Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA.
Clin Orthop Relat Res. 2024 Aug 1;482(8):1455-1468. doi: 10.1097/CORR.0000000000003016. Epub 2024 Feb 27.
Hip pain due to femoroacetabular impingement (FAI) is thought to adversely impact sexual satisfaction because of exacerbation of symptoms with hip ROM. However, the effect of FAI on sexual satisfaction and improvement after surgery to treat FAI is largely absent from published studies, despite patients' apparent interest in it as registered by the frequent appearance of these topics on online anonymous discussion platforms. In addition, details regarding its impact on the decision to pursue surgery and the success of hip arthroscopy in alleviating FAI-related sexual dysfunction based on the specific role assumed during intercourse (penetrative versus receptive) remains unknown.
QUESTIONS/PURPOSES: Given that sexual intercourse involves different amounts of hip ROM depending on whether patients assume the penetrative or receptive role, this study evaluated the effect of FAI and hip arthroscopy on sexual activity based on role. Compared with patients who participate in the penetrative role during sexual intercourse, do patients who participate in the receptive role (1) experience greater difficulty with sexual function because of FAI symptoms, (2) take longer to return to sexual intercourse after hip arthroscopy, and (3) experience greater improvements in reported sexual function after hip arthroscopy for FAI?
This was a retrospective cohort study of patients undergoing hip arthroscopy for FAI. Between January 2017 and December 2021, 293 patients were treated with hip arthroscopy for FAI and enrolled in our longitudinally maintained database. Among all patients treated surgically, 184 patients were determined to be potentially eligible for study inclusion based on a minimum follow-up of 6 months postoperatively. The 6-month timepoint was chosen based on published data suggesting that at this timepoint, nearly 100% of patients resumed sexual intercourse with minimal pain after hip arthroscopy. Of the potentially eligible patients, 33% (61 patients) could not be contacted by telephone to obtain verbal consent for participation and 9% (17 patients) declined participation, leaving 106 eligible patients. Electronic questionnaires were sent to all eligible patients and were returned by 58% (61 patients). Forty-two percent of eligible patients (45) did not respond to the questionnaire and were therefore excluded from the analysis. Two percent (2) completed most survey questions but did not specify their role during intercourse and were therefore excluded. The mean age of included patients was 34 ± 9 years, and 56% were women The mean follow-up time was 2 ± 1 years. In total, 63% of included patients reported participating in the receptive role during sexual intercourse (49% receptive only and 14% both receptive and penetrative). Hip symptoms during sexual intercourse preoperatively and postoperatively were evaluated using a questionnaire created by our team to answer our study questions, drawing from one of the only published studies on the matter and combining the questionnaire with sexual position-specific questions garnered from arthroplasty research. Patients who reported participating in the receptive role during intercourse (either exclusively or in addition to the penetrative role) were compared with those who participated exclusively in the penetrative role. There were no specific postoperative recommendations in terms of the timing of return to sexual intercourse, other than to resume when comfortable.
Overall, 61% of patients (36 of 59) reported that hip pain somewhat or greatly interfered with sexual intercourse preoperatively. Patients who participated in receptive intercourse were more likely to experience preoperative hip pain that interfered with intercourse than patients who participated exclusively in penetrative intercourse (odds ratio 5 [95% confidence interval 2 to 15]; p < 0.001). Postoperatively, there was no difference in time until return to sexual activity between those in the penetrative group (median 6 weeks [range 2 to 14 weeks]) and those in the receptive group (median 6 weeks [range 4 to 14 weeks]; p = 0.28). Postoperatively, a greater number of patients participating in the penetrative role reported no or very little pain, compared with patients participating in the receptive role (67% [14 of 21] versus 49% [17 of 35]). However, with regard to preoperative to postoperative improvement, patients who participated in the receptive role had greater pain with positions involving more hip flexion and abduction and experienced a greater improvement than their penetrative counterparts in these positions postoperatively. Despite this improvement, however, 33% of patients (7 of 21) participating in the penetrative role and 51% of patients (18 of 35) participating in the receptive role continued to report either some or a great amount of pain at final follow-up.
Hip pain secondary to FAI interferes with sexual relations, particularly for partners who participate in the receptive role. Postoperatively, both patients participating in receptive and penetrative intercourse resumed sexual intercourse at a median of 6 weeks. After hip arthroscopy, the greatest improvement in pain was seen in receptive partners during sexual positions that involved more hip flexion and abduction. Despite this improvement, most patients, regardless of sexual role assumed, reported some degree of residual pain. Patients planning to undergo arthroscopic surgery for FAI, particularly those who participate in receptive intercourse, should be appropriately counseled about reasonable postoperative expectations based on our findings.
