Lee Simon, Frank Rachel M, Harris Joshua, Song Sang Hoon, Bush-Joseph Charles A, Salata Michael J, Nho Shane J
Rush University Medical Center, Chicago, Illinois, USA
Rush University Medical Center, Chicago, Illinois, USA.
Am J Sports Med. 2015 Aug;43(8):1850-6. doi: 10.1177/0363546515584042. Epub 2015 May 12.
It is unknown if chronic hip pain due to femoroacetabular impingement (FAI) may cause sexual difficulties. Available evidence suggests that hip arthroscopic surgery may be effective for the treatment of symptomatic FAI; however, sexual function before and after hip arthroscopic surgery has not been reported.
PURPOSE/HYPOTHESIS: The purpose of this study was to determine the presence and significance of sexual difficulties in patients with chronic hip pain due to symptomatic FAI both before and after hip arthroscopic surgery. The hypotheses were that (1) chronic hip pain due to symptomatic FAI has a negative effect on sexual function, (2) hip arthroscopic surgery improves the level of sexual function postoperatively, (3) the characteristics of sexual difficulties may be dependent on sex or age, (4) patients lack knowledge of potential sexual activity changes in the preoperative and postoperative periods, and (5) patients desire a greater level of discussion regarding potential changes in sexual function.
Case series; Level of evidence, 4.
A 23-item Likert-style questionnaire assessing preoperative and postoperative sexual function and a modified Harris Hip Score questionnaire were administered to 305 consecutive patients who underwent hip arthroscopic surgery for FAI with a minimum 1-year follow-up. Comparative analysis was performed between sexes and age groups (young: <40 years; old: >40 years).
Of 131 respondents, preoperative sexual difficulties were reported by 66%, occurring 30.8 ± 49.1 days after the onset of FAI symptoms. Primary causes of difficulty included pain (77.9%), stiffness (47.1%), and loss of interest (21.4%). Sexual activity resumed 29.2 ± 20.1 days postoperatively, while sex with minimal pain occurred at 48.8 ± 40.6 days. Female patients and older patients (>40 years old) resumed sexual activity later (female: 34.8 ± 23.2 days; male: 21.0 ± 10.7 days; P < .0001) (young: 26.3 ± 21.7 days; old: 35.7 ± 13.5 days; P = .017). The frequency of sexual activity increased in 32.3%, decreased in 16.9%, and was unchanged in 48.5%. Among patients who reported an increase in the frequency of sexual activity, there was a greater proportion of male patients and younger patients (female: 38.1%; male: 61.9%; P < .0001) (young: 78.6%; old: 21.4%; P < .0001). More female patients reported alterations in sexual positioning (female: 82.3%; male: 17.7%; P < .0001). To obtain information on sexual function, 77.4% of patients preferred a discussion with the surgeon, and 67.4% preferred a booklet on the subject. Relief of pain after arthroscopic surgery was experienced by 88.9%, and only 10.8% reported current sexual difficulties.
This study demonstrates the prevalence of sexual difficulties among the majority of patients with symptomatic FAI, the significant effect that these difficulties may have on quality of life, and the ability of hip arthroscopic surgery to improve sexual function postoperatively. While further studies are required to elucidate what specific factors are associated with sexual difficulties, the current study suggests that this is an important topic to explore.
因股骨髋臼撞击症（FAI）导致的慢性髋部疼痛是否会引起性功能障碍尚不清楚。现有证据表明，髋关节镜手术可能对有症状的FAI治疗有效；然而，尚未有关于髋关节镜手术前后性功能的报道。
目的/假设：本研究的目的是确定有症状的FAI导致慢性髋部疼痛的患者在髋关节镜手术前后性功能障碍的存在情况及意义。假设为：（1）有症状的FAI导致的慢性髋部疼痛对性功能有负面影响；（2）髋关节镜手术可改善术后性功能水平；（3）性功能障碍的特征可能取决于性别或年龄；（4）患者对术前和术后潜在的性活动变化缺乏了解；（5）患者希望就性功能的潜在变化进行更深入的讨论。
病例系列；证据等级，4级。
对305例连续接受髋关节镜手术治疗FAI且随访至少1年的患者，采用一份23项李克特式问卷评估术前和术后性功能，并使用改良的Harris髋关节评分问卷。对性别和年龄组（年轻组：<40岁；老年组：>40岁）进行比较分析。
在131名受访者中，66%报告术前存在性功能障碍，发生在FAI症状出现后30.8±49.1天。性功能障碍的主要原因包括疼痛（77.9%）、僵硬（47.1%）和兴趣丧失（21.4%）。术后29.2±20.1天恢复性活动，而疼痛轻微时进行性行为的时间为48.8±40.6天。女性患者和老年患者（>40岁）恢复性活动的时间较晚（女性：34.8±23.2天；男性：21.0±10.7天；P<.0001）（年轻组：26.3±21.7天；老年组：35.7±13.5天；P=.017）。性活动频率增加的占32.3%，减少的占16.9%，不变的占48.5%。在报告性活动频率增加的患者中，男性患者和年轻患者的比例更高（女性：38.1%；男性：61.9%；P<.0001）（年轻组：78.6%；老年组：21.4%；P<.0001）。更多女性患者报告了性行为姿势的改变（女性：82.3%；男性：17.7%；P<.0001）。为获取性功能相关信息，77.4%的患者希望与外科医生讨论，67.4%的患者希望获得关于该主题的手册。88.9%的患者在关节镜手术后疼痛得到缓解，只有10.8%的患者报告目前存在性功能障碍。
本研究表明，大多数有症状的FAI患者存在性功能障碍，这些障碍可能对生活质量有显著影响，且髋关节镜手术能够改善术后性功能。虽然需要进一步研究以阐明与性功能障碍相关的具体因素，但目前的研究表明这是一个值得探讨的确重要课题。
