The effect of sexual dysfunction on health-related quality of life in men following traumatic pelvic fractures.

Abstract

Pelvic trauma disproportionately affects a younger population and has the potential to cause long-term sexual dysfunction. We hypothesized that the presence of sexual dysfunction after traumatic pelvic fracture negatively impacts health-related quality of life (HrQOL) in men. A total of 228 patients with traumatic pelvic fractures treated at a level 1 trauma center between 2012 and 2017 completed a survey that evaluated postinjury HrQOL and sexual function. Inverse probability weighting was used to adjust for survey nonresponse. Pelvic fracture characteristics were classified based on the Orthopedic Trauma Association classification system. Sexual function was evaluated using the International Index of Erectile Function, and HrQOL was evaluated using the EuroQol 5 Dimensions Questionnaire (EQ-5D). Quality-adjusted life years were determined based on calculated EQ-5D utility indices. Multiple regression models were created to evaluate the association between sexual health and HrQOL. After inverse probability weighting and adjustment for potential confounders, a decrease in International Index of Erectile Function was associated with a decline in overall HrQOL as measured by the EQ-5D visual analog scale (β = 0.28, p = 0.02). No association was identified between Orthopedic Trauma Association pelvic fracture configuration and risk of postinjury erectile dysfunction (ED) (p = 0.99). Furthermore, 53.3% of men reported persistent ED at a median of 42.6 months (interquartile range, 28.0-63.3 months) following injury. The presence of ED was independently associated with a decrease in HrQOL (β = 10.92, p < 0.001). This difference equates to a loss of 1.6 quality-adjusted life years per 10 years for men with ED following pelvic fracture relative to those without. Sexual dysfunction is an independent risk factor for decreased HrQOL in pelvic trauma survivors. Further work is needed to create appropriate patient-centered survivorship care pathways that incorporate sexual health evaluation. Prognostic, level IV.