“Traumatic pelvic injuries, while relatively common, disproportionally affect men younger than age 45,” explains Niels V. Johnsen, MD, MPH. “Fortunately, as multidisciplinary trauma care has improved over time, a larger proportion of men are surviving serious injuries. The increased survival, however, brings a greater risk of living with long-term complications related to these injuries. Previous studies have found that nearly one-half of men with traumatic pelvic fracture experience some degree of sexual dysfunction following injury. However, despite sexual function being an important subjective factor in determining health-related quality of life (HRQOL), most men with persistent sexual dysfunction fail to discuss the topic with their healthcare provider for a variety of reasons.”

For a study published in the Journal of Trauma and Acute Care Surgery, Dr. Johnsen and colleagues aimed to address this lack of communication between patient and physician by examining the objective impact that sexual dysfunction (and erectile dysfunction) have on HRQOL. “We sought to collect data on sexual health following traumatic pelvic injuries in order to build a foundation of understanding, with the goal of establishing a multidisciplinary, patient-centered, survivorship care model for patients who have experienced pelvic trauma,” says Dr. Johnsen.

Sexual Function Independently Crucial to QOL

In the study, 228 men with traumatic pelvic fractures, who were treated at a level 1 trauma center between 2012 and 2017, completed a survey that evaluated post-injury HRQOL and sexual function. Pelvic fracture characteristics were classified based on the Orthopaedic Trauma Association (OTA) classification system. Sexual function was evaluated utilizing the International Index of Erectile Function (IIEF) and HRQOL was measured using the EuroQol 5 Dimensions Questionnaire (EQ-5D). Quality-adjusted life years (QALY) were determined based on calculated EQ-5D utility indices. Multiple regression models were created to evaluate the association between sexual health and HRQOL.

“Our primary findings show that after adjusting for age, relationship status, and severity of overall injury, a decline in sexual function was independently and significantly associated with a decline in HRQOL (Table),” says Dr. Johnsen. “Erectile dysfunction, in particular, was significantly associated with a decline in overall HRQOL, and its presence was associated with a loss of 1.6 QALY during a 10-year period. Sexual function is independently important to QOL and if providers fail to address sexual health, it can have a significant negative impact on patients.”

Physicians Need to Work With Multidisciplinary Groups

“Our research findings add to a growing body of evidence indicating that men frequently experience a decline in sexual function following significant pelvic trauma, that these sexual health concerns often go unaddressed by the healthcare system, and that failure to address them leads to a poorer QOL,” Dr. Johnsen says. “As physicians, we need to recognize this and work with multidisciplinary groups, including urologists, trauma surgeons, orthopedic surgeons, primary care providers, physical therapists, and others to build survivorship programs that incorporate assessment and management of sexual health into the standard follow-up evaluation for these patients.”

Acknowledging some limitations to the study, Dr. Johnsen and colleagues write, “Our results may not be representative of the national pelvic trauma patient population since our cohort consisted of patients treated mainly in the Pacific Northwest region. In addition, the majority of patients were White and insured. Given the differences in health outcomes of minority patients, as well as cultural differences, more research is needed to determine if the association between sexual dysfunction and HRQOL is valid across various socioeconomic groups.”

The study team is currently working on a similar evaluation in women to determine if the relative importance that men place on sexual health and HRQOL holds true for both sexes. “Furthermore, we have plans to prospectively develop post-injury protocols and care pathways that incorporate the provision of sexual health information to patients and ensure that patients have potential sexual health concerns addressed following injury.”