臺灣博碩士論文加值系統

下泌尿道症候群（Lower Urinary-Tract symptoms）的婦女常會出現性功能障礙情形，進而影響到夫妻的關係及性滿意度（Salonia, Zanni, Nappi, Briganti, Deho, & Fabbri et al 2004; Yip, Chan, Pang, Leung, Tang, & Shek et al, 2003）。本研究旨在探討自述有下泌尿道症候婦女的性生活品質狀況及其相關影響因素。
本研究採橫斷式（Cross-sectional）的相關性研究設計（Correlational design），以方便取樣方式，於北部某醫學中心與80例自述有下泌尿道症候群婦女進行結構式問卷訪談。問卷內容包括：女性性功能量表、尿失禁生活衝擊量表簡式、泌尿困擾量表簡式、相關醫療變項、及個人基本屬性。統計分析方式包括：描述性統計、獨立樣本t檢定、曼－惠特尼U檢定、K-W檢定、皮爾森積差相關、史匹曼等級相關係數、及逐步複迴歸。
研究結果如下：（1）本研究樣本泌尿嚴重度及生活的衝擊屬輕度。身體活動中等至嚴重受限有14.6%，旅遊中等至嚴重受限有13.8%，社交/人際關係中等至嚴重受限有3.8%，情緒中等至嚴重受影響有35.0%。（2）泌尿問題困擾屬輕微。嚴重頻尿有21.3%，急尿有6.3%，應力性尿失禁有7.5%，解不乾淨（阻塞症狀）有12.5%，解尿時下腹部疼痛或不適（子宮陰道脫垂現象）有11.3%。（3）整體性功能平均得分偏低，極可能性活動失調者有68.8%。性慾望、性喚醒-感覺、性喚醒-濕潤、性高潮、及性享樂有一半以上極可能功能失調，而性疼痛失調有23例（29.1%）。（4）有下泌尿道症候群的婦女普遍對性生活不滿意，性生活品質也變差。（5）泌尿症狀嚴重度與伴侶相處的關係及性生活品質有顯著負相關，情緒健康會影響整體性功能與性享樂的表現。有阻塞症狀者在性喚醒－感覺與高潮的表現都比較差，有應力失禁者在整體性功能、性慾望、性喚醒－感覺、及性享樂的表現比較差。（6）整體性功能與伴侶關係無關，與性生活的滿意、性生活品質呈顯著正相關。（7）應力尿失禁、經濟狀況、及情緒健康狀態為影響性生活品質重要因子，能解釋性生活品質的能力共為16.9％。本研究結果能作為臨床醫護實務上照顧有下泌尿道症候群婦女的參考，及護理教育的依據。
關鍵字：下泌尿道症候群、泌尿症狀嚴重度、性功能、性生活品質

Abstract
Female subjects with lower urinary tract symptoms had major impact on their sexual function and influence on the relationships and sexual satisfactions between marital intimacy（Salonia et al., 2004; Yip et al., 2003）. The purpose of this study was to explore the factor associated with the quality of sexual life among female subjects complained of lower urinary tract symptoms.
A cross-sectional, correlational design was used in this study. Eligible female subjects were enrolled from a medicine center in northern Taiwan. Eighty female subjects with complaints of lower urinary tract symptoms were included in this study to receive questionnaires evaluation. The questionnaires included: Female sexual function questionnaire, Incontinence Impact Questionnaire - Short Form, Urogenital Distress Inventory - Short Form, Personal medical history, and demographics. These data were analyzed by using descriptive statistics, two sample t-test, Mann-Whitney t-test, Kruskal-Wallis t-test, Pearson correlation coefficient, Spearman rank-order correlation coefficient, and stepwise multiple regression.
The results of this study were as below: （1）The severity of urinary symptoms and impact on daily life were both mild. But the proportion of moderate to sever impact on physical activity was 14.6%, on travel was 13.8%, on social / interaction relationships was 3.8%, and on emotion was 35.0%. （2）Urogenital distress were mild. Including 21.3% of subjects suffered from frequency, 6.3% with urgency, 7.5% with stress urinary incontinence, 12.5% with incomplete empty (obstruction sign), 11.3% with pain or discomfort voiding (Uterus prolapsed).（3）Total sexual function score were low, with 68.8% of subjects with high probability of sexual activity disorder. More than half of these subjects had desire, arousal-lubrication, arousal-sensation, organism, and enjoyment disorders. A total of 23 subjects（29.1%）had sexual pain. （4）Most of subjects complained of lower urinary tract symptoms were not satisfactory on their sexual function and had poor quality of sexual life. （5）There was a significant negative correlation between severity of urinary symptoms and partner relationships and quality of sexual life. Emotional status had major negative impact on total sexual scores and enjoyment of sexuality. Subjects with obstructive symptom had major negative impact on arousal –sensation and organism functions. Subjects with stress symptoms also had negative impact on total sexual scores, desire, arousal-sensation and enjoyment sexuality. （6）No correlation was noted between total sexual scores and partner relationships. There was a significant positive correlation between total sexual scores with satisfaction of sexual life and quality of sexual life. （7）Stress symptoms, economical status, and emotional status were major predictors on quality of sexual life and explained 16.9% of the variances. The findings in this study could provide a reference in clinical practice in taking care of female patients with lower urinary tract symptoms, and for teaching purpose in nursing education.

