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Fifty to eighty percent of patients suffering from chronic kidney disease (CKD) experience a form of sexual dysfunction (SD), even after renal transplantation. Despite this, inquiring about SD is often not included in the daily practice of renal care providers.This paper explores the perspectives of renal social workers regarding sexual care for patients and evaluates their practice, attitude towards responsibility and knowledge of SD.A cross-sectional study was conducted using a 41-item online survey.Seventy-nine members of the Dutch Federation of Social Workers Nephrology.It was revealed that 60% of respondents discussed SD with a fifth of their patients. Frequency of discussion was associated with experience (p = 0.049), knowledge (p = 0.001), supplementary education (p = 0.006), and the availability of protocols on sexual care (p = 0.007). Main barriers towards discussing SD consisted of 'culture and religion' (51.9%), 'language and ethnicity' (49.4%), and 'presence of a third person' (45.6%). Sufficient knowledge of SD was present in 28% of respondents. The responsibility for discussion was 96% nephrologists and 81% social workers.This study provides evidence that a part of Dutch nephrology social workers do not provide sexual care regularly, due to insufficient experience and sexual knowledge, absence of privacy and protocols and barriers based on cultural diversity. According to the respondents the responsibility for this aspect of care should be multidisciplinary. Recommendations include a need for further education on the topic, private opportunities to discuss SD and multidisciplinary guidelines on sexual care.

A new multiple electrode probe, the Multiple Array Probe Leiden (MAPLe), has been developed for biofeedback registration of the individual pelvic floor musculature (PFM). The aim was to determine the reliability and differentiation of electromyography (EMG) signals measured with the MAPLe in healthy volunteers.Two hundred twenty nine healthy volunteers not seeking treatment or using medication for symptoms of prolapse, lower urinary tract, bowel, pain, and/or sexual function related to pelvic floor dysfunction were qualified to participate. Subjects were asked to perform five tasks: rest, maximum voluntary contractions, endurance, cough, and valsalva. Mean EMG values per electrode were registered. Test-retest reliability was assessed using linear mixed model with random subject effects. One-way ANOVA tests were performed to detect differences between groups.Magnetic resonance imaging (MRI) showed that each of the electrodes could be related nearest to the individual muscles. For test-retest, the intraclass correlation ranged from 0.53 to 0.91. The MAPLe showed significant differences in average EMG values between men and women, and between nulliparous and parous, pre- and prostmenpausal women. Significant differences were seen between the left and right sides of the pelvic floor. In addition, the activity nearest to the individual pelvic floor muscles (external anal sphincter (EAS), puborectalis muscle, bulbospongiosus, ischiocavernosus and the pubococcygeus muscle) could be determined.The MAPLe is a reliable instrument measuring the EMG signals of the different sides and levels nearest to the pelvic floor musculature and is capable to differentiate between men and women, nulliparous, parous, pre- and postmenopausal. The findings of this study have implications for the diagnosis and treatment of pelvic floor dysfunction in the future.

To evaluate the validity and reliability of the English translation of an interviewer-administered pelvic floor questionnaire, the "Pelvic Floor Inventories Leiden" (PeLFIs) for women, which addresses complaints of prolapse, bladder, and bowel dysfunction, pelvic floor pain and/or sexual dysfunction related to pelvic floor dysfunction.The formal forward-backward translation of the PeLFIs was performed by bilingual Dutch/English translators. The final English version was administered to healthy volunteers (N = 94) and patients (N = 180) in Canada and the United States. Psychometric properties of the English version were examined, including internal consistency, test-retest reliability, content, and construct validity. Internal consistency was measured using Cronbach's alpha. Test-retest reliability was assessed by intraclass correlation coefficients. Construct validity was established by comparing scores in healthy volunteers and patients (using t-tests) and by intercorrelating domains.The forward-backward translation of the English version of the PeLFIs was consistent with the original Dutch questionnaire. In total, 274 questionnaires were administered. The retest was administered 2 weeks after the initial PeLFIs interview. Internal consistency of the questionnaire was 0.88 for the total scale. Cronbach's alpha of the domains ranged from 0.71 to 0.95. For the test-retest reliability, the agreement rate between the two tests exceeded 95% and the intraclass correlation ranged from 0.6 to 0.8. The differences between healthy volunteers and patients were statistically significant for all domains, but did not exceed the minimal important difference for some domains. Correlations between the domains were moderate to high.The PeLFIs questionnaire has been translated successfully into English and in its evaluation has shown adequate internal consistency and reliability.

To determine whether pelvic floor dysfunction (PFD) might be a risk factor for or consequence of febrile urinary tract infection (UTI), as UTI in adults is a common infection in which an underlying urological abnormality is often considered, and as in children, PFD is also thought to have a pathophysiological role in adults with UTI.A multicentre case-control study was conducted at 26 primary-care centres and at six Emergency Departments of regional hospitals. Cases were consecutive patients agedor =18 years, who presented with febrile UTI. Controls were randomly selected subjects who visited their general practitioner for reasons other than UTI or fever. A validated pelvic floor questionnaire (the Pelvic Floor Inventories Leiden, PelFIs) was used to assess pelvic floor function.Between October 2006 and December 2007, 153 cases were included; of these, the completed questionnaires of 102 (response rate 67%) were compared to those of 100 of 110 (response rate 91%) controls. The median age of cases and controls was 65 and 58 years, respectively; 40% of cases and controls were men. The percentage of PelFIs outcomes consistent with PFD were comparable between cases and controls, at 21% vs 23%, respectively (odds ratio 0.9, 95% confidence interval, CI, 0.4-1.78). In the multivariate analysis, comorbidity (odds ratio 4.9, 95% CI 2.2-11.1) and a history of UTI (odds ratio 2.5, 95% CI 1.0-6.1) were independent significant risk factors for febrile UTI, whereas PFD was not (odds ratio 1.0, 0.5-2.2). Within the group of cases, PFD was not associated with bacteriuria during assessment of PelFIs (odds ratio 1.1, 95% CI 0.4-3.5) and inversely related to a history of UTI within the previous year (odds ratio 0.2, 0.1-0.9).PFD is common among adults but it does not seem to be a risk factor for febrile UTI.

Sexual abuse and sexual functioning are topics that health professionals find difficult to discuss. Women who present with pelvic-floor complaints often experience sexual difficulties; therefore, questions regarding sexual function should be a routine part of screening. Furthermore, pelvic-floor complaints are correlated with sexual abuse and asking about abuse should be a routine part of screening as well. Considering the fact that many practitioners have difficulty enquiring about abuse, we have suggested that a questionnaire may be helpful in improving the recognition and management of patients who have a history of sexual abuse.The efficiency of detecting sexual abuse by a self-administered questionnaire.Report of sexual abuse in a self-administered pelvic-floor questionnaire before visiting our outpatient pelvic-floor department was evaluated with the Pelvic Floor Leiden Inventories (PelFIs) administered by a pelvic- floor clinician in a later stage.The percentage of sexual abuse detected by a taken questionnaire administered by a pelvic-floor clinician not confessed during a previous self-administered questionnaire.Sexual abuse was reported in 20 patients with pelvic-floor dysfunction during administration of the PelFIs and were also evaluated on our pelvic-floor department. Only six of the patients (30%) did not note in the self-administered questionnaire that they had a history of sexual abuse.A self-administered questionnaire for pelvic-floor complaints is reliable in detecting sexual abuse and can be helpful in daily practice.