Sexual Activity and Satisfaction in Women with Spinal Cord Disease: Influence of Urinary Incontinence and Other Predictors

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Objectives: Evaluate sexual activity and satisfaction in women with spinal cord disease (SCD) and their associations with urinary incontinence. Setting: Outpatient neuro-urology clinics at a tertiary rehabilitation center in Brazil. Methods: Ninety-eight women aged ≥18 years with traumatic or non-traumatic SCD were included. Clinical and demographic data were collected through structured interviews. Bladder symptoms were assessed with the Neurogenic Bladder Symptom Score–Short Form (NBSS-SF). Sexual function was evaluated with the Female Sexual Function Index (FSFI), and sexual satisfaction with the WHOQOL-BREF. Sexual activity was defined as intercourse within six months. Logistic regression identified predictors of sexual activity and satisfaction. Results: Mean age was 43.0 ± 12.1 years; most cases were non-traumatic (85.7%), mainly multiple sclerosis (55.9%). Urinary incontinence was reported by 52.0%, severe in 28.6%. Sexual activity was reported by 48 women (49.0%), of whom 58.3% had FSFI-defined dysfunction and 60.4% reported satisfaction. Incontinence was strongly associated with inactivity (72.5% vs. 27.5%, p < 0.001) and lower FSFI scores (16.2 ± 10.3 vs. 24.4 ± 9.1, p < 0.001). On multivariate analysis, urinary continence (OR 5.0, 95% CI 1.7–14.4), younger age (OR 0.93/year, 95% CI 0.89–0.98), and being married (OR 10.9, 95% CI 3.6–33.3) predicted sexual activity and satisfaction. Conclusions: Urinary incontinence is an independent barrier to sexual health in women with SCD. Targeted continence management may improve quality of life. Sponsorship: No external funding. Health sciences/Signs and symptoms/Urological manifestations Health sciences/Health care/Quality of life Figures Figure 1 Figure 2 Introduction Spinal cord disorders (SCD), including both traumatic spinal cord injury (SCI) and non-traumatic etiologies such as multiple sclerosis, transverse myelitis, and myelomeningocele, affect multiple domains of quality of life. In women, these conditions often disrupt sexual health through a combination of neurophysiological, psychological, and relational mechanisms ( 1 – 3 ). Sexual dysfunction in women with SCD may present as reduced desire, impaired arousal, diminished vaginal lubrication, difficulty achieving orgasm, and overall dissatisfaction with sexual life ( 4 , 5 ), often coexisting with impaired mobility, sensory deficits, fatigue, altered body image, and mood disorders ( 6 , 7 ). Lower urinary tract dysfunction (LUTD), particularly urinary incontinence (UI), is one of the most distressing commorbidities in this context. UI may lead to embarrassment, avoidance of intimacy, and diminished self-esteem ( 8 – 10 ), while bladder management strategies such as intermittent catheterization or use of absorbent products can further affect confidence and quality compromise sexual well-being ( 11 , 12 ). Despite its frequency, the impact of LUTD on sexual health in women with SCD remains underexplored ( 8 , 13 ). A clearer understanding of how urinary symptoms intersects with sexual activity and satisfaction in women with SCD help designing targeted rehabilitation strategies. Recognizing potential modifiable contributors, such as UI, may offer practical opportunities to improve quality of life in this vulnerable population ( 9 , 13 , 14 ). The objective of this study is to evaluate sexual activity and satisfaction in women with SCD and to investigate their associations with urinary incontinence and bladder management strategies. Methods This cross-sectional study evaluated the sexual function and related factors in women with spinal cord diseases (SCD) of both traumatic (T) and non-traumatic (NT) etiologies at a tertiary rehabilitation center. The primary objective was to assess how urinary incontinence and bladder management impact sexual life in women living with SCD. Eligible participants were identified during routine medical visits to the urology and rehabilitation outpatient clinics of the participating tertiary center. The study was approved by the Institutional Ethics Board (IRB Approval Nº 86965218.3.0000.0068), and informed consent was obtained from all participants. The study enrolled women aged 18 years or older with SCD for at least one year and sufficient cognitive ability to understand and consent were eligible for the study. Exclusion criteria included language barriers and cognitive impairment. that prevented comprehension of study materials. We investigated factors associated with sexual activity, satisfaction with sexual life, and the interplay between sexual outcomes, bladder management, and incontinence severity. Clinical and sociodemographic data (age, marital status, education, and occupation) data were obtained through in-person interviews conducted by trained investigators using a structured evaluation designed specifically for this study. Clinical variables related to SCD included its etiology, duration, and severity of neurological impairment. Due to the heterogeneous etiologies, we did not apply a single standardized neurological scale. Instead, we used ambulatory status as a pragmatic and clinically relevant proxy for neurological impairment. The Neurogenic Bladder Symptom Score – Short Form (NBSS-SF), a validated tool for neurological lower urinary tract dysfunction, was employed to assess bladder management and incontinence. The NBSS-SF scores range from 0 (best) to 28 (worst) and include