Key words: lower urinary tract symptoms, severity of urinary symptoms,
sexual function, quality of sexual life

目錄
頁數
指導教授推薦書……………………………………………………………………..
口試委員審定書………………………………………………………………………
授權書………………………………………………………………………………..iii
致謝…………………………………………………………………………………..iv
中文摘要………………………………………………………………………..……v
英文摘要……………………………………………………………………………...vi
目錄……………………………………………………………………………….…..ix
圖表目錄………………………………………………………………….………….xii
附錄目錄……………………………………………………………………………...xiv
第一章 緒論…………………………………………………………………………..1
第一節研究動機及重要性………………………………………………………1
第二節研究目的…………………………………………………………………3
第三節研究問題………………………………………………………………….3
第四節名詞界定……………………………………………..……….…………..4
第二章 文獻查證………………………………………………………………………6
第一節下泌尿道症候群………………………………………………………….6
第二節性生活品質………………………………………………………………13
第三節女性性功能………….…………………………………….…………….15
第三章 研究架構、假設…………………………………………………………..24
第一節研究架構………………………………………………………………24
第二節研究假設………………………………………………………………..25
第四章 研究方法……………………………………………………………………26
第一節研究設計……………………………………………………………….26
第二節研究對象與場所………………………………………………………26
第三節研究工具……………………………………………………………..27
第四節研究工具信度及效度測定…………………………………………….31
第五節倫理考量……………………………………………………………..37
第六節收集資料階段…………………………………………….………….37
第七節資料統計與分析………………………………………………………39
第五章 結果…………………………………………………………..……………42
第一節 樣本的基本屬性、相關醫療變項、泌尿症狀嚴重度、性生活品質
（性功能、性生活滿意度、性生活重要性）的狀況………………42
第二節 樣本的基本屬性、相關醫療變項與泌尿症狀嚴重度、性生活品質
、性功能、及性活動次量表的相關性………………………………52
第三節 樣本的泌尿症狀嚴重度與性生活品質、性功能、性生活滿意度
的相關性…………………………………………………………..62
第四節 下泌尿道症候婦女之性生活品質的預測……………………………69

第六章 討論……………………………………………………………………..71
第一節 樣本的基本屬性、泌尿症狀嚴重度、性生活品質、性生活滿意度、性功能的得分狀況…………………………………………….…………71
第二節 樣本的基本屬性、相關醫療變項與泌尿症狀嚴重度、性生活品質
、性功能、性活動的相關性…………………………………..…78
第三節 樣本的泌尿症狀嚴重度與性生活品質、性功能的相關性……..82
第四節 影響下泌尿道症候婦女性生活品質的預測因子…………………83
第七章 結論與建議………………………………………………………………85
第一節 結論……………………………………………………….….….85
第二節 護理的應用及建議…………………………………………….…87
第三節 研究限制與建議…………………………………………….……89
參考文獻…………………………………………………………………….…..90
中文部分…………………………………………………………….……..90
英文部分………………………………………………………….………..91
附錄……………………………………………………………………….……..101





