The impact of acetabular labral tears on sexual activity in women

Raut, Shruti; Kamal, Jessica; Norrish, Alan; Khanduja, Vikas

doi:10.1093/jhps/hnz060

Cited by 5 publications

(6 citation statements)

References 14 publications

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“…Despite this, a prior study [12] reported that only 28% of patients received information regarding sexual activity preoperatively or postoperatively, highlighting an important discordance between the patient experience and surgeon-perceived effects of FAI on sexual relations. In a survey study, 94% (86 of 92) of sexually active women who underwent hip arthroscopy for labral tears reported hip pain with sexual intercourse preoperatively [17]. Given that women more frequently assume the role of the receptive partner, this is consistent with our data demonstrating patients participating in receptive intercourse are affected more by FAI-related hip pain.…”

Section: Discussionsupporting

confidence: 89%

“…Given that women more frequently assume the role of the receptive partner, this is consistent with our data demonstrating patients participating in receptive intercourse are affected more by FAI-related hip pain. Twenty of the patients in that same study [17] specifically reported their hip pain was positional, with the greatest amount of pain occurring in the flexed and abducted positions, which our data also supports. It is unsurprising that sexual relations are affected by FAI, because pain is typically elicited during extremes of ROM, especially flexion, which is involved in many sexual positions.…”

Section: Discussionsupporting

confidence: 83%

“…However, a greater proportion of patients participating in the receptive role reported no or very little hip pain postoperatively (49% [17 of 35]) than preoperatively (27% [10 of 37]). Similarly, in the mentioned study of 104 sexually active women with labral tears undergoing hip arthroscopy, while 89% (82 of 92) of women with preoperative hip pain during sexual intercourse reported improvement in their hip pain postoperatively, there were "a significant number" that reported some residual hip symptoms during sexual activity [17].…”

Section: Improvements In and Persistent Symptoms With Sexual Relation...mentioning

confidence: 88%

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Hip Arthroscopy Improves Sexual Function in Receptive Partners with Femoroacetabular Impingement Syndrome