subdomains such as incontinence, storage, voiding, and consequences. Satisfaction with bladder condition was defined as a response of “pleased” or “mostly satisfied” to the overall bladder-related quality of life question. Women reporting urine leakage a few times per week, or more were classified as incontinent, while severe incontinence was defined as daily leakage requiring ≥3 pads/day (15). Sexual function was assessed using the Female Sexual Function Index (FSFI), a validated tool evaluating six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain/discomfort. A total FSFI score of ≤26.55 was used to define sexual dysfunction. Women who reported no sexual activity in the past six months were classified as sexually inactive, and their FSFI scores, except for the "desire" domain, were excluded (16–18) Satisfaction with sexual life was assessed using Question 21 of the WHOQOL-BREF, which specifically addresses this domain on a Likert scale ranging from “very dissatisfied” to “very satisfied.” For the purposes of this study, responses of “satisfied” or “very satisfied” were considered indicative of sexual satisfaction. Although the full WHOQOL-BREF was administered, only data from Question 21 were analyzed in this manuscript (19). Univariate analyses were conducted to identify predictors of sexual activity and satisfaction. Variables with p < 0.10 were entered into multivariable logistic regression models to determine independent predictors. Associations between categorical variables were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Continuous variables were summarized as mean ± standard deviation or median (interquartile range), and compared using Student’s t-test or Mann–Whitney test, as appropriate. Categorical variables were analyzed with the chi-square test, and ANOVA with Bonferroni correction was applied for comparisons across more than two groups. Correlations were evaluated using Spearman’s coefficient. Statistical significance was set at p < 0.05. Analyses were performed using GraphPad Prism, version 5.0.3 (GraphPad Software, San Diego, CA, USA). Results A total of 98 women with spinal cord disease (SCD) were evaluated. Mean age was 43.0 (12.1) years (19–69 years). The etiology of SCD was traumatic in 14 women (14.3%) and non-traumatic in 84 (85.7%), with multiple sclerosis as the most common cause, affecting 47 (55.9%) women. Regarding neurological impairment, 38 (38.8%) walked independently, 26 (26.5%) with an assistive device or orthosis and 21 (21.4%) were wheelchair users. Additional sociodemographic and clinical characteristics are summarized in Table 1. Most participants (65 women, 66.3%) voided spontaneously, 25 (25.5%) performed clean intermittent catheterization (CIC), and 8 (8.2%) used an indwelling catheter (urethral or suprapubic). The mean NBSS-SF score was 11.0 (6.9). Urinary incontinence was reported by 51 (52.0%) women, with severe incontinence in 28 (28.6%) of them. Satisfaction with bladder condition was reported by only 34 (34.7%) women. Sexual activity within the past six months was reported by 48 (49.0%) participants. The mean FSFI score was 22.0 (10.1), with 28 sexually active women (58.3%) scoring ≤26.55, indicating sexual dysfunction. Among these 48 sexually active women, 29 (60.4%) were satisfied with their sexual life. Notably, 8 sexually inactive women (16.0%) also reported satisfaction, highlighting the multifactorial nature of sexual well-being. Sexually active women had lower NBSS-SF scores (mean difference −5.3, 95% CI −8.0 to −2.6, p < 0.001). Among those with urinary incontinence, 37 (72.5%) were sexually inactive. Incontinent participants had lower FSFI scores than continent women (16.2 (10.3) vs. 24.4 (9.1); p < 0.001) Univariate analysis identified younger age, marital status, premenopausal status, not being a wheelchair user, urinary continence, and not performing CIC as factors associated with sexual activity (Table 2). Being married significantly increased the likelihood of sexual activity (OR 12.8, 95% CI, 4.8 to 33.9; p < 0.001), while urinary incontinence was strongly associated with reduced likelihood of sexual activity (OR 0.12, 95% CI, 0.0 to 0.3; p < 0.001). On multivariate analysis, urinary continence (OR 5.0, 95% CI, 1.7 to 14.4; p = 0.012), younger age (OR 0.93, 95% CI, 0.89 to 0.98; p = 0.002), and marital status (OR 10.9, 95% CI, 3.6 to 33.3; p < 0.001) were significant predictors of sexual activity. Similarly, satisfaction with sexual life was associated with being married (OR 13.8, 95% CI, 4.2 to 45.4; p < 0.001), urinary continence (OR 6.0, 95% CI, 2.0 to 18.2; p < 0.001), and younger age (OR 0.93, 95% CI, 0.9 to 1.0; p = 0.009); see Table 3 and Figures 1 and 2. Discussion This study reveals a substantial burden of sexual dysfunction and urinary incontinence among women with spinal cord disease (SCD) ( 1 , 3 , 5 ). Sexual dysfunction is both common and multidimensional in this population, with nearly 60% of sexually active women scoring in the dysfunctional range on the FSFI ( 20 ). Over half of participants reported urinary incontinence, which was strongly associated with reduced sexual activity and satisfaction. Younger age, marital status, and urinary continence were independent predictors of both sexual activity and sexual satisfaction, demonstrating the combined influence of physical, relational, and psychological factors on sexual health after SCD ( 9 , 21 , 22 ). These results are consistent with prior research. Elmelund et al. reported urinary incontinence in 49% of women with neurological disease, closely matching our finding of 