圖表目錄
頁數
圖3-1 概念架構………………………………………………………………….……24
表4-1 女性性功能量表每構面得分代表意義……………………………………….28
表4-2 性功能、尿失禁生活衝擊、與泌尿困擾量表前趨測試研究之信度……………34
表4-3 性功能、尿失禁生活衝擊、與泌尿困擾量表正式施測研究之信度…….…..….34
表5-1 下泌尿道症群婦女基本屬性及相關醫療的狀況………………….….….…46
表5-1 下泌尿道症群婦女基本屬性及相關醫療的狀況（續） ………….…….…47
表5-2 泌尿症狀嚴重度與次量表（尿失禁生活衝擊、泌尿問題困擾）得分情形.48
表5-3 尿失禁衝擊量表與泌尿困擾量表每題得分情形…………………………...49
表5-4 下泌尿道症候群婦女性生活品質、性功能總量表及次量表的得分情形.…50
表5-5 性功能量表每題得分與排序情形……………………………………..….…51
表5-5 性功能量表每題得分與排序情形（續）……………………………..…...52
表5-6 下泌尿道症群婦女基本屬性、相關醫療變項與泌尿嚴重度的關係…….…55
表5-7 下泌尿道症群婦女基本屬性、醫療變項與性生活品質的關係…………...56
表5-8 下泌尿道症群婦女基本屬性、相關醫療變項與性功能總量表的關係..….57
表5-9 下泌尿道症候群婦女基本屬性、相關醫療變項與性慾望、性喚醒-感覺的關係..58
表5-10 下泌尿道症候群婦女基本屬性、相關醫療變項與性喚醒-濕潤、性高潮的關係.59
表5-11 下泌尿道症候群婦女基本屬性、相關醫療變項與性疼痛、性享樂的關係…….60
表5-12 基本屬性、相關醫療變項與性功能及次量表（性活動）的關係（摘要）61
表5-13 泌尿症狀嚴重度次量表與性功能總量表、性慾望的關係……………….64
表5-14 泌尿症狀嚴重度次量表與性喚醒-感覺、性喚醒-濕潤的關係…………….65
表5-15 泌尿症狀嚴重度次量表與性高潮、性疼痛的關係 ……………………….66
表5-16 泌尿症狀嚴重度次量表與性享樂、性生活品質的關係…………….…...67
表5-17 泌尿症狀嚴重度及次量表與性功能總量表及次量表（性活動）
的關係（摘要）………………………………………………………….68
表5-18 下泌尿道症候群婦女泌尿症狀嚴重度、性功能及次量表、性生活品質
、伴侶的關係、性生活滿意度的關係（N=80）……………………………….69
表5-19 下泌尿道症候群婦女性生活品質的預測因子…………………………….70











附錄目錄
頁數
附錄一 專家效度名單………………………………………………….……………101
附錄二 尿失禁生活衝擊量表（簡式）…………………………………………….102
附錄三 尿失禁生活衝擊量表（簡式）專家效度分數…………………………….103
附錄四 泌尿困擾量表（簡式）致專家說明書………………………….…………104
附錄五 泌尿問題困擾量表（簡式）專家效度分數……………………………….105
附錄六 性功能問卷致專家說明書……………………………………….………..106
附錄七 性功能量表專家效度分數………………………………………….……..107
附錄八 研究工具使用同意書………………………………………………….……109
附錄九 研究工具使用同意書……………………………………………….…

