Long-term psychosexual adjustment of adults born with classic bladder exstrophy

Irene Paraboschi; Gianluca Sampogna; Massimo Di Grazia; Waifro Rigamonti; Alfredo Berrettini

doi:10.1016/j.jpurol.2024.04.010

Long-term psychosexual adjustment of adults born with classic bladder exstrophy

J Pediatr Urol. 2024 Apr 22:S1477-5131(24)00203-1. doi: 10.1016/j.jpurol.2024.04.010. Online ahead of print.

Authors

Irene Paraboschi¹, Gianluca Sampogna², Massimo Di Grazia³, Waifro Rigamonti⁴, Alfredo Berrettini⁵

Affiliations

¹ Department of Pediatric Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy. Electronic address: irene.paraboschi@hotmail.com.
² Spinal Unit, Niguarda Hospital, Milano, Italy.
³ AUSL Romagna, Infermi Hospital, Rimini, Italy.
⁴ Urology Clinic-Pediatric Urology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy.
⁵ Department of Pediatric Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy.

PMID: 38710600
DOI: 10.1016/j.jpurol.2024.04.010

Abstract

Background: In literature studies exploring long-term psychosexual development and intimacy of adults living with the complex genitourinary conditions associated with classic bladder exstrophy (BE) are scarce, with small sample sizes and lacking in methodology.

Objective: This study aims to examine areas of potential psychosexual distress in adults born with classic BE to develop targeted clinical interventions.

Study design: The validated Sexrelation Evaluation Schedule Assessment Monitoring (SESAMO) questionnaire was administered to all BE patients aged ≥18 years operated on in our tertiary referral center during infancy. Z-scores were calculated for each area of interest, considering i) gender (female vs male); ii) committed partnership status (singles vs couples); iii) the voiding technique adopted to empty the bladder.

Results: A total of 33 (F:M 12:21; singles: couples 11:22) adults with BE were enrolled in the study at a median age of 39 (32-47) years. Overall, BE adults performed the worst regarding psychosexual identity (z-score:-1.282), pleasure (z-score:-0.915) and desire (z-score:-0.583); singles regarding relational attitude (z-score:-1.751) and imaginative eroticism (z-score:-0.806); couples regarding extramarital sexuality (z-score:-1.175) and sexual communication (z-score:-0.255). When it came to gender, females significantly performed worse than males regarding psychosexual identity (-1.645 vs -1.282; p-value:<0.0001) and areas of pleasure (-1.126 vs -0.359; p-value:<0.001). Single females performed worse than males regarding actual masturbation (-0.763 vs 0.583; p-value:<0.05) and better regarding relational attitude (-1.226 vs -1.751; p-value:<0.05). Females in stable relationships performed worse than males regarding actual masturbation (-1.645 vs 0.306; p-value:<0.05) and better regarding sexual intercourse (1.866 vs -0.565; p-value:<0.01). The voiding techniques used to empty the bladder did not show any influence on these results.

Conclusion: Adults with BE have a greater likelihood of experiencing a wide range of psychosexual difficulties. Identifying the specific areas of psychological distress can help them cope with their medical experience and actual clinical condition and clinicians plan adequate psychological interventions.

Keywords: Bladder exstrophy; Psychological well-being; Psychosexual adjustment.