52% with nearly one-third experiencing severe symptoms ( 8 ). Mahler et al. described pervasive concerns about urine leakage during intimacy in women performing intermittent catheterization, a concern mirrored in our cohort, where urinary incontinence independently predicted sexual inactivity and lower FSFI scores ( 23 ). The association between clean intermittent catheterization and reduced sexual activity further illustrates the impact of bladder dysfunction on sexual well-being ( 11 , 12 , 14 ). Despite the central role of sexual health in quality of life, sexuality and intimacy are frequently overlooked in SCD care. Studies indicate that healthcare providers often avoid discussions of sexual function due to discomfort, limited training, or the perception that sexuality is peripheral to neurological rehabilitation ( 2 , 5 , 24 ). Our findings confirm the importance of addressing sexual health systematically as part of routine clinical care. Urinary incontinence introduces substantial psychological and relational barriers. Embarrassment, diminished self-confidence, and fear of leakage can impact sexual spontaneity and contribute to the avoidance of intimacy ( 8 , 12 ). Although behavioral, pharmacologic, and surgical treatments for urinary incontinence are available, these issues remain under-addressed among women with neurological disease ( 14 , 25 ). Our findings reinforce the importance of routine screening and targeted interventions for urinary incontinence to optimize sexual and emotional health. Importantly, urinary continence, marital status, and younger age were associated not only with increased sexual activity, but also with greater sexual satisfaction. These associations reflect the importance of functional and relational factors in shaping both behavioral and subjective aspects of sexual well-being ( 9 , 21 , 22 ). Notably, some sexually inactive women reported satisfaction with their sexual life, suggesting the sexual well-being may be supported by emotional intimacy, non-coital sexual expression, or adaptive perspectives ( 6 , 22 ). Several limitations of this study should be considered. First, the cross-sectional design precludes causal inference. Second, important confounders - including mood disorders, body image concerns, partner availability, and history of sexual trauma - were also not assessed and may have influenced results. Third, the use of mobility status as a surrogate for neurological impairment, while practical, does not fully capture the range of neurological deficits, potentially oversimplifying associations with sexual function. Lastly, we did not evaluate fecal incontinence, which is common in this population and may further impact on sexual health. While we observed strong associations between urinary incontinence and adverse sexual outcomes, further interventional studies are needed to investigate whether continence treatment improves sexual health in women with SCD. Nevertheless, evidence from women with non-neurogenic urinary incontinence suggests that treatment improves sexual function and satisfaction, supporting similar approaches for neurogenic cases ( 26 – 28 ). Also, the NBSS-SF does not assess incontinence specifically during sexual activity - a domain that may be particularly relevant. Future research may benefit from incorporating complementary tools or qualitative assessments. Finally, the FSFI may underestimate the burden of dysfunction among sexually inactive women, as it does not fully capture satisfaction or distress outside the context of partnered sexual activity. Sexual health is central to emotional well-being and quality of life for women with SCD, yet sexual dysfunction remains common and under-recognized in this group. Our findings indicate that urinary incontinence is a substantial independent barrier to sexual activity and satisfaction. These results highlight the importance of recognizing and assessing urinary symptoms and sexual health in rehabilitation programs, supporting existing recommendations for comprehensive clinical assessment in this population. Declarations AI Disclosure Statement During the preparation of this work, the authors used OpenAI’s ChatGPT (GPT-5) to assist with language editing, grammar refinement, formatting, and figure generation. The authors reviewed and edited the content and take full responsibility for the publication. Ethical Approval IRB Approval Nº 86965218.3.0000.0068 This study was approved by the Institutional Review Board (IRB Approval Nº 86965218.3.0000.0068). Written informed consent was obtained from all participants. Competing Interests The authors declare no competing interests. Funding This study was conducted without specific financial support. Conflicts of Interest The authors declare no conflicts of interest related to this work. Author Contributions RMC: Study conception and design, data collection, manuscript drafting. Acknowledgments The authors thank the staff and Urology Residents of the neuro-urology clinics at Hospital das Clínicas, Universidade de São Paulo, for their support during patient recruitment and data collection. Data Availability Statement The datasets generated and/or analyzed during the current study are included within the published article. 