Sexual dysfunction is prevalent long after physical injuries from major trauma have been treated and resolved. Nearly a third of patients who had sustained moderate to severe trauma reported some degree of sexual dysfunction, and most characterized the dysfunction as severe, a year after a traumatic event. A total of 3,087 of 10,122 patients who were treated for trauma had sexual dysfunction according to findings from a study reported at the 2008 Clinical Congress of the American College of Surgeons. The study included patients who were treated in one of 69 hospitals from 14 states across the country.

This is one of the first studies to examine sexual dysfunction in trauma patients. “There have been other studies looking at the general prevalence of sexual dysfunction in a demographic population, such as in the state of Massachusetts, and there have been studies looking at patients with specific injuries such as pelvic fracture or spinal cord injury. But there has not been a study that looked at sexual dysfunction in the broad trauma population,” according to Mathew D. Sorensen, MD, MS, a resident in urology at the University of Washington, Seattle.

General and trauma surgeons at the University of Washington decided to conduct the study after hearing complaints about sexual dysfunction from young trauma patients. The surgeons did not expect to find that sexual dysfunction was so widespread among trauma patients, however. “The prevalence of sexual dysfunction in this study was more common than we expected it to be.

Overall, the sexual dysfunction rate in this study is about double what it is in studies of healthy patients. And, for patients under the age of 50 years, the rate is about triple. 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 imparted by known risk factors for sexual dysfunction, such as increasing age, diabetes, and lower socioeconomic status,” Dr. Sorensen said.

The risk of sexual dysfunction in this study was also independent of the type of traumatic injury. “Unlike other studies that have shown an increased risk of sexual dysfunction after specific injuries involving parts of the body that are involved in sexual function, such as the pelvis and spine or genitalia, it appears from our study that just the general occurrence of a traumatic event may result in sexual dysfunction,” Dr. Sorensen said.

The risk also was not related to gender. Most of the patients in the study (68 percent) were male. The prevalence of sexual dysfunction was similar for both sexes, with 21 percent of men and 23 percent of women reporting severe or complete sexual dysfunction.

Findings from this study should serve as a wake-up call for physicians who treat trauma patients, Dr. Sorensen said. “For most practitioners, both primary care and trauma physicians, sexual function is not on their radar screen and most often they think of erectile dysfunction in men. Sexual dysfunction is a complex and difficult topic for most practitioners to discuss. But sexual function is a major determinant of quality of life, impacts both men and women, and if physicians don’t ask patients about their sexual health, the patients are 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. We hope this study brings the issue to light and draws attention to it,” he said.

Sexual dysfunction is a topic trauma patients should be aware of so they can bring it up with their physicians. “If patients recognized that sexual dysfunction happens to many men and women who have had major trauma, then they may feel less of a taboo about bringing up the topic,” Dr. Sorensen said.

The researchers at the University of Washington are not sure why sexual dysfunction may be a persistent problem for trauma patients. However, Dr. Sorensen suspects that it may be related to psychological effects of trauma and its aftermath. “Patients surviving major trauma often have long-standing limitations. It’s been shown in previous studies that many of these patients have pain and many develop depression. All of these factors have been associated with sexual dysfunction. So it’s possible that just by being involved in a major traumatic event, a patient may recover and be discharged from the hospital but still have physical, mental, or emotional limitations a year later. That may be part of the reason why patients have sexual dysfunction,” he explained.

Dr. Sorensen and his colleagues are analyzing data from the study to try to understand what raises the risk of sexual dysfunction for trauma patients. “If we can identify what it is about patients who get hurt severely that puts them at high risk for sexual dysfunction, then we may be able to intervene earlier in their hospital course. If depression or post-traumatic stress disorder (PTSD) are important contributors to sexual dysfunction, it may be possible to reverse sexual dysfunction by treating these conditions. Alternatively, it may be possible to make depression or PTSD less severe by treating sexual dysfunction,” Dr. Sorensen said.

Also involved in the study were Hunter Wessells, MD, FACS; Frederick P. Rivara, MD, MPH; David H. Zonies, MD; Gregory J. Jurkovich, MD, FACS; Jin Wang, PhD; and Ellen J. MacKenzie, PhD.

Source: American College of Surgeons (ACS)