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Quirk, F. H., Heiman, J. R., Rosen, R. C., Laan, E., Smith, M. D. & Boolell, M.（2002）.Development of a sexual function questionnaire for clinical trials of female sexual dysfunction. Journal of women`s Health & Gender-Based Medicine, 11(3), 277-285.
Quirk, F. H., Haughie, S. & Symonds, T.（2005）. The use of sexual function questionnaire as a screening tool for women with sexual dysfunction. J Sex Med, 2: 469-477.
Rosen R. C., Taylor, J. F., Leiblum, S. R. & Bachmann, G. A.（1993）Pevalence of sexual dysfunction in women: result of a survey study of 329 women in an outpatient gynecology clinical. J Sex Marital Ther,19: 171-188.
Renaud, C., Byers, E. S. & Pan, S.（1997）. Sexual and relationship satisfaction in Mainland China. Journal of sex Research, 34(4), 399-410.
Rosen, R. C. (2000). Prevalence and risk factors of sexual dysfunction in men and women. Curr Psychiatry Rep 2:189-195.
Rogers G. R., Villarreal, A., Dammerer-Doak, D. & Qualls, C. (2001). Sexual function in women with and without urinary incontinence and/or pelvic organ prolapse. Int Urogynecol J. 12:361-365.
Sutherst, J. R.（1979）. Sexual dysfunction and urinary incontinence, Br J Obstet Gynaecol, 86: 387-388.
Sutherst, J. R. & Brown, M.（1980）. Sexual dysfunction associated with urinary incontinence. Urol Int, 35:414-6.
Spector, I. P. & Carey, M. P. (1990). Incidence and prevalence of the sexual dysfunctions: a critieal review. Arch Sex Behav, 19:389-409.
Sarrel, P. M.（1990）. Sexuality and menopause. Obstet Gynecol, 75: 26s-30s.
Sarrel, P. M.（1998）. Overian hormones and vaginal blood flow:using laser Doppler velocimetry to measure effects in a clinical trial of post-menopausal women. Int J lmpot Res 10: S91-S93.
Shaw, C.（2002）. A systematic review of the literature on the prevalence of sexual impairment in women with urinary incontinence and the prevalence of urinary leakage during sexual activity. European Urology, 42: 432-440.
Salonia, A., Zanni, G., Nappi, R. E., Briganti, A., Deho`, F., Fabbri, F., Colombo, R., Guazzoni, G., & Giolamao, V. D.（2004）. Sexual dysfunction is common in women with lower urinary tract symptom and urinary incontinence: result of a cross-sectional study. European Urology, 45(2004), 642-648.
Schober, J. M.（2004）. Sexual quality of life in an intersexual population: a needs assessment. BJU International 93(suppl 3) 54-56.
Saleh, N., Bener, A., Khenyab, N., Al-Mansori, Z. & Muraikhi, A.（2005）. Prevalence, awareness and determinants of health care-seeking behaviour for urinary incontinence in Qatari women: a neglected problem. Maturitas, 50(1), 58-65.
Sekine, M., Chandola, T., Martikaimen, P., Marmot, M., & Kagamimori, ak.（2006）. Socioeconomic inequalities in physical and mental functioning of Japanese civil servants: Explanatons from work and family characteristics. Social Aciense & Medicine, 63, 430-445.
Temml, C., Haidinger, G., Schmidbauer, J., Schatzi, G. & Madersbacher, S.（2000）. Urinary incontinence in both sexes: prevaleuce rates and impact ou.quality of life and sexual life. Meurourol Urodyn, 9:259-71.
Uebersax, J. S., Wyman, J. F., Shumaker, S. A., McClish, D. K. & Fantl, J. A. （1995）. Short form to assess life quality and symptom distress for urinary incontinence in woman: the incontinence impact questionnaire and the urogenital distress inventory. Neurourology and Urodynamics, 14: 131-139.
Valerius, A. J.（1997）. The psychosocial impact of urinary incontinence on women aged 25-24 years. Urol Murs, 17(3):96-103.
Vierhout, M. E. & Gianotten, W. L.（1993）. Mechanisms of urine loss during sexual activity. Eur J Obstet Gynecol Reprod Biol, 52: 45-47.
Walters, M. D., Taylor, S. & Schoenfeld, L. S.（1990）. Psychosexual study of womenwith detrusor instability. Obstet Gynecol, 75:22-26.
World Health Organization（1992）. The ICD-10 classification of mental and behavioral disorders. Geneva: World Health Organization.
Wang, P. D., & Lin, R. S.（1994）. Sexual activity of women in Taiwan. Social Biology, 41(3-4), 143-149.
Weiner, D. N., & Rosen, R. C.（1997）. Medications and their impact, in Colilla J（ED）: Sexual function in Pepole with Disability and Chronic Illness: A Health Professionals Guide, 85-115. Gaithersburg, Maryland, Aspen Publications.
Yip, S. K., Chan, A., Pang, S., Leung, P., Tang, C., Shek, D. & Chung, T.（2003）. The impact of urodynamic stress incontinence and detrusor overactivity on marital relationships and sexual function. American Journal of Obstetrics and Gynecology, 188(5), 1244-1248.
Yukio, H., Osamu, Y. & Kunihiko, H.（2005）. An epidemiological suvey of overactive bladder symptoms in Japan. BJU International, 96(9), 1314-1418.

Zippe, C. D., Raina, R., Shah, A. D., Massanyi, E. Z., Agarwal, A., Ulchaker, J., Jones, S. & Klein, E.（2004）. Female sexual dysfunction after radical cystectomy: a new outcome measure. Urology, 63(6), 1153-1157.
Zhang, W., Song, Y., He, X., Xu, B., Huang, H., He, C., Hao, L., & Li, Y., （2005）. Prevalance and risk factors of lower urinary tract symptoms in Fuzhou Chinese women. European Urology 48: 309-313.










