PELVIC TRAUMA AND IMPAIRED SEXUAL ACTIVITY

Abstract

Purpose: Van Den Bosch reported diminished quality of sexual intercourse in 40% of the patients victims of pelvic fractures. Using the Rosen self-administered questionnaire, five aspects of sexual activity were analysed: erectile function and orgasm, sexual desire, satisfaction with sexual intercourse and overall satisfaction. This retrospective series included patients with pelvic ring fractures in 1999.

Material and methods: The situation of 46 patients, aged 30 to 70 years was assessed with the International Index of Erectile Function self-administered questionnaire and a questionnaire concerning the patient’s status. The radiographic analysis included the Tyle classification. Associated injury to the membranous urethra were noted. Students t test was used to compare the IIEF scores in the study population and in a control population constituted for validation of the questionnaire.

Results: Forty-six patients responded (60.1%). None of the patients complained of disorders before the accident. Thirty-seven patients had sexual activities during the four weeks before responding including 11 (29.7%) with variable degrees of dyserection. Pubic dysfunction was the only factor associated with impaired sexual activity, leading to lower satisfaction and erectile function. There was no relationship between the five IIEF items and age, duration of follow-up, Tyle classification, branch fractures.

Discussion: This study is the first using the IIEF score to ascertain the degree of male sexual dysfunction after pelvic fractures. This self-administered questionnaire provides a tool adapted to the patient’s needs. Compared with the control group, we noted a prevalence of erectile dysfunction to the order of 30% with a significant diminution of overall satisfaction (p < 0.05). There was no significant correlation between male sexual sequelae, type of fracture and the notion of urethra injury. Pubic dysjunction is regularly correlated with decreased erectile function and overall satisfaction, probably in relation with injury to the cavernous bodies. Impaired sexual function, found long after the trauma (mean follow-up 26.8 years) suggests a permanent injury.

Conclusion: The IIEF self-administered questionnaire is interesting for young male patients victims of pelvic trauma, particularly in case of pubic dysjunction. Used during rehabilitation, it can identify patients with sexual sequelae (erectile function) in an overall medical and medicolegal management scheme.