Female Sexual Dysfunction After Pelvic Fracture: A Comprehensive Review of the Literature

Abstract

Background Female sexual dysfunction (FSD) after pelvic fracture (PFx) has garnered little attention in the urology literature. Aim To review and summarize the current evidence regarding female PFx-related sexual function. Methods We performed a systematic review in accordance with PRISMA guidelines, including PubMed, EMBASE, and MEDLINE. We included only English-language manuscripts and abstracts with sufficient data for inclusion. We used the search terms “female sexual dysfunction AND pelvic fracture,” “sexual dysfunction AND pelvic fracture,” and “female pelvic fracture AND sexual dysfunction.” A total of 177 articles were identified; 41 abstracts were reviewed; of which, 19 manuscripts were reviewed. Fifteen met inclusion criteria for analysis. Outcomes The main outcome measures of this study are rates and types of female sexual dysfunction after pelvic fracture. RESULTS FSD is prevalent after PFx, with reported rates between 25% and 62%. Three studies used the validated Female Sexual Function Index. The other 12 used non-validated questionnaires or adapted quality-of-life questionnaires with specific questions regarding FSD. The most common complaints include difficulty with intercourse, dyspareunia, orgasmic dysfunction, genitourinary pain, decreased interest in intercourse, decreased satisfaction with intercourse, and pelvic floor dysfunction. Only 1 study addressed resolution of dysfunction (30 of 98 patients [30.4%]). Clinical Implications FSD is prevalent and an under-recognized sequela of pelvic fracture. This requires future prospective study to better characterize sexual dysfunction and identify effective treatments in trauma survivors. Strength and Limitations To Increase awareness of FSD after pelvic trauma and the impact on the quality of life in trauma survivors. The current literature is limited by a lack of standardized assessment of FSD, limited follow-up, and minimal discussion of treatment options, in addition to the inherent bias of retrospective studies. CONCLUSIONS FSD after traumatic PFx is not uncommon, occurs mostly in young women, and can be morbid. FSD after PFx is underreported in the urology literature. Thus, all female PFx patients should be screened for FSD by validated questionnaires. The published literature offers little knowledge as to the epidemiology, evaluation, definition, and potential treatments of FSD after PFx. Prospective studies are needed to better understand female sexual function in trauma survivors and the potential methods for prevention and rehabilitation, all within the context of a multidisciplinary approach.

Association of Pelvic Trauma With Rates of Cesarean Section, Sexual Dysfunction, and Genitourinary Dysfunction in a National Database

“…Prior studies have suggested increased rates of C-section, SD, and GD after pelvic fractures. 3 4 5 6 7 8 , 10 - 12 However, these studies have key limitations, such as small sample size and reliance on questionnaires. A clearer picture of the long-term effect of pelvic fracture on these outcomes is crucial and may allow orthopaedic surgeons to better counsel patients with these injuries.…”

“…Similarly, pelvic fractures have been associated with persistent symptoms of sexual dysfunction (SD) 4 , 10 - 12 and genitourinary dysfunction (GD), 4 , 7 which likely arise from concomitant injury to nearby soft-tissue and key nervous, reproductive, and urinary structures. However, because many of these studies assess dysfunction with questionnaires instead of confirmed diagnosis, reliance on data from patient self-reporting and nonvalidated questionnaires may cause survey and measurement bias.…”

Birth rate after major trauma in fertile-aged women: a nationwide population-based cohort study in Finland

“…When compared to wrist fractures, hip or thigh fractures and pelvic fractures were the only major traumas included in this study that had a negative impact on the birth rate during the five subsequent years after sustaining the fracture. There are a few studies that have reported sexual dysfunction in women with proximal thigh traumas or pelvic traumas, with sexual dysfunction occurring mostly among younger women [13,14]. However, a study on proximal thigh traumas reported that in most cases only a few women report anything other than mild or no sexual dysfunction after 1-year follow-up [14].…”

“…Many earlier studies have focused mainly on trauma and abnormalities of the reproductive system, especially of the uterus and ovaries [12]. It has been reported, however, that musculoskeletal trauma around the area of the pelvic ring and the femur can cause sexual dysfunction and dyspareunia [13,14]. Moreover, women in Finland who have undergone total hip replacement are reported to have a lower birth rate than women in the general population [15].…”

Quantifying Urinary and Sexual Dysfunction After Pelvic Fracture

“…Johnsen et al 46,47 have explored barriers to care of sexual health concerns in men after traumatic pelvic fractures, with the most common issues identified as a lack of discussion with their healthcare provider after injury combined with the belief that sexual dysfunction would resolve with time, plus the perceived lack of value and importance placed on sexual health as a component of survivorship. Similarly, a recent systematic review by Walton et al 48 identified female sexual dysfunction as an underrecognized sequela of pelvic fracture, noting that future prospective studies need to better characterize sexual dysfunction and, most importantly, identify effective treatments for female sexual health in trauma survivors. Together, this would indicate that patient counseling and timing of interventions as it relates to urinary and sexual disabilities needs to be different, and that early involvement of multidisciplinary experts is important.…”