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Sutherst, J. R. & Brown, M.（1980）. Sexual dysfunction associated with urinary incontinence. Urol Int, 35:414-6.
Spector, I. P. & Carey, M. P. (1990). Incidence and prevalence of the sexual dysfunctions: a critieal review. Arch Sex Behav, 19:389-409.
Sarrel, P. M.（1990）. Sexuality and menopause. Obstet Gynecol, 75: 26s-30s.
Sarrel, P. M.（1998）. Overian hormones and vaginal blood flow:using laser Doppler velocimetry to measure effects in a clinical trial of post-menopausal women. Int J lmpot Res 10: S91-S93.
Shaw, C.（2002）. A systematic review of the literature on the prevalence of sexual impairment in women with urinary incontinence and the prevalence of urinary leakage during sexual activity. European Urology, 42: 432-440.
Salonia, A., Zanni, G., Nappi, R. E., Briganti, A., Deho`, F., Fabbri, F., Colombo, R., Guazzoni, G., & Giolamao, V. D.（2004）. Sexual dysfunction is common in women with lower urinary tract symptom and urinary incontinence: result of a cross-sectional study. European Urology, 45(2004), 642-648.
Schober, J. M.（2004）. Sexual quality of life in an intersexual population: a needs assessment. BJU International 93(suppl 3) 54-56.
Saleh, N., Bener, A., Khenyab, N., Al-Mansori, Z. & Muraikhi, A.（2005）. Prevalence, awareness and determinants of health care-seeking behaviour for urinary incontinence in Qatari women: a neglected problem. Maturitas, 50(1), 58-65.
Sekine, M., Chandola, T., Martikaimen, P., Marmot, M., & Kagamimori, ak.（2006）. Socioeconomic inequalities in physical and mental functioning of Japanese civil servants: Explanatons from work and family characteristics. Social Aciense & Medicine, 63, 430-445.
Temml, C., Haidinger, G., Schmidbauer, J., Schatzi, G. & Madersbacher, S.（2000）. Urinary incontinence in both sexes: prevaleuce rates and impact ou.quality of life and sexual life. Meurourol Urodyn, 9:259-71.
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Valerius, A. J.（1997）. The psychosocial impact of urinary incontinence on women aged 25-24 years. Urol Murs, 17(3):96-103.
Vierhout, M. E. & Gianotten, W. L.（1993）. Mechanisms of urine loss during sexual activity. Eur J Obstet Gynecol Reprod Biol, 52: 45-47.
Walters, M. D., Taylor, S. & Schoenfeld, L. S.（1990）. Psychosexual study of womenwith detrusor instability. Obstet Gynecol, 75:22-26.
World Health Organization（1992）. The ICD-10 classification of mental and behavioral disorders. Geneva: World Health Organization.
Wang, P. D., & Lin, R. S.（1994）. Sexual activity of women in Taiwan. Social Biology, 41(3-4), 143-149.
Weiner, D. N., & Rosen, R. C.（1997）. Medications and their impact, in Colilla J（ED）: Sexual function in Pepole with Disability and Chronic Illness: A Health Professionals Guide, 85-115. Gaithersburg, Maryland, Aspen Publications.
Yip, S. K., Chan, A., Pang, S., Leung, P., Tang, C., Shek, D. & Chung, T.（2003）. The impact of urodynamic stress incontinence and detrusor overactivity on marital relationships and sexual function. American Journal of Obstetrics and Gynecology, 188(5), 1244-1248.
Yukio, H., Osamu, Y. & Kunihiko, H.（2005）. An epidemiological suvey of overactive bladder symptoms in Japan. BJU International, 96(9), 1314-1418.

Zippe, C. D., Raina, R., Shah, A. D., Massanyi, E. Z., Agarwal, A., Ulchaker, J., Jones, S. & Klein, E.（2004）. Female sexual dysfunction after radical cystectomy: a new outcome measure. Urology, 63(6), 1153-1157.
Zhang, W., Song, Y., He, X., Xu, B., Huang, H., He, C., Hao, L., & Li, Y., （2005）. Prevalance and risk factors of lower urinary tract symptoms in Fuzhou Chinese women. European Urology 48: 309-313.