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The relationship between injury mechanism and sexual dysfunction in surgically treated pelvic fractures

  • Altuğ DuramazEmail author
  • Mehmet Hakan Ilter
  • Şükrü Yıldız
  • Erdem Edipoğlu
  • Cem İpek
  • Mustafa Gökhan Bilgili
Original Article

Abstract

Purpose

The aim of the study was to identify the incidence of new sexual dysfunction reported by the patient in surgical treatment of pelvic ring injuries, and to describe the relationship between new sexual dysfunction and type of fracture.

Methods

Ninety-five patients who were operated for pelvic fracture were included in the study. Patients were evaluated according to age, gender, marital status, body mass index, trauma mechanism, fracture classification, genitourinary injury, accompanying injury, injury severity score, surgical technique, fixation material, duration of operation, functional outcomes, blood loss, complications, and sexual dysfunction. Functional outcomes were assessed with Female Sexual Functioning Index (FSFI), International Index of Erectile Function-5 (IIEF5), Arizona Sexual Experience Scale (ASEX), and Modified Majeed’s pelvic outcomes grading scale (MPS).

Results

Genitourinary symptoms were erectile dysfunction (ED) in 13 men, ejaculatory dysfunction in 9 men, and dyspareunia in 23 women. Urethral stricture developed in 4 males and 1 female with the urethral injury. FSFI score, ASEX score, and MPS score showed the statistically significant difference between the fracture types (p = 0.021, p = 0.032 and p = 0.020, respectively). There were no significant difference between fracture types in terms of the IIEF5 score, and no significant relationship between fracture type and ED development (p = 0.141).

Conclusion

Anteroposterior compression (APC) is the most common cause of sexual dysfunction in both sexes, independent of surgery. In addition, the most common cause of ED in men is vertical shear (VS). Especially patients with APC and VS injuries should be multidisciplinary evaluated with gynecology, urology, and psychiatry departments.

