Painful intercourse common after pelvic ring injuries - Academy News at the 2007 AAOS Annual Meeting

Painful intercourse common after pelvic ring injuries

By Sally Chapralis

Pelvic trauma in women has multiple negative effects, including sexual dysfunction and reproductive problems. Poor outcome scores are common, particularly for women with partial posterior injuries or symphyseal disruption, according to poster exhibit P489.

Although previous studies have reported the negative effects of pelvic trauma on genitourinary and reproductive function of women, the pattern and severity of the injuries and final fracture alignment have not been studied.

This retrospective review involved injury results for 96 women younger than 55 years of age with pelvic ring injury (range: 16 years to 53 years). Under the Orthopaedic Trauma Association classification system, half the patients had B-type injuries and half had C-type injuries. A B-type injury is partially unstable posteriorly, and a C-type injury is completely unstable posteriorly.

Forty-two women were treated operatively and 54 had nonoperative treatment. Forty-six patients completed Musculoskeletal Function Assessment (MFA), obstetrical history, and sexual function questionnaires at the 12-month follow-up.

Pain with intercourse was reported by 22 patients (49 percent); pain with intercourse was more common among women who had B-type fractures (56 percent) than among those with C-type fractures (39 percent; p = 0.15). Patients with B-type fractures had higher MFA scores (mean = 37.9), indicating poorer overall function, than those with C-type fractures (mean = 33.6), although this difference was not statistically significant.

Symphyseal disruption was associated with both painful intercourse and low function scores. Among patients with symphyseal disruption, 78 percent reported dyspareunia, and 86 percent reported MFA scores greater than 20.

Among the 22 post-injury pregnancies (17 patients), 14 required Cesarean section deliveries. Six of the women who had Cesarean sections had been treated with open reduction and internal fixation of the anterior pelvic ring (p = 0.03). Five patients—four of whom had nonoperative treatment for their pelvic injuries—had uncomplicated vaginal deliveries (p = 0.047).

The results of this study confirm the relationship between pelvic ring fractures in women (particularly those involving partial posterior injuries and symphyseal disruption) and increased pain during intercourse, MFA scores > 20, and increased need for Cesarean sections.

Researchers include Heather A. Vallier, MD, and Beth Ann Mahdinec, BS, both of Cleveland. The authors report no conflicts of interest.

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