Characterization of Female Sexual Dysfunction Associated with Spinal Pathology and Surgery.

Abstract

Studies demonstrate the connection between adverse sexual function and medical conditions such as diabetes and heart disease. However, in the areas of spinal and spinal cord pathologies that require surgical interventions, there are scant data. We undertook a narrative review to synthesize what is known on the topic, raise awareness, and call for action. PubMed and Google Scholar identified case reports and primary studies evaluating female sexual dysfunction associated with spinal pathology as well as surgical intervention success were reviewed to contextualize and characterize female sexual dysfunction. Available case reports and primary studies suggest that female sexual dysfunction can result from traumatic spinal etiologies, malignant tumors, and benign tumors with and without bony involvement. Although identified as a key preoperative predictor in maintenance or improvement of neurologic status, sexuality is rarely addressed in the neurosurgical care plan. In spinal stenosis and degenerative spine disease, over half of patients report pain with sexual activity. Importantly, while pain can hinder sexual activity in females, there are other sexual issues, including desire and subjective arousal, lubrication, orgasm, and satisfaction that are usually not explored. Studies show the impact of spinal pathologies on frequency of sexual intercourse, hypoesthesia, anorgasmia, and depression. Surgical intervention of spinal pathologies has been cited to improve back pain however other types of sexual dysfunction usually fails to improve after surgical intervention. The lack of high-quality research with adequate numbers of female participants that appropriately characterizes the nuances of female sexual dysfunction across various spinal pathologies, with post-surgical intervention analysis and consideration of surgical approach, necessitates consideration for future study. A pre-op and post-op sexual history in all woman undergoing spinal surgery should be a standard of care.