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Predictors of improvement in sexual function of women with urinary incontinence after treatment with pelvic floor exercises: a secondary analysis. J Sex Med. 2015;12(3):746–55. Tables Table 1 to 3 are available in the Supplementary Files section. Additional Declarations There is no duality of interest Supplementary Files CoXXpiadeTable1XXXSociodemographic1.xlsx Table 1 CoXXpiadeTable2Factorsassociatedwithsexualactivity.xlsx Table 2 CoXXpiadeTable3Independentpredictors.xlsx Table 3 Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: revise 13 Oct, 2025 Review # 1 received at journal 08 Oct, 2025 Review # 2 received at journal 04 Oct, 2025 Reviewer # 2 agreed at journal 02 Oct, 2025 Reviewer # 1 agreed at journal 30 Sep, 2025 Reviewers invited by journal 29 Sep, 2025 Editor assigned by journal 16 Sep, 2025 Submission checks completed at journal 09 Sep, 2025 First submitted to journal 05 Sep, 2025 Unknown event 04 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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14:28:39","extension":"png","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":43102,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineCoXXpiadeFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7530704/v1/1cc11d424e6dcc47c2af9492.png"},{"id":93340928,"identity":"f5f176bc-0a3d-4225-9d4f-5dbbaf3aea5b","added_by":"auto","created_at":"2025-10-12 14:36:39","extension":"xml","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":76782,"visible":true,"origin":"","legend":"","description":"","filename":"SC202503650structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7530704/v1/8b74274ee0b19fabf41e4c47.xml"},{"id":93340086,"identity":"e3da8972-81d3-404b-8ffe-f2016118b622","added_by":"auto","created_at":"2025-10-12 14:28:40","extension":"html","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85415,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7530704/v1/93fba7415d1bd3abbfff3dcb.html"},{"id":93340068,"identity":"49c1f85a-776a-4ceb-852e-c846fcc8db11","added_by":"auto","created_at":"2025-10-12 14:28:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":88297,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot showing adjusted odds ratios and 95% confidence intervals for the three multivariate predictors of sexual activity and sexual satisfaction, all of which were statistically significant (p \u0026lt; 0.05). Although the annual effect of age appears modest, it compounds over time to substantially lower the probability of sexual activity and satisfaction (see Figure 2 for age-related trends).\u003c/p\u003e","description":"","filename":"CoXXpiadeFigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7530704/v1/f198803fc1900168a2c9171b.png"},{"id":93340925,"identity":"cca255fc-2f70-4850-9b19-ed992e701ea5","added_by":"auto","created_at":"2025-10-12 14:36:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":168145,"visible":true,"origin":"","legend":"\u003cp\u003eProbability of Sexual Activity and Sexual Satisfaction by Age in Women with Spinal Cord Disease: Predicted probability of sexual activity (solid line) and sexual satisfaction (dashed line) according to age, based on logistic regression models in women with spinal cord disease. The figure demonstrates a progressive decline in the likelihood of both outcomes as age increases, illustrating the cumulative impact of aging on sexual health in this population. Shaded areas indicate 95% confidence intervals.\u003c/p\u003e","description":"","filename":"CoXXpiadeFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7530704/v1/c50ae2bc3b22d458e0429985.png"},{"id":93340951,"identity":"2f93e2be-854d-4445-8fba-2ed87f7d7b3b","added_by":"auto","created_at":"2025-10-12 14:36:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":603594,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7530704/v1/b5ec7882-8e75-4769-8fe9-37a18e94535b.pdf"},{"id":93340066,"identity":"9ce83f74-9b60-4390-9361-96d496b23662","added_by":"auto","created_at":"2025-10-12 14:28:39","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":5527,"visible":true,"origin":"","legend":"\u003cp\u003eTable 1\u003c/p\u003e","description":"","filename":"CoXXpiadeTable1XXXSociodemographic1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7530704/v1/eb7f0b662cfbde30ed8452bf.xlsx"},{"id":93340070,"identity":"4e08f7b5-bcc2-4182-bf03-d2ece8be4696","added_by":"auto","created_at":"2025-10-12 14:28:39","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":5294,"visible":true,"origin":"","legend":"Table 2","description":"","filename":"CoXXpiadeTable2Factorsassociatedwithsexualactivity.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7530704/v1/9af4bab4ba48c3ff0f720c0d.xlsx"},{"id":93340075,"identity":"dea53661-7d54-4eb7-8364-cf1789f79d06","added_by":"auto","created_at":"2025-10-12 14:28:39","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":5138,"visible":true,"origin":"","legend":"\u003cp\u003eTable 3\u003c/p\u003e","description":"","filename":"CoXXpiadeTable3Independentpredictors.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7530704/v1/ee6b5785cc1076d8da7cf774.xlsx"}],"financialInterests":"There is no duality of interest","formattedTitle":"Sexual Activity and Satisfaction in Women with Spinal Cord Disease: Influence of Urinary Incontinence and Other Predictors","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSpinal cord disorders (SCD), including both traumatic spinal cord injury (SCI) and non-traumatic etiologies such as multiple sclerosis, transverse myelitis, and myelomeningocele, affect multiple domains of quality of life. In women, these conditions often disrupt sexual health through a combination of neurophysiological, psychological, and relational mechanisms (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e–\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Sexual dysfunction in women with SCD may present as reduced