Dyssynergic Defecation and Sexual Issues
Dyssynergic defecation does not directly cause sexual dysfunction, but both conditions frequently coexist as part of broader pelvic floor dysfunction, with sexual problems arising from shared anatomical abnormalities, pelvic floor muscle dysfunction, and pain syndromes rather than from the defecatory disorder itself.
Understanding the Relationship
The connection between dyssynergic defecation and sexual issues is indirect but clinically significant:
Pelvic floor dysfunction encompasses multiple domains including defecatory disorders, urinary incontinence, pelvic organ prolapse, sexual dysfunction, and pelvic pain, with approximately 25-33% of postmenopausal women affected by these overlapping conditions 1.
Sexual dysfunction is recognized as a distinct component of pelvic floor dysfunction alongside voiding and defecation disorders, with these conditions adversely impacting psychological, physical, social, and sexual well-being 2.
The American Society of Clinical Oncology guidelines specifically address sexual problems in the context of pelvic floor dysfunction, recommending pelvic floor physiotherapy for patients with pain or other pelvic floor issues that interfere with sexual function 1.
Shared Anatomical and Functional Mechanisms
The coexistence of these problems stems from common underlying pathology:
Pelvic floor muscle dyssynergia manifests as paradoxical contraction or failure to relax during defecation, but these same muscles are involved in sexual response and can contribute to dyspareunia (painful intercourse) and vaginismus 3, 4.
Structural abnormalities such as rectoceles, enteroceles, and pelvic organ prolapse detected on defecography are present in multiple pelvic compartments simultaneously, affecting both defecatory and sexual function 1.
Pelvic floor descent and muscle weakness contribute to both evacuation disorders and sexual dysfunction, with imaging studies showing these changes affect the entire pelvic floor support system 5, 3.
Clinical Evaluation Approach
When patients present with both defecatory and sexual complaints:
Digital rectal examination can identify increased sphincter tone, pelvic floor dyssynergia, and structural abnormalities that may contribute to both defecatory dysfunction and sexual pain 1.
Anorectal manometry combined with balloon expulsion testing confirms dyssynergic defecation and should be performed when clinical features suggest difficult evacuation 1.
MR defecography or fluoroscopic cystocolpoproctography provides comprehensive assessment of all pelvic compartments, detecting clinically occult abnormalities in approximately one-third of patients that may impact both defecatory and sexual function 1, 6.
Pelvic floor physiotherapy assessment should be offered to evaluate the full spectrum of pelvic floor dysfunction, including sexual complaints, as these conditions require integrated evaluation 1, 2.
Treatment Implications
The therapeutic approach addresses the underlying pelvic floor dysfunction:
Biofeedback therapy is the Grade A recommended treatment for dyssynergic defecation, with 70-80% effectiveness, and also improves pelvic floor muscle coordination that may benefit sexual function 1, 5.
Pelvic floor physiotherapy is specifically recommended for patients with pain or pelvic floor issues that interfere with intimacy, addressing both defecatory and sexual symptoms simultaneously 1, 2.
Combined rehabilitation programs using pelviperineal kinesitherapy and biofeedback have shown significant improvement in pelvic floor function, with normalization of muscle coordination patterns that affect multiple domains 3.
Treatment of one component (such as dyssynergic defecation) may improve overall pelvic floor function and indirectly benefit sexual symptoms, though sexual dysfunction should be addressed directly with appropriate interventions 1, 2.
Important Clinical Caveats
Do not assume causation: Sexual dysfunction in patients with dyssynergic defecation requires independent evaluation and may have multiple contributing factors beyond the defecatory disorder 2.
Screen for all pelvic floor dysfunction components: Patients presenting with one symptom often have clinically occult abnormalities in other compartments that require comprehensive assessment 1.
Consider psychological factors: Depression and quality of life issues are common in pelvic floor dysfunction and contribute to both defecatory and sexual symptoms, requiring integrated management 5.
Avoid overlooking structural causes: Imaging may reveal rectoceles, enteroceles, or prolapse that contribute to both symptom complexes and may require surgical intervention in refractory cases 1, 6.