BODY-IMAGE AND PELVIC ORGAN PROLAPSEIN A BRAZILIAN POPULATION: VALIDATION OF THE BIPOP QUESTIONNAIRE ANDCORRELATION WITH ATRACTIVENESS AND SEXUAL FUNCTION SCORES
R. M. MORONI 1, L. BRITO 2,C. H. FERREIRA 3, L. A. LARA 4, C. JULIATO 5,P. S. MAGNANI 6, E. B. DE CASTRO 2, M. V.ROSIQUE2, A. A. NOGUEIRA 7;
1Gynecologyand Obstetrics, UNOESTE, Cascavel, Brazil, 2Gynecology andObstetrics, Univ. of Campinas, Campinas, Brazil, 3Rehabilitationand Functional Development, Ribeirao Preto Med. Sch., Univ. of SaoPaulo, Ribeirao Preto, Brazil, 4Gynecology and Obstetrics,Ribeirao Preto Med. Sch., Univ. of Sao Paulo, Ribeirao Preto, Brazil,5Univ. of Campinas, Campinas, Brazil, 6Ginecologiae Obstetrícia, Hosp. das Clínicas da Faculdade de Medic, RibeirãoPreto, Brazil, 7Ribeirao Preto Med. Scool: Univ. of,Ribeirao Preto - SP, Brazil.
Introduction: Female pelvicorgan prolapse (POP) is a group of common disorders which may berelated to several different symptoms, such as vaginal bulge,dyspareunia and voiding/ defecatory obstruction. These symptoms maylead to perceptions of body deformity and to changes in perceivedbody image, possibly contributing to social isolation and sexualaversion. Body image (BI) is a construct that tries to measure suchperceptions, but may be influenced by cultural aspects. The impactthat changes in body image have on sexual function may also varyamong populations.
Objective: To translate and validate theBody Image on Pelvic Organ Prolapse Questionnaire (BIPOP), aninstrument specifically designed to measure the impact of POP on BI,to a population of Brazilian women. Secondarily, compare BI betweenwomen with and without POP, and study the correlation between BIscores and sexual function scores among Brazilian women.
Methods:a cross-sectional study in which a Portuguese version of the BIPOPinstrument (BIPOP) was developed and administered to a group of 42women with POP. They also answered the Attractiveness subscale of theBody Attitudes Questionnaire (BAQ) and the Female Sexual FunctionIndex (FSFI). The BAQ subscale was also administered to 40 womenwithout POP. Internal consistency of the translated version of theBIPOP was assessed using Cronbach`s alpha. Test-retestreliability was assessed by re-administering the instrument after onemonth and using intraclass correlation coefficients (ICC). Body imageamong women with and without POP was compared using theattractiveness subscale of the BAQ, through an independent t test.Moreover, the correlation between body image and sexual functionamong women with POP was assessed by studying the correlation betweenBIPOP scores and FSFI scores among sexually active women withPOP.
Results: mean age was 63.9 ± 11.4 and 50.7 ± 10.1among women with and without POP, respectively; 62% (26 women) of thewomen with POP had higher degrees of prolapse (POP-Q 3 and 4), while38% had lesser degrees of prolapse (POP-Q 1 and 2). Internalconsistency of the portuguese-adapted BIPOP instrument wassatisfactory, with a Cronbach’s alpha of 0.90, suggestingthat after translation, the instrument’s items are still stronglycorrelated among each other; total BIPOP scores, Partner andAttractiveness subscales had good reliability after a month, withICCs of 0.89, 0.77 and 0.88, respectively. There was also nosignificant difference when basal and 30-day scores were compared(paired t test). When comparing Attractiveness scores of womenwith and without POP, using the BAQ instrument, there was nosignificant difference between these groups (POP = 15.26 ± 4.37;Non-POP = 14.77 ± 4,26; p = 0.61; independent t test).Among the 42 POP patients included, 22 were sexually active. The meanFSFI score among these patients was 18.97 ± 6.21, suggesting sexualdysfunction. However, correlation between BIPOP scores (body image)and FSFI scores (sexual function) was non-significant in thispopulation, with r = -0.04. We hypothesize that in ourpopulation, the perception of genital deformity did not compromisethe feelings of being attractive and likeable, when women were notspecifically questioned about their genital symptoms. Likewise, wecould not detect a correlation between worsening sexual function andworsening prolapse-specific impacts on body image, and there weremany women with worse prolapse-specific body image scores who hadbetter sexual function scores.
Conclusions: Aftertranslation and adaptation to Brazilian Portuguese, the BIPOPinstrument remains consistent and reliable, and may be used infurther research exploring the impact of POP on female body image. Inthe studied population, however, general attractiveness perceptionwas not affected by POP, as measured by a general attractivenesssubscale (BAQ) that could be employed in both women with and withoutPOP. It seems that in Brazilian population, the presence of POP wasnot a main determinant of sexual function. Limitations of this studyinclude a generally low educational level of the included women,which could have impacted the perception of their own bodies inregards to a lack of basic knowledge of normal anatomy and acceptanceof genital prolapse as normal feature of aging.
References:1 - Am J Obstet Gynecol 2011; 204:441.e1-5; 2 - J Sex Med. 2010;7(12):3957-62.