desire, impaired arousal, diminished vaginal lubrication, difficulty achieving orgasm, and overall dissatisfaction with sexual life (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), often coexisting with impaired mobility, sensory deficits, fatigue, altered body image, and mood disorders (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eLower urinary tract dysfunction (LUTD), particularly urinary incontinence (UI), is one of the most distressing commorbidities in this context. UI may lead to embarrassment, avoidance of intimacy, and diminished self-esteem (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e–\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), while bladder management strategies such as intermittent catheterization or use of absorbent products can further affect confidence and quality compromise sexual well-being (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Despite its frequency, the impact of LUTD on sexual health in women with SCD remains underexplored (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA clearer understanding of how urinary symptoms intersects with sexual activity and satisfaction in women with SCD help designing targeted rehabilitation strategies. Recognizing potential modifiable contributors, such as UI, may offer practical opportunities to improve quality of life in this vulnerable population (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe objective of this study is to evaluate sexual activity and satisfaction in women with SCD and to investigate their associations with urinary incontinence and bladder management strategies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis cross-sectional study evaluated the sexual function and related factors in women with spinal cord diseases (SCD) of both traumatic (T) and non-traumatic (NT) etiologies at a tertiary rehabilitation center. The primary objective was to assess how urinary incontinence and bladder management impact sexual life in women living with SCD. Eligible participants were identified during routine medical visits to the urology and rehabilitation outpatient clinics of the participating tertiary center. The study was approved by the Institutional Ethics Board (IRB Approval N\u0026ordm; 86965218.3.0000.0068), and informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003eThe study enrolled women aged 18 years or older with SCD for at least one year and sufficient cognitive ability to understand and consent were eligible for the study. Exclusion criteria included language barriers and cognitive impairment. that prevented comprehension of study materials. We investigated factors associated with sexual activity, satisfaction with sexual life, and the interplay between sexual outcomes, bladder management, and incontinence severity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClinical and sociodemographic data (age, marital status, education, and occupation) data were obtained through in-person interviews conducted by trained investigators using a structured evaluation designed specifically for this study. Clinical variables related to SCD included its etiology, duration, and severity of neurological impairment. Due to the heterogeneous etiologies, we did not apply a single standardized neurological scale. Instead, we used ambulatory status as a pragmatic and clinically relevant proxy for neurological impairment.\u003c/p\u003e\n\u003cp\u003eThe Neurogenic Bladder Symptom Score \u0026ndash; Short Form (NBSS-SF), a validated tool for neurological lower urinary tract dysfunction, was employed to assess bladder management and incontinence. The NBSS-SF scores range from 0 (best) to 28 (worst) and include subdomains such as incontinence, storage, voiding, and consequences. Satisfaction with bladder condition was defined as a response of \u0026ldquo;pleased\u0026rdquo; or \u0026ldquo;mostly satisfied\u0026rdquo; to the overall bladder-related quality of life question. Women reporting urine leakage a few times per week, or more were classified as incontinent, while severe incontinence was defined as daily leakage requiring \u0026ge;3 pads/day (15).\u003c/p\u003e\n\u003cp\u003eSexual function was assessed using the Female Sexual Function Index (FSFI), a validated tool evaluating six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain/discomfort. A total FSFI score of \u0026le;26.55 was used to define sexual dysfunction. Women who reported no sexual activity in the past six months were classified as sexually inactive, and their FSFI scores, except for the \u0026quot;desire\u0026quot; domain, were excluded (16\u0026ndash;18)\u003c/p\u003e\n\u003cp\u003eSatisfaction with sexual life was assessed using Question 21 of the WHOQOL-BREF, which specifically addresses this domain on a Likert scale ranging from \u0026ldquo;very dissatisfied\u0026rdquo; to \u0026ldquo;very satisfied.\u0026rdquo; For the purposes of this study, responses of \u0026ldquo;satisfied\u0026rdquo; or \u0026ldquo;very satisfied\u0026rdquo; were considered indicative of sexual satisfaction. Although the full WHOQOL-BREF was administered, only data from Question 21 were analyzed in this manuscript (19).