Rynecki,

Kingery,

DeClouette

et al. 2024

Clin Orthop Relat Res

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Background Hip pain due to femoroacetabular impingement (FAI) is thought to adversely impact sexual satisfaction because of exacerbation of symptoms with hip ROM. However, the effect of FAI on sexual satisfaction and improvement after surgery to treat FAI is largely absent from published studies, despite patients’ apparent interest in it as registered by the frequent appearance of these topics on online anonymous discussion platforms. In addition, details regarding its impact on the decision to pursue surgery and the success of hip arthroscopy in alleviating FAI-related sexual dysfunction based on the specific role assumed during intercourse (penetrative versus receptive) remains unknown. Questions/purposes Given that sexual intercourse involves different amounts of hip ROM depending on whether patients assume the penetrative or receptive role, this study evaluated the effect of FAI and hip arthroscopy on sexual activity based on role. Compared with patients who participate in the penetrative role during sexual intercourse, do patients who participate in the receptive role (1) experience greater difficulty with sexual function because of FAI symptoms, (2) take longer to return to sexual intercourse after hip arthroscopy, and (3) experience greater improvements in reported sexual function after hip arthroscopy for FAI? Methods This was a retrospective cohort study of patients undergoing hip arthroscopy for FAI. Between January 2017 and December 2021, 293 patients were treated with hip arthroscopy for FAI and enrolled in our longitudinally maintained database. Among all patients treated surgically, 184 patients were determined to be potentially eligible for study inclusion based on a minimum follow-up of 6 months postoperatively. The 6-month timepoint was chosen based on published data suggesting that at this timepoint, nearly 100% of patients resumed sexual intercourse with minimal pain after hip arthroscopy. Of the potentially eligible patients, 33% (61 patients) could not be contacted by telephone to obtain verbal consent for participation and 9% (17 patients) declined participation, leaving 106 eligible patients. Electronic questionnaires were sent to all eligible patients and were returned by 58% (61 patients). Forty-two percent of eligible patients (45) did not respond to the questionnaire and were therefore excluded from the analysis. Two percent (2) completed most survey questions but did not specify their role during intercourse and were therefore excluded. The mean age of included patients was 34 ± 9 years, and 56% were women The mean follow-up time was 2 ± 1 years. In total, 63% of included patients reported participating in the receptive role during sexual intercourse (49% receptive only and 14% both receptive and penetrative). Hip symptoms during sexual intercourse preoperatively and postoperatively were evaluated using a questionnaire created by our team to answer our study questions, drawing from one of the only published studies on the matter and combining the questionnaire with sexual position–specific questions garnered from arthroplasty research. Patients who reported participating in the receptive role during intercourse (either exclusively or in addition to the penetrative role) were compared with those who participated exclusively in the penetrative role. There were no specific postoperative recommendations in terms of the timing of return to sexual intercourse, other than to resume when comfortable. Results Overall, 61% of patients (36 of 59) reported that hip pain somewhat or greatly interfered with sexual intercourse preoperatively. Patients who participated in receptive intercourse were more likely to experience preoperative hip pain that interfered with intercourse than patients who participated exclusively in penetrative intercourse (odds ratio 5 [95% confidence interval 2 to 15]; p = <0.001). Postoperatively, there was no difference in time until return to sexual activity between those in the penetrative group (median 6 weeks [range 2 to 14 weeks]) and those in the receptive group (median 6 weeks [range 4 to 14 weeks]; p = 0.28). Postoperatively, a greater number of patients participating in the penetrative role reported no or very little pain, compared with patients participating in the receptive role (67% [14 of 21] versus 49% [17 of 35]). However, with regard to preoperative to postoperative improvement, patients who participated in the receptive role had greater pain with positions involving more hip flexion and abduction and experienced a greater improvement than their penetrative counterparts in these positions postoperatively. Despite this improvement, however, 33% of patients (7 of 21) participating in the penetrative role and 51% of patients (18 of 35) participating in the receptive role continued to report either some or a great amount of pain at final follow-up. Conclusion Hip pain secondary to FAI interferes with sexual relations, particularly for partners who participate in the receptive role. Postoperatively, both patients participating in receptive and penetrative intercourse resumed sexual intercourse at a median of 6 weeks. After hip arthroscopy, the greatest improvement in pain was seen in receptive partners during sexual positions that involved more hip flexion and abduction. Despite this improvement, most patients, regardless of sexual role assumed, reported some degree of residual pain. Patients planning to undergo arthroscopic surgery for FAI, particularly those who participate in receptive intercourse, should be appropriately counseled about reasonable postoperative expectations based on our findings. Level of Evidence Level III, therapeutic study.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 83%

Section: Improvements In and Persistent Symptoms With Sexual Relation...mentioning

confidence: 88%

See 1 more Smart Citation

Hip Arthroscopy Improves Sexual Function in Receptive Partners with Femoroacetabular Impingement Syndrome

Rynecki,

Kingery,

DeClouette

et al. 2024

Clin Orthop Relat Res

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“…Also, Raut et al. surveyed 120 female patients who had hip arthroscopy for labral repair and found that 94% of sexually active patients had pain before surgery and 89% had improvement post-surgery but still suffered some discomfort [ 40 ]. The sexual function questionnaires used in this study (IIEF, FSFI) focus mainly on satisfaction with sexual intercourse and genital-related symptoms, but do not specifically ask about hip pain during sex.…”

Section: Discussionmentioning

confidence: 99%

Sexual and urinary function post-surgical treatment of femoroacetabular impingement: experience from the FIRST trial and embedded cohort study

