Introduction: Pelvic neurovascular damage accounts for the well-known association between pelvic fracture and sexual dysfunction. The impact of sexual dysfunction on quality of life has been well-documented but has historically focused on patients with lower urinary tract injuries. These injuries have been shown to be associated with higher rates of SD and therefore are more likely to influence patient-reported quality of life. We hypothesized that the presence of SD following pelvic fracture negatively impacts health-related quality of life (HrQOL) even for patients with no lower urinary tract injuries.
Methods: Women treated for pelvic fracture at a level 1 trauma center between 2012 and 2017 were invited to complete an online survey. Patients with spinal cord injuries, associated lower urinary tract injuries, and isolated acetabular fractures were excluded. Sexual function was assessed using the Female Sexual Function Index (FSFI). HrQOL was evaluated using the visual analog scale (VAS) component of the EuroQol 5 Dimensions Questionnaire (EQ-5D). Inverse probability weighting was utilized to adjust for subject nonresponse. Multivariate regression was performed to evaluate the impact of sexual function on HrQOL.
Results: 98 of the 780 potential subjects completed the survey (12.6%). Responders had a mean age at time of injury of 42.2 years (SD 22.4) and median time since injury of 45 months (IQR 30.0, 57.4). After weighting, median FSFI score was 19.1 (IQR 5.5, 27.7), and median EQ-5D VAS score was 71 (IQR 60, 85).
Bivariate linear analysis showed that FSFI scores and time since injury were significantly associated with patient-reported HrQOL. A decrease in FSFI scores correlated to a decline in EQ-5D VAS score (ß = 0.62, 95% CI 0.30 – 0.95, p <0.001). Additionally, after adjustment for potential confounders, FSFI, time from injury, and age were all independently associated with HrQOL, with FSFI having the largest effect size (Table 1).
Conclusions: Younger age, increased time since injury, and higher FSFI scores were all independently associated with improved HrQOL scores among women with a history of traumatic pelvic fracture, with FSFI scores as the strongest independent predictor for decreased HrQOL in this patient population. These data highlight the importance of addressing sexual health issues in female pelvic trauma survivors in the post-injury setting.
.jpg)
.jpg)