\u003c/p\u003e\n\u003cp\u003eUnivariate analyses were conducted to identify predictors of sexual activity and satisfaction. Variables with p \u0026lt; 0.10 were entered into multivariable logistic regression models to determine independent predictors. Associations between categorical variables were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Continuous variables were summarized as mean \u0026plusmn; standard deviation or median (interquartile range), and compared using Student\u0026rsquo;s t-test or Mann\u0026ndash;Whitney test, as appropriate. Categorical variables were analyzed with the chi-square test, and ANOVA with Bonferroni correction was applied for comparisons across more than two groups. Correlations were evaluated using Spearman\u0026rsquo;s coefficient. Statistical significance was set at p \u0026lt; 0.05. Analyses were performed using GraphPad Prism, version 5.0.3 (GraphPad Software, San Diego, CA, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 98 women with spinal cord disease (SCD) were evaluated. Mean age was 43.0 (12.1) years (19\u0026ndash;69 years). The etiology of SCD was traumatic in 14 women (14.3%) and non-traumatic in 84 (85.7%), with multiple sclerosis as the most common cause, affecting 47 (55.9%) women. Regarding neurological impairment, 38 (38.8%) walked independently, 26 (26.5%) with an assistive device or orthosis and 21 (21.4%) were wheelchair users. Additional sociodemographic and clinical characteristics are summarized in Table 1.\u003c/p\u003e\n\u003cp\u003eMost participants (65 women, 66.3%) voided spontaneously, 25 (25.5%) performed clean intermittent catheterization (CIC), and 8 (8.2%) used an indwelling catheter (urethral or suprapubic). The mean NBSS-SF score was 11.0 (6.9). Urinary incontinence was reported by 51 (52.0%) women, with severe incontinence in 28 (28.6%) of them. Satisfaction with bladder condition was reported by only 34 (34.7%) women.\u003c/p\u003e\n\u003cp\u003eSexual activity within the past six months was reported by 48 (49.0%) participants. The mean FSFI score was 22.0 (10.1), with 28 sexually active women (58.3%) scoring \u0026le;26.55, indicating sexual dysfunction. Among these 48 sexually active women, 29 (60.4%) were satisfied with their sexual life. Notably, 8 sexually inactive women (16.0%) also reported satisfaction, highlighting the multifactorial nature of sexual well-being.\u003c/p\u003e\n\u003cp\u003eSexually active women had lower NBSS-SF scores (mean difference \u0026minus;5.3, 95% CI \u0026minus;8.0 to \u0026minus;2.6, p \u0026lt; 0.001). Among those with urinary incontinence, 37 (72.5%) were sexually inactive. Incontinent participants had lower FSFI scores \u0026nbsp;than continent women (16.2 (10.3) vs. 24.4 (9.1); p \u0026lt; 0.001)\u003c/p\u003e\n\u003cp\u003eUnivariate analysis identified younger age, marital status, premenopausal status, not being a wheelchair user, urinary continence, and not performing CIC as factors associated with sexual activity (Table 2). Being married significantly increased the likelihood of sexual activity (OR 12.8, 95% CI, 4.8 to 33.9; p \u0026lt; 0.001), while urinary incontinence was strongly associated with reduced likelihood of sexual activity (OR 0.12, 95% CI, 0.0 to 0.3; p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eOn multivariate analysis, urinary continence (OR 5.0, 95% CI, 1.7 to 14.4; p = 0.012), younger age (OR 0.93, 95% CI, 0.89 to 0.98; p = 0.002), and marital status (OR 10.9, 95% CI, 3.6 to 33.3; p \u0026lt; 0.001) were significant predictors of sexual activity. Similarly, satisfaction with sexual life was associated with being married (OR 13.8, 95% CI, 4.2 to 45.4; p \u0026lt; 0.001), urinary continence (OR 6.0, 95% CI, 2.0 to 18.2; p \u0026lt; 0.001), and younger age (OR 0.93, 95% CI, 0.9 to 1.0; p = 0.009); see Table 3 and Figures 1 and 2.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study reveals a substantial burden of sexual dysfunction and urinary incontinence among women with spinal cord disease (SCD) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Sexual dysfunction is both common and multidimensional in this population, with nearly 60% of sexually active women scoring in the dysfunctional range on the FSFI (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Over half of participants reported urinary incontinence, which was strongly associated with reduced sexual activity and satisfaction. Younger age, marital status, and urinary continence were independent predictors of both sexual activity and sexual satisfaction, demonstrating the combined influence of physical, relational, and psychological factors on sexual health after SCD (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThese results are consistent with prior research. Elmelund et al. reported urinary incontinence in 49% of women with neurological disease, closely matching our finding of 52% with nearly one-third experiencing severe symptoms (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Mahler et al. described pervasive concerns about urine leakage during intimacy in women performing intermittent catheterization, a concern mirrored in our cohort, where urinary incontinence independently predicted sexual inactivity and lower FSFI scores (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The association between clean intermittent catheterization and reduced sexual activity further illustrates the impact of bladder dysfunction on sexual well-being (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite the central role of sexual health in quality of life, sexuality and intimacy are frequently overlooked in SCD care. Studies indicate that healthcare providers often avoid discussions of sexual function due to discomfort, limited training, or the perception that sexuality is peripheral to neurological rehabilitation (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Our findings confirm the importance of addressing sexual health systematically as part of routine clinical care.