Background: To determine the prevalence and predictors of sexual dysfunction (SDF) after moderate-to-severe trauma in a large multicenter study.
Methods: The National Study on the Costs and Outcomes of Trauma was a prospective cohort study involving 69 hospitals from 15 regions in 14 states. Men and women aged 18 to 84 years with moderate-to-severe injures participated in 3 and 12 month postinjury interviews. At 12 months, sexual function was assessed using the Functional Capacity Index. Predictors of SDF were determined using adjusted multivariate Poisson regression. Sensitivity analyses were conducted on patients aged 18 to 30 years.
Results: Of 10,122 weighted subjects, 3,087 (30.5%) reported some degree of SDF, with the majority reporting severe SDF. On multivariate analysis, independent predictors of SDF included increasing age (aRR 1.02 per year age), decreasing household income category (aRR 1.12–1.60), lower baseline global health status (aRR 1.27–3.54), preexisting diabetes (aRR 1.34) increasing Injury Severity Score (aRR 1.02 per point increase), pelvic fracture (aRR 1.45), lower extremity fracture (aRR 1.48), and spinal cord injury (aRR 3.73).
Conclusions: SDF is common and usually severe after major trauma. Injury severity is a significant independent predictor of SDF. This may be due to persistent physical, psychologic, or social limitations from injury. Given the effect on quality of life, these data support the need in the clinical setting to identify and address SDF after trauma. Further investigation is necessary to determine the mechanism by which injury severity mediates SDF and whether earlier interventions can decrease the later risk of SDF.
From the Departments of Urology, Surgery, Pediatrics and Epidemiology (M.D.S, H.W., F.P.R., D.H.Z., G.J.J., J.W.), University of Washington School of Medicine, Harborview Medical Center; Harborview Injury Prevention Research Center, Seattle, Washington and Johns Hopkins Bloomberg School of Public Health (E.J.M.), Center for Injury Research and Policy, Baltimore, Maryland.
Submitted for publication April 28, 2008.
Accepted for publication July 29, 2008.
Supported by Harborview Injury Prevention and Research Center (HIPRC) R49/CE000197 from the Centers for Disease Control, the National Study on the Cost and Outcomes of Trauma (NSCOT) R49/CCR316840 from National Center for Injury Prevention and Control of the CDC and Prevention grant (R01/AG20361) from National Institute on Aging of the NIH.
Presented at the College of Trauma Regional Resident Essay competition, Region X, Olympia, WA. Washington state winner best clinical presentation. Podium presentation December 1, 2007; Northwest Urological Society, Vancouver, BC Canada. Podium presentation December 8, 2007; and Accepted: American College of Surgeons 94th annual Clinical Congress, San Francisco, CA. October 13, 2008.
Address for reprints: Mathew D. Sorensen, MD, Department of Urology University of Washington School of Medicine, 1959 NE Pacific Street, Box 356510, Seattle, WA 98195; email: firstname.lastname@example.org.