After trauma, 31% report sexual dysfunction

Nearly one-third of trauma patients reported at least some degree of sexual dysfunction a year after injury. According to a multicenter prospective cohort study.

This rate is about double that of healthy patients, and triple that of healthy patients under the age of 50 years, the annual clinical conference of the American College of Surgeons said.

“In fact, we found that a moderate to severe traumatic injury imparts a risk of sexual dysfunction above and beyond the risk that may be impaired by known risk factors for sexual dysfunction, such as increasing age, diabetes, and lower socioeconomic status,” the University of Washington, Seattle said in a prepared statement.

The study was based on data from the National Study on the Costs and Outcomes of Trauma (NSCOT), which included 69 hospitals from 16 geographic regions in the United States. Patients were between 18 and 84 years of age and had moderate to severe injuries patients completed a 45-minute phone interview.

Of 10,122 patients, 3,087 (31%) answered yes to the question, “As a result of your physical health, were you limited in your ability to have sexual relations?”

Investigators then assessed whether those patients had mild or severe sexual dysfunction. For 57% of the patients with sexual dysfunction, that dysfunction was severe.

The investigators performed a multivariate analysis, adjusting for gender, race, marital status, mechanism of injury, and genitourinary injury to determine the independent predictors of severe sexual dysfunction.

As expected, spinal cord injury emerged as the best predictor of severe sexual dysfunction, with an adjusted relative risk of 3.7. But with the relative risk of 2.3, very severe injury turned out to be a better predictor of severe sexual dysfunction than did either pelvic fracture or a lower extremity fracture, both of which had relative risks of 1.5.

Other significant independent predictors of severe sexual dysfunction were age, global health status, diabetes, and income category.

Chronic pain proved to be another independent predictor of severe sexual dysfunction after the investigators adjusted for age, gender, race, comorbidities, self-reported health, mechanism of injury, injury severity, pelvic fracture, spinal cord injury, lower extremity fracture, and genitourinary injury.

Patients with pain grade II (high intensity) had 2.4 times the risk of severe sexual dysfunction than those with no pain. That adjusted odds ratio increased to 7.26 among patients with pain grade III (moderately limiting), and to 36.4 among patients with pain grade IV (severely limiting).

The investigators also found an independent association between sexual dysfunction and depression. Patients with depressive symptoms had more than seven times the risk of severe sexual dysfunction and depression. Patients with depressive symptoms had more than seven times the risk of severe sexual dysfunction than those with no depressive symptoms. However, in response to a question from the audience, “Whether it’s the sexual dysfunction that’s causing depression or the depression that’s causing sexual dysfunction, that’s all really unknown.”

The prepared statement quoted as saying that these findings should serve as a wake-up call for physicians who treat trauma patients. “For most practitioners, both primary most care and trauma physicians, sexual function is not on their radar screen, and most often they think of erectile dysfunction in men . . . But sexual dysfunction is a major determinant of quality of life, impacts both men and women, and if physicians don’t ask patients is unlikely to bring it up. This is something physicians should be asking their patients about, because there are excellent medications that work in the majority of patients.”