\u003c/p\u003e\u003cp\u003eUrinary incontinence introduces substantial psychological and relational barriers. Embarrassment, diminished self-confidence, and fear of leakage can impact sexual spontaneity and contribute to the avoidance of intimacy (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Although behavioral, pharmacologic, and surgical treatments for urinary incontinence are available, these issues remain under-addressed among women with neurological disease (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Our findings reinforce the importance of routine screening and targeted interventions for urinary incontinence to optimize sexual and emotional health.\u003c/p\u003e\u003cp\u003eImportantly, urinary continence, marital status, and younger age were associated not only with increased sexual activity, but also with greater sexual satisfaction. These associations reflect the importance of functional and relational factors in shaping both behavioral and subjective aspects of sexual well-being (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Notably, some sexually inactive women reported satisfaction with their sexual life, suggesting the sexual well-being may be supported by emotional intimacy, non-coital sexual expression, or adaptive perspectives (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSeveral limitations of this study should be considered. First, the cross-sectional design precludes causal inference. Second, important confounders - including mood disorders, body image concerns, partner availability, and history of sexual trauma - were also not assessed and may have influenced results. Third, the use of mobility status as a surrogate for neurological impairment, while practical, does not fully capture the range of neurological deficits, potentially oversimplifying associations with sexual function. Lastly, we did not evaluate fecal incontinence, which is common in this population and may further impact on sexual health.\u003c/p\u003e\u003cp\u003eWhile we observed strong associations between urinary incontinence and adverse sexual outcomes, further interventional studies are needed to investigate whether continence treatment improves sexual health in women with SCD. Nevertheless, evidence from women with non-neurogenic urinary incontinence suggests that treatment improves sexual function and satisfaction, supporting similar approaches for neurogenic cases (\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Also, the NBSS-SF does not assess incontinence specifically during sexual activity - a domain that may be particularly relevant. Future research may benefit from incorporating complementary tools or qualitative assessments. Finally, the FSFI may underestimate the burden of dysfunction among sexually inactive women, as it does not fully capture satisfaction or distress outside the context of partnered sexual activity.\u003c/p\u003e\u003cp\u003eSexual health is central to emotional well-being and quality of life for women with SCD, yet sexual dysfunction remains common and under-recognized in this group. Our findings indicate that urinary incontinence is a substantial independent barrier to sexual activity and satisfaction. These results highlight the importance of recognizing and assessing urinary symptoms and sexual health in rehabilitation programs, supporting existing recommendations for comprehensive clinical assessment in this population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eAI Disclosure Statement\u003c/h3\u003e\n\u003cp\u003eDuring the preparation of this work, the authors used OpenAI\u0026rsquo;s ChatGPT (GPT-5) to assist with language editing, grammar refinement, formatting, and figure generation. The authors reviewed and edited the content and take full responsibility for the publication.\u003c/p\u003e\u003ch2\u003eEthical Approval\u003c/h2\u003e\n\u003cp\u003eIRB Approval N\u0026ordm; 86965218.3.0000.0068\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board (IRB Approval N\u0026ordm; 86965218.3.0000.0068). Written informed consent was obtained from all participants.\u003c/p\u003e\n\u003ch2\u003eCompeting Interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis study was conducted without specific financial support.\u003c/p\u003e\n\u003ch2\u003eConflicts of Interest\u003c/h2\u003e\n\u003cp\u003eThe authors declare no conflicts of interest related to this work.\u003c/p\u003e\n\u003ch2\u003eAuthor Contributions\u003c/h2\u003e\n\u003cp\u003eRMC: Study conception and design, data collection, manuscript drafting.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eThe authors thank the staff and Urology Residents of the neuro-urology clinics at Hospital das Cl\u0026iacute;nicas, Universidade de S\u0026atilde;o Paulo, for their support during patient recruitment and data collection.\u003c/p\u003e\n\u003ch2\u003eData Availability Statement\u003c/h2\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are included within the published article. Additional data are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOtero-Villaverde S, Ferreiro-Velasco ME, Montoto-Marqu\u0026eacute;s A, Salvador de la Barrera S, Arias-Pardo AI, Rodriguez-Sotillo A. Sexual satisfaction in women with spinal cord injuries. Spinal Cord. 2015;53(7):557\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHou S, Rabchevsky AG. Autonomic consequences of spinal cord injury. Compr Physiol. 2014;4(4):1419\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCharlifue SW, Gerhart KA, Menter RR, Whiteneck GG, Manley MS. Sexual issues of women with spinal cord injuries. Spinal Cord. 1992;30(3):192\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWhipple B, Komisaruk BR. Sexuality and women with complete spinal cord injury. 