- 12

Conflicts of Interest
The authors declare no conflicts of interest regarding the publication of this paper. Open Journal of Obstetrics and Gynecology Ask the patient to be on the examination according to the gynecological examination.
Gh, Pb ( Figure A2) and Tvl were measured first when the prolapse was reduced and patient asked not to strain. Aa and Ap were marked using marker pen. Then patient was asked to strain maximally C point ( Figure A2) (Table A1, Table A2).     Stage I The most distal portion of the prolapse is more than 1 cm above the level of hymen Quantification value is less than −1 cm.

Stage II
The most distal portion of the prolapse is 1 cm or less proximal or distal to the hymen Quantification value is ≥−1 cm but ≤+1 cm Stage III The most distal portion of the prolapse protrudes more than1 cm below the hymenal plane. Quantification value is >+1 but <+(tvl − 2 cm) Stage IV Complete eversion of vaginal walls. Quantification value > (+tvl − 2 cm)