Harmsen Rita Th E, Nicolai Melianthe P J, Den Oudsten Brenda L, Putter Hein, Haanstra Tsjitske M, Nolte Peter A, Van Royen Barend J, Elzevier Henk
Department of Orthopaedic Surgery, VU University Medical Center, De Boelelaan 1117, 1081 BT, Amsterdam, The Netherlands.
Department of Urology, University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, Netherlands.
Int Orthop. 2017 Dec;41(12):2433-2445. doi: 10.1007/s00264-017-3473-7. Epub 2017 Apr 27.
To explore practises of orthopaedic surgeons (and residents) in addressing sexual function (SF) in patients before and after total hip arthroplasty (THA).
A 26-item questionnaire was sent to health professionals (n = 849); 526 (62.0%) responses were included in the analyses.
About 78% of the respondents (77.5%) almost never addressed SF. The most mentioned reason was that "patients do not ask" (47.4%) followed by "I am not aware of possible needs" (38.6%). SF was even less discussed (25.9%) in elderly patients (>60 years). The beneficial effect of THA on SF was rated the highest in retired surgeons (p ≤ 0.001), in which male surgeons scored higher than female surgeons (p = 0.002). The importance of sexual dificulties (SD) in the decision to undergo surgery was rated lowest by residents (p = 0.020). Rating the risk for dislocation varied between occupations (p = 0.008) and gender (p = 0.016), female surgeons rated highest (median 5); 54.1% indicated the orthopaedic surgeon is responsible for providing information about the safe resumption of sexual activity.
Surgeons show little attention to SF related issues in THA patients, which seems not in accordance to patients' needs. Addressing SF increases throughout a surgeon's career. There were divergent views and there is no "common advice" about the safe resumption of sexual activity. The results emphasize the need for guidelines and training in order to encourage addressing SF both, before and after THA.
探讨骨科医生(及住院医师)在全髋关节置换术(THA)前后处理患者性功能(SF)的做法。
向卫生专业人员发放了一份包含26个条目的问卷(n = 849);分析纳入了526份(62.0%)回复。
约78%的受访者(77.5%)几乎从不提及性功能。最常提到的原因是“患者未询问”(47.4%),其次是“我未意识到可能的需求”(38.6%)。在老年患者(>60岁)中,对性功能的讨论更少(25.9%)。退休外科医生对THA对性功能的有益影响评价最高(p≤0.001),其中男性外科医生得分高于女性外科医生(p = 0.002)。住院医师对性功能障碍(SD)在手术决策中的重要性评价最低(p = 0.020)。不同职业(p = 0.008)和性别(p = 0.016)对脱位风险的评级存在差异,女性外科医生评级最高(中位数为5);54.1%表示骨科医生有责任提供关于安全恢复性活动的信息。
外科医生对THA患者的性功能相关问题关注较少,这似乎不符合患者的需求。在外科医生的职业生涯中,对性功能问题的关注有所增加。对于安全恢复性活动存在不同观点,且没有“通用建议”。结果强调需要制定指南和进行培训,以鼓励在THA前后都关注性功能问题。