Level III, therapeutic study.
髋关节撞击症（FAI）引起的髋关节疼痛被认为会通过加剧髋关节活动范围（ROM）时的症状而对性满意度产生不利影响。然而，FAI 对性满意度的影响以及治疗 FAI 的手术效果在已发表的研究中基本没有体现，尽管患者在网上匿名讨论平台上频繁出现的这些话题表明他们对此类问题非常关注。此外，关于 FAI 对是否选择手术的影响，以及髋关节镜手术在缓解 FAI 相关性功能障碍方面的成功程度，这些问题都取决于在性行为过程中所扮演的具体角色（主动还是被动），目前仍不清楚。
问题/目的：由于在性行为中，根据患者是主动还是被动，髋关节 ROM 的程度不同，本研究根据角色评估 FAI 和髋关节镜手术对性行为的影响。与参与主动性行为的患者相比，（1）参与被动性行为的患者是否会因 FAI 症状而导致性功能障碍更困难，（2）髋关节镜手术后多久才能恢复性行为，以及（3）髋关节镜手术后，因 FAI 而接受手术的患者的报告性功能是否有更大的改善？
这是一项针对髋关节撞击症患者髋关节镜手术的回顾性队列研究。在 2017 年 1 月至 2021 年 12 月期间，对 293 例 FAI 患者进行了髋关节镜手术，这些患者均被纳入我们长期维护的数据库中。在所有接受手术治疗的患者中，根据术后至少 6 个月的随访，确定有 184 例患者可能符合纳入研究的条件。选择 6 个月的时间点是基于已发表的数据，这些数据表明，在此时间点，近 100%的髋关节镜手术后的患者在进行性行为时几乎没有疼痛。在潜在的合格患者中，33%（61 例）无法通过电话联系以获得参与研究的口头同意，9%（17 例）拒绝参与，最终有 106 例合格患者。向所有合格患者发送了电子问卷，有 58%（61 例）患者做出了回复。42%的合格患者（45 例）没有回复问卷，因此被排除在分析之外。2%（2 例）的患者填写了大部分调查问题，但没有指定他们在性行为中的角色，因此也被排除在外。纳入患者的平均年龄为 34 ± 9 岁，56%为女性，平均随访时间为 2 ± 1 年。在所有纳入的患者中，63%的患者报告在性行为中处于被动角色（49%的患者仅处于被动角色，14%的患者处于被动和主动角色）。术前和术后髋关节在性行为中的症状通过我们团队创建的问卷进行评估，该问卷借鉴了唯一一项关于该主题的已发表研究，并结合了从关节置换研究中获得的与特定性姿势相关的问题。与仅参与主动性行为的患者相比，报告在性行为中处于被动角色的患者（无论是单独还是与主动性行为相结合）的情况如下：（1）术前髋关节疼痛干扰性行为的发生率，处于被动角色的患者比处于主动角色的患者更常见（比值比 5 [95%置信区间 2 至 15]；p < 0.001）。（2）术后，处于主动角色的患者（中位数 6 周 [范围 2 至 14 周]）和处于被动角色的患者（中位数 6 周 [范围 4 至 14 周]）恢复性行为的时间没有差异（p = 0.28）。术后，与处于被动角色的患者相比，处于主动角色的患者报告疼痛程度较轻或几乎没有疼痛的比例更高（67%[14 例/21 例]与 49%[17 例/35 例]）。然而，就术前到术后的改善程度而言，在涉及更多髋关节屈曲和外展的姿势中，处于被动角色的患者疼痛程度更大，且在这些姿势中术后改善程度更大。然而，尽管有这种改善，33%（7 例/21 例）处于主动角色的患者和 51%（18 例/35 例）处于被动角色的患者在最终随访时仍报告存在一定程度或大量疼痛。
FAI 引起的髋关节疼痛会干扰性关系，特别是对于参与被动性行为的伴侣。术后，无论是参与主动还是被动性行为的患者，都在中位数为 6 周时恢复了性行为。髋关节镜手术后，在涉及髋关节更多屈曲和外展的性姿势中，被动性行为的患者疼痛改善最大。尽管有这种改善，但大多数患者（无论其扮演的性角色如何）仍报告存在一定程度的残余疼痛。计划接受髋关节镜手术治疗 FAI 的患者，尤其是那些参与被动性行为的患者，应根据我们的研究结果，对术后的合理预期进行适当的指导。
III 级，治疗性研究。