Jean

Simunovic

Duong

et al. 2022

Journal of Hip Preservation Surgery

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The goal of this study was to investigate the sexual and urinary function and any related complications in patients post-hip arthroscopy for the treatment of femoroacetabular impingement (FAI). Data from 214 patients enrolled in the FIRST trial and 110 patients enrolled in the trial’s embedded prospective cohort study (EPIC) were analyzed. EPIC patients either refused to participate in the trial or did not meet the FIRST eligibility criteria. Outcomes included the International Consultation on Continence Questionnaire (ICIQ) for males (ICIQ-MLUTS) and females (ICIQ-FLUTS) and the Female Sexual Function Index (FSFI) and International Index of Erectile Function (IIEF) administered before surgery and at 6 weeks and 12 months. Urinary and sexual function adverse events were recorded up to 24 months. Linear regression analyses were conducted to compare the osteochondroplasty and lavage groups in the FIRST trial and to evaluate age and traction time as prognostic factors among all patients. Longer traction time was associated with a small but statistically significant improvement in urinary voiding function in males at 6 weeks and 12 months (MD (95% CI) = 0.25 (0.12, 0.39), P < 0.001 and 0.21 (0.07, 0.35), P = 0.004), respectively. Mean traction time was 43.7 (± 23.2) min for FIRST trial and 52.8 (± 15.2) min for EPIC cohort patients. Increasing age in male patients was associated with a decrease in urinary continence at 6 weeks (MD (95% CI) = 0.25 (−0.42, −0.09), P = 0.003). FIRST male patients who received osteochondroplasty improved significantly in sexual function at 12 months compared to males in the EPIC cohort (MD (95% CI) = 2.02 (0.31, 3.72), P = 0.020). There was an overall complication rate of 1.2% at 24 months [one urinary infection, two instances of erectile dysfunction (one transient and one ongoing at 24 months) and one reported transient numbness of tip of the penis]. Hip arthroscopy for the treatment of FAI has a low rate of sexual and urinary dysfunction and adverse events.

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“…For instance, acetabular labral tears can have a negative effect on female sexual activity. [10] The advances in arthroscopic techniques aim to both reduce complication rates, find novel ways to enhance training, improve outcomes, and identify novel approaches to complex pathologies previously untreated by this minimally invasive technique.…”

mentioning

confidence: 99%

Recent advances and future trends in hip arthroscopy

Zhang

Pettit

Kumar

et al. 2020

JASSM

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Hip arthroscopy (HA) is a well-established minimally invasive technique used to treat a wide range of conditions. Technological innovations have expanded the scope of HA and improved its outcomes. Several authors have described post-less arthroscopy to overcome the risk associated with the use of the perineal post for obtaining distraction of the hip joint. Instrument refinement has improved the efficacy of labral repair and reconstruction. Several treatment strategies are available for articular cartilage defects including ACI, MACI, and mosaicplasty, to name a few. Some authors have suggested that ligamentum teres reconstruction is helpful in young active patients with femoroacetabular impingement experiencing subluxation of the hip joint. The incorporation of new technology and patient-specific approaches represents a new way to improve HA outcomes. Virtual reality simulation training is the key to overcoming the steep learning curve associated with HA and to achieve high standards early in a surgeon’s career. Computer-based navigation surgery may be the key to accurately resecting the cam deformity and reducing the rate of revision surgery due to inaccurate resection at the index procedure. Assessment and optimization of the baseline psychological state and effective pre-habilitation may also improve outcome measures. Adequate stratification of the pathology and assessment of baseline patient characteristics influences the long-term outcome following the HA.

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The impact of acetabular labral tears on sexual activity in women

Cited by 5 publications

References 14 publications

Hip Arthroscopy Improves Sexual Function in Receptive Partners with Femoroacetabular Impingement Syndrome

Hip Arthroscopy Improves Sexual Function in Receptive Partners with Femoroacetabular Impingement Syndrome

Sexual and urinary function post-surgical treatment of femoroacetabular impingement: experience from the FIRST trial and embedded cohort study

Recent advances and future trends in hip arthroscopy

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