Keywords

Pelvic fractures Surgical treatment Pelvic injury mechanism Sexual dysfunction 

Notes

Funding

No fund was declared.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Giannoudis PV, Grotz MR, Tzioupis C, Dinopoulos H, Wells GE, Bouamra O, et al. Prevalence of pelvic fractures, associated injuries, and mortality: the United Kingdom perspective. J Trauma. 2007;63:875–83.CrossRefGoogle Scholar
  2. 2.
    Vallier HA, Cureton BA, Schubeck D. Pelvic ring injury is associated with sexual dysfunction in women. J Orthop Trauma. 2012;26(5):308–13.CrossRefGoogle Scholar
  3. 3.
    Ter–Grigorian AA, Kasyan GR, Pushkar DY. Urogenital disorders after pelvic ring injuries. Cent Eur J Urol. 2013;66:352–6.Google Scholar
  4. 4.
    Figler B, Hoffler ED, Reisman W, Carney K, Moore T, Feliciano D, et al. Multi-disciplinary update on pelvic fracture associated bladder and urethral injuries. Injury. 2012;43:1242–9.CrossRefGoogle Scholar
  5. 5.
    Flint L, Cryer G. Pelvic fracture: the last 50 years. J Trauma. 2010;69:483–8.CrossRefGoogle Scholar
  6. 6.
    Ceylan HH, Kuyucu E, Erdem R, Polat G, Yılmaz F, Gümüş B, et al. Does pelvic injury trigger erectile dysfunction in men? Chin J Traumatol. 2015;18(4):229–31.CrossRefGoogle Scholar
  7. 7.
    Corona G, Ricca V, Bandini E, Mannucci E, Petrone L, Fisher AD, et al. Association between psychiatric symptoms and erectile dysfunction. J Sex Med. 2008;5:458–68.CrossRefGoogle Scholar
  8. 8.
    Wright J, Nathens A, Rivara F, MacKenzie E, Wessells H. Specific fracture configurations predict sexual and excretory dysfunction in men and women 1 year after pelvic fracture. J Urol. 2006;176:1540–5.CrossRefGoogle Scholar
  9. 9.
    Harvey-Kelly KF, Kanakaris NK, Eardley I, Giannoudis PV. Sexual function impairment after high energy pelvic fractures: evidence today. J Urol. 2011;185(6):2027–34.CrossRefGoogle Scholar
  10. 10.
    Odutola AA, Sabri O, Halliday R, Chesser TJ, Ward AJ. High rates of sexual and urinary dysfunction after surgically treated displaced pelvic ring injuries. Clin Orthop Relat Res. 2012;470(8):2173–84.CrossRefGoogle Scholar
  11. 11.
    Cannada LK, Barr J. Pelvic fractures in women of childbearing age. Clin Orthop Relat Res. 2010;468:1781–9.CrossRefGoogle Scholar
  12. 12.
    Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS, Poka A, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990;30:848–56.CrossRefGoogle Scholar
  13. 13.
    Aygin D, Eti Aslan F. The Turkish adaptation of female sexual funtion index. Türkiye Klinikleri J Med Sci. 2005;25:393–9.Google Scholar
  14. 14.
    Turunç T, Deveci S, Güvel S, Peşkircioğlu L. The assessment of Turkish validation with 5 question version of International Index of Erectile Function (IIEF-5). Turk J Urol. 2007;33:45–9.Google Scholar
  15. 15.
    Soykan A. The reliability and validity of Arizona Sexual Experiences Scale in Turkish ESRD patients undergoing hemodialysis. Int J Impot Res. 2004;16(6):531–4.CrossRefGoogle Scholar
  16. 16.
    Sullivan MP, Scolaro JA, Milby AH, Mehta S. Isolated pelvic ring injuries: functional outcomes following percutaneous, posterior fixation. Eur J Orthop Surg Traumatol. 2015;25(6):1025–30.CrossRefGoogle Scholar
  17. 17.
    Gurevitz S, Bender B, Tytiun Y, Velkes S, Salai M, Stein M. The role of pelvic fractures in the course of treatment and outcome of trauma patients. Isr Med Assoc J. 2005;7:623–6.Google Scholar
  18. 18.
    Copuroglu C, Yilmaz B, Yilmaz S, Ozcan M, Ciftdemir M, Copuroglu E. Sexual dysfunction of male, after pelvic fracture. Eur J Trauma Emerg Surg. 2017;43(1):59–63.CrossRefGoogle Scholar
  19. 19.
    Collinge CA, Archdeacon MT, LeBus G. Saddle-horn injury of the pelvis: the injury, its outcomes, and associated male sexual dysfunction. J Bone Jt Surg Am. 2009;91:1630–6.CrossRefGoogle Scholar
  20. 20.
    Malavaud B, Mouzin M, Tricoire JL, Game X, Rischmann P, Sarramon JP, et al. Evaluation of male sexual function after pelvic trauma by the International Index of Erectile Function. Urology. 2000;55:842–6.CrossRefGoogle Scholar
  21. 21.
    Wright JL, Nathens AB, Rivara FP, MacKenzie EJ, Wessells H. Specific fracture configurations predict sexual and excretory dysfunction in men and women 1 year after pelvic fracture. J Urol. 2006;176:1540–5.CrossRefGoogle Scholar
  22. 22.
    Harwood PJ, Grotz M, Eardley I, Giannoudis PV. Erectile dysfunction after fracture of the pelvis. J Bone Jt Surg Br. 2005;87:281–90.CrossRefGoogle Scholar
  23. 23.
    Metze M, Tiemann AH, Josten C. Male sexual dysfunction after pelvic fracture. J Trauma. 2007;63:394–401.CrossRefGoogle Scholar
  24. 24.
    Tripathy SK, Goyal T, Sen RK. Nonunions and malunions of the pelvis. Eur J Trauma Emerg Surg. 2015;41(4):335–42.CrossRefGoogle Scholar
  25. 25.
    Wilkes RA, Seymour N. Dyspareunia due to exostosis formation after pelvic fracture. Br J Obstet Gynaecol. 1993;100:1050–1.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopedics and TraumatologyBakırköy Dr. Sadi Konuk Education and Research HospitalBakırköyTurkey
  2. 2.Department of Gynecology and ObstetricsBakırköy Dr. Sadi Konuk Education and Research HospitalBakırköyTurkey
  3. 3.Department of UrologyKanuni Sultan Süleyman Education and Research HospitalKüçükçekmeceTurkey

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