Painful sex and other sexual problems are common in women after a pelvic fracture, according to a recent Journal of Sexual Medicine review.

However, sexual dysfunction in this population is “understudied and underappreciated,” the authors added.

Motor vehicle accidents, pedestrian accidents, and falls are some of the most frequent causes of pelvic fracture in women. Injuries can affect the musculoskeletal, gastrointestinal, and urinary systems as well as sexual function.

Female sexual function after pelvic fracture has not been widely addressed in medical literature, the authors noted. To learn more, they reviewed 15 studies published between 1995 and 2019.

Overall, the studies involved 842 women who had been treated for a pelvic fracture. The participants’ average age was 32 years, and the average follow-up duration after fracture was 63.8 months.

The researchers found no consistent definition of female sexual dysfunction among the studies. Some used validated assessment tools; for example, three studies used the Female Sexual Function Index (FSFI). Others used non-validated tools, such as questionnaires that were adapted to assess women’s sexuality after pelvic fracture.

Causes of sexual dysfunction were multifactorial, the authors said, and associated with the physical effects of fracture, treatment of fracture, and resulting psychological issues. Problems with mobility and pain contributed to the women’s sexual dysfunction as well.

The authors also reported on the following areas:

• Dyspareunia. Nine of the studies focused on painful intercourse (dyspareunia), which was the most common sexual dysfunction reported, affecting 3% to 64% of the women. Pain was linked to nerve damage as well as damage to vascular and erectile tissues.
• Orgasms. In five of the studies, orgasm dysfunction was addressed. Between 7% and 67% of the women reported orgasm difficulties, most often diminished orgasm intensity or inability to reach orgasm at all. Neurovascular injuries may explain these issues, the authors said.
• Sexual interest and satisfaction. Seven studies assessed sexual interest and satisfaction, which affected 4% to 45% of the women. Pain, orgasm difficulties, and body image concerns were contributing factors.
• Pelvic floor dysfunction. About two-thirds of the women had pelvic floor dysfunction, based on data from the two studies that assessed it.
• Resolution. Only one study discussed resolution of sexual dysfunction and reported a rate of 30%.

The authors pointed out several limitations to their research. The reviewed studies included small numbers of women and follow-up times were variable. It was not clear how well the women functioned sexually before pelvic fracture or how much comorbidities (such as menopausal status or medications) might have influenced their sexuality.

The authors recommended further research on treatments for women facing sexual problems after pelvic fracture.

“We need to collaborate with our trauma, orthopedic, and gynecology colleagues to improve the overall understanding of [female sexual dysfunction], which may have a significant impact on [quality of life] of trauma survivors,” they wrote.

Resources

• The Journal of Sexual Medicine - “Female Sexual Dysfunction After Pelvic Fracture: A Comprehensive Review of the Literature”
  Walton, Alice B., BS, et al.
  (Full-text. Published: February 13, 2021)
  https://www.jsm.jsexmed.org/article/S1743-6095(20)31134-6/fulltext