This study highlights the key factors important to TMGRS decision-making and offers new insights into the complex relationship between decisional conflict and knowledge of surgical risks and options.
INTRODUCTION AND OBJECTIVE: Pelvic neurovascular damage accounts for the well-known association between pelvic fracture and sexual dysfunction. The impact of sexual dysfunction on quality of life has been well-documented but has historically focused on patients with lower urinary tract injuries. These injuries have been shown to be associated with higher rates of SD and therefore are more likely to influence patient-reported quality of life. We hypothesized that the presence of SD following pelvic fracture negatively impacts health-related quality of life (HrQOL) even for patients with no lower urinary tract injuries.METHODS: Women treated for pelvic fracture at a level 1 trauma center between 2012 and 2017 were invited to complete an online survey. Patients with spinal cord injuries, associated lower urinary tract injuries, and isolated acetabular fractures were excluded. Sexual function was assessed using the Female Sexual Function Index (FSFI). HrQOL was evaluated using the visual analog scale (VAS) component of the EuroQol 5 Dimensions Questionnaire (EQ-5D). Inverse probability weighting was utilized to adjust for subject nonresponse. Multivariate regression was performed to evaluate the impact of sexual function on HrQOL.RESULTS: 98 of the 780 potential subjects completed the survey (12.6%). Responders had a mean age at time of injury of 42.2 years (SD 22.4) and median time since injury of 45 months (IQR 30.0, 57.4). After weighting, median FSFI score was 19.1 (IQR 5.5, 27.7), and median EQ-5D VAS score was 71 (IQR 60, 85). Bivariate linear analysis showed that FSFI scores and time since injury were significantly associated with patient-reported HrQOL. A decrease in FSFI scores correlated to a decline in EQ-5D VAS score (b [ 0.62, 95% CI 0.30e0.95, p <0.001). Additionally, after adjustment for potential confounders, FSFI, time from injury, and age were all independently associated with HrQOL, with FSFI having the largest effect size (Table 1).CONCLUSIONS: Younger age, increased time since injury, and higher FSFI scores were all independently associated with improved HrQOL scores among women with a history of traumatic pelvic fracture, with FSFI scores as the strongest independent predictor for decreased HrQOL in this patient population. These data highlight the importance of addressing sexual health issues in female pelvic trauma survivors in the post-injury setting.
Introduction Providers will encounter transgender individuals in their practice, and it is important that they understand the unique challenges that these individuals face. Objective We sought to characterize the challenges transfeminine individuals face in seeking urological care through a developed questionnaire. Methods IRB approval was obtained to develop (with transgender community feedback) and administer a 58-item questionnaire assessing urinary and sexual health. Participants were recruited from the local community and the Philadelphia Trans Wellness Conference. We assessed the urologic care experiences of participants while comparing vaginoplasty (VP) and non-vaginoplasty (NVP) respondents. Results A total 32% of participants (n=17) sought care from a medical provider for GU/sexual symptoms in the past year. 41% of respondents (n=7) who sought medical care saw a urologist, with the majority having seen a urologist based on a referral or recommendation from another physician (n=5, 71%). Among all participants who had been to a urology practice in the past, 57% reported that they experienced a lack of knowledge about transgender health needs from a provider and/or office staff. 14 (26%) participants reported choosing not to see a urologist for one or more of the following reasons: 12 (85.7%) due to fear of being mistreated, disrespected, and/or misgendered, 10 (71.4%) due to discomfort around discussing urinary or sexual function issues as a transgender or gender nonconforming, 3 (21.4%) due to issues with insurance coverage, 3 (21.4%) due to issues with transportation or missing work, and 1 (7.14%) indicated “Other”. With respect to specific patterns of care between VP and NVP participants, we noted that NVP individuals were more likely to seek care for genitourinary issues (p=0.02) than NVP individuals. We also found that a higher proportion of VP compared to NVP individuals (45.5% vs 28.6%) sought general urologic care. Conclusions Transfeminine individuals experience a range of socio-economic barriers to urologic care. Participants indicated a reluctance to seek care because of discomfort and fear, and most reported inexperience from staff regarding transgender care. We noted that VP individuals were more likely to seek care from a urologist than NVP individuals, which may reflect a greater familiarity with the medical system. It is important for providers to be aware with these issues and communicate in a compassionate and affirming manner with their transgender patients. Disclosure No
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