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J Sex Med. 2010;7(1 Pt 2):374\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eScheepe JR, Alamyar M, Pastoor H, Hintzen RQ, Blok BFM. Female sexual dysfunction in multiple sclerosis: results of a survey among Dutch urologists and patients. Neurourol Urodyn. 2015;34(3):242\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCardozo L, Rovner E, Wagg A, Wein A, Abrams P. Epidemiology of urinary incontinence in women. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 7th ed. Bristol: ICI-ICS; 2023. p. 27\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShawer S, Khunda A, Waring GJ, Ballard P. Impact of intravesical onabotulinumtoxinA (Botox) on sexual function in patients with overactive bladder syndrome: a systematic review and meta-analysis. Int Urogynecol J. 2022;33(2):235\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhunda A, McCormick C, Ballard P. Sacral neuromodulation and sexual function: a systematic review and meta-analysis of the literature. Int Urogynecol J. 2019;30(3):339\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSacomori C, Cardoso FL. Predictors of improvement in sexual function of women with urinary incontinence after treatment with pelvic floor exercises: a secondary analysis. J Sex Med. 2015;12(3):746\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"spinal-cord","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"sc","sideBox":"Learn more about [Spinal Cord](http://www.nature.com/sc/)","snPcode":"41393","submissionUrl":"https://mts-sc.nature.com/cgi-bin/main.plex","title":"Spinal Cord","twitterHandle":"@journalsci","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7530704/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7530704/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Study design: Cross-sectional study.\r\nObjectives: Evaluate sexual activity and satisfaction in women with spinal cord disease (SCD) and their associations with urinary incontinence.\r\nSetting: Outpatient neuro-urology clinics at a tertiary rehabilitation center in Brazil.\r\nMethods: Ninety-eight women aged ≥18 years with traumatic or non-traumatic SCD were included. Clinical and demographic data were collected through structured interviews. Bladder symptoms were assessed with the Neurogenic Bladder Symptom Score–Short Form (NBSS-SF). Sexual function was evaluated with the Female Sexual Function Index (FSFI), and sexual satisfaction with the WHOQOL-BREF. Sexual activity was defined as intercourse within six months. Logistic regression identified predictors of sexual activity and satisfaction.\r\nResults: Mean age was 43.0 ± 12.1 years; most cases were non-traumatic (85.7%), mainly multiple sclerosis (55.9%). Urinary incontinence was reported by 52.0%, severe in 28.6%. Sexual activity was reported by 48 women (49.0%), of whom 58.3% had FSFI-defined dysfunction and 60.4% reported satisfaction. Incontinence was strongly associated with inactivity (72.5% vs. 27.5%, p \u003c 0.001) and lower FSFI scores (16.2 ± 10.3 vs. 24.4 ± 9.1, p \u003c 0.001). On multivariate analysis, urinary continence (OR 5.0, 95% CI 1.7–14.4), younger age (OR 0.93/year, 95% CI 0.89–0.98), and being married (OR 10.9, 95% CI 3.6–33.3) predicted sexual activity and satisfaction.\r\nConclusions: Urinary incontinence is an independent barrier to sexual health in women with SCD. Targeted continence management may improve quality of life.\r\nSponsorship: No external funding.","manuscriptTitle":"Sexual Activity and Satisfaction in Women with Spinal Cord Disease: Influence of Urinary Incontinence and Other Predictors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-12 14:28:34","doi":"10.21203/rs.3.rs-7530704/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2025-10-14T00:15:01+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-10-08T06:38:04+00:00","index":1,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2025-10-04T20:57:47+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-10-02T14:03:47+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2025-09-30T10:19:01+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2025-09-29T17:46:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-16T17:06:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-09T10:13:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"Spinal Cord","date":"2025-09-05T14:11:26+00:00","index":"","fulltext":""},{"type":"checksFailed","content":"","date":"2025-09-04T16:02:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"spinal-cord","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"sc","sideBox":"Learn more about [Spinal Cord](http://www.nature.com/sc/)","snPcode":"41393","submissionUrl":"https://mts-sc.nature.com/cgi-bin/main.plex","title":"Spinal Cord","twitterHandle":"@journalsci","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"2e4e9a86-a4be-4f41-a25f-e2c55e04aa3b","owner":[],"postedDate":"October 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":55528194,"name":"Health sciences/Signs and symptoms/Urological manifestations"},{"id":55528195,"name":"Health sciences/Health care/Quality of life"}],"tags":[],"updatedAt":"2026-04-29T13:57:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-12 14:28:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7530704","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7530704","identity":"rs-7530704","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}