Severe Pelvic Fracture Impairs Sexual Function

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SAN FRANCISCO—Men and women who suffer an acute pelvic fracture that is severe enough to require surgery have a significantly increased risk of a decrease in sexual function, British investigators reported here at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting,

Peter V. Giannoudis, MD, and colleagues at the University of Leeds examined sexual function in 67 patients who underwent surgery for a pelvic fracture at their institution over a recent 12-month period. Patients were 18 to 65 years old at the time of their accident and had been injured at least 12 months prior to enrollment. The study excluded patients with co-morbidities linked to sexual dysfunction.

Acute pelvic injuries are indicators of high-energy trauma and are most often caused by motor vehicle accidents, said Dr. Giannoudis, Professor and Chairman of the Trauma & Orthopaedic Surgery Department. Pedestrians who are hit by a car or “crushed” in a motorcycle accident or fall from a significant height are also at increased risk of acute pelvic trauma.

Despite advances in critical care medicine and acute trauma management, mortality and morbidity remain high, and chronic complications like sexual dysfunction may occur even with less severe fractures, he added. Although the urogenital system, including the bladder, urethra, vagina, uterus, and prostate, is often affected because of proximity to the bony pelvis, the impact of fracture to these structures on sexual function has not been rigorously examined. Awareness of the effect of severe pelvic fractures on sexual function is extremely important since blunt pelvic trauma affects mostly young adults, a population that is more likely to be sexually active, he said.

Results showed that while no patient in the study had sought medical attention for sexual function prior to their injury, 50 (71.5%) patients showed a decrease in overall sexual function after their fracture. Of these, 47.1% had sexual function below the accepted threshold of dysfunction, defined as a Female Sexual Function Index score of 25.5 or less and International Index of Erectile Function score of 30 or less. Also, 24.3% of patients had a measurable, but milder decrease in sexual function.

The change in sexual function was significant and comparable in men and women. In contrast, urethral injuries are much more rarely reported in women than men due to anatomic variations, Dr. Giannoudis noted.

The study also found that all sexual function domains for males and females were affected following severe pelvic fracture. This finding underscores the “appropriateness” of using a scoring system with multiple domains to assess sexual function, he said.

Dr. Giannoudis cautioned that the small sample size